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Use of AI in Healthcare and the Push for Fair Research Practises in Enterprise Enviroments

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Tina Ličková Tina Ličková
•  17.09.2023
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Dr. Gyles is a clinical UX strategist with a decade of healthcare experience, focusing on international collaborations to shape user experiences that benefit both clinicians and patients.

Welcome to the 12th and concluding episode of UX Research Geeks’ digital healthcare special and our first series. In this episode, we explore clinical UX strategy with Gyles, a healthcare expert with a decade of experience, as we discuss the impact of artificial intelligence, patient engagement, and principles for inclusive product design.

Episode highlights

00:02:22 – Getting to Know Gyles Morrison
00:09:17 – The Role of AI in Diagnosis
00:20:04 – Utilizing Technology for Self-Monitoring
00:27:23 – Strategic Implementation of Health Technology
00:35:19 – Challenging Stakeholders
00:40:48 – Promoting Inclusivity in Healthcare
00:47:33 – Where to Connect with Gyles Morrison

About our guest Gyles Morrison

Dr. Gyles Morrison is a Clinical UX Strategist with 12 years of healthcare experience (as of 2023). Originally a doctor in the UK, he now works globally, aiding UX professionals and healthcare firms in crafting valuable products and services for clinicians and patients. His expertise spans digital therapeutics, healthcare behavior change, health equality, and UX strategy. Gyles also leads the Clinical UX Association, a worldwide community passionate about healthcare. As a UX mentor and career coach, he assists doctors transitioning from clinical practice to UX careers and delivers talks and workshops on career change, personal development, and personal branding. You can connect with him through his website or on LinkedIn.

We need a lot more work done in AI because, as we already noticed, and it’s a global phenomenon, we don’t have enough clinicians providing healthcare services to patients.

Dr. Gyles Morrison, a Clinical UX Strategist
Dr. Gyles Morrison, a Clinical UX Strategist

Podcast transcript

[00:00:00] Tina Ličková: 

Hello and welcome to UX Research Geeks. I’m your host Tina Ličková, a researcher and a strategist, and this podcast is brought to you by UXtweak, an all-in-one UX research tool.

This is the 12th episode of UX research geeks. And the last part of the digital healthcare special. In the previous three episodes, we spoke with James, Sayali and Tjaša about the experience of inclusive research and the importance of inspiration from the academic field, and the global challenges in the digital healthcare space.

In this episode, we had an interesting discussion with Gyles, who is a clinical UX strategist with 10 years history in healthcare, digital health, and clinical UX starting as a doctor in UK, he now works internationally helping UX professionals and healthcare companies make products and services that are valued by clinicians and patients.

He specializes in using healthcare behavioral science and digital therapeutics to improve healthcare outcomes. He is also an instructor in the Clinical UX Academy and the founder of the Black UX Society. With Gyles, we talked about the pains and gains of artificial intelligence and what it brings to healthcare, how patients need to be proactive in their own health management, and what principles can actually help to design better inclusive products.

We couldn’t have a better guest for closing this special, Gyles is truly one of the biggest experts on this field. We wish you a great listen.

How are you?

[00:01:37] Gyles Morrison: I’m good. I’m good. I’m excited to be on the podcast.

[00:01:41] Tina Ličková: Yeah, we made it because you had a really busy summer, didn’t you?

[00:01:44] Gyles Morrison: I have. It’s been eventful highs and lows. But the ultimate high is becoming a dad. Congrats on that. I’m a very happy man right now.

[00:01:54] Tina Ličková: Yeah, I can imagine. Baby girl, right?

[00:01:57] Gyles Morrison: That’s right.

[00:01:58] Tina Ličková: Yeah. Congrats to you and your wife.

[00:02:00] Gyles Morrison: Thank you.

[00:02:01] Tina Ličková: Good. We finally made it. I’m really happy because we spoke about adding you into the healthcare special. And I was really hesitant that we have to have you there because I think you’re one of the people who is not only vocal on LinkedIn, but really one of the biggest experts on healthcare, digital healthcare and UX.

[00:02:22] Gyles Morrison: Thank you.

[00:02:22] Tina Ličková: So maybe you could tell your, about yourself in your own words.

[00:02:27] Gyles Morrison: Sure. My name is Dr. Giles Morrison, or just Gyles , I wasn’t born with my medical degree. I work as a clinical UX strategist, which basically means that I look at the strategic work that needs doing with regards to UX efforts for products and services utilized by clinicians and patients.

The very regulated area of healthcare and digital health, and there’s a lot of ethical legal considerations at times. Which influenced the work that we do makes it even more complicated, but I love it because when you work in this space, it can have huge impact for literally millions of people through the different patients that the clinicians using your products and services are going to be serving or the magnitude of patients that you directly serve as well.

So I’ve been in this field now since September, 2014. So just over eight years as of recording this podcast. And I fell into the role, to be honest, I think I’m still over a generation of UXs who had ambitions of being creative and doing something wonderful in tech. And then you realize that UX is actually a profession.

And so you pursue that. Yeah, this, the main sort of work I do then is particularly looking at how we can use digital therapeutics. So this is an evidence based digital tool, plus or minus some sort of wearable technology, physical device. That can prevent, manage, or treat disease. So that’s… To do with healthcare behavioral science to change people’s health behaviors or the way clinicians work.

But that’s a particularly huge topic of what I do, but also looking at how we can tackle health inequalities. Recognizing that there are social determinants of health that there is as a thing as institutionalized discrimination that people are adversely affected by the current status quo of healthcare.

And how design can overcome that.

[00:04:32] Tina Ličková: Before we jump into this one, because there is a lot of stuff to talk about, I’m just curious, what was, like, how does one become, from a doctor, a UX strategist? You told us when it happened and that they got you changed, but what was the motivation for it?

[00:04:52] Gyles Morrison: The main motivation for leaving medicine comes in two parts. There was push factors and pull factors. So push factors to leave medicine. As I’m sure a lot of people are already aware, we have to do long day shifts, 12 hour shifts, sometimes 24 hour shifts. That’s not so common in the UK, but it does happen around the world.

Night shifts, weekend shifts, 12 days in a row shifts. It takes up a lot of your time. And I felt like I was losing myself. I knew that there was a lot of who I was as a creative person, as someone to spend time with family and friends. And I recognized that as much as I loved serving patients, I didn’t love the life I was living.

I wasn’t really living a life for myself. And it was a tough decision to decide to leave medicine, but I knew that I deserved to be happier in the day job. So the pull factor is really for digital health in general, not so much UX. I didn’t know about UX when I first got into the field. It took me six months to discover it as a profession, in fact.

But I knew I wanted to do something that was creative, that still required my knowledge and experience of a doctor, but to problem solve in new ways in digital health, a role that would allow me to travel, that could still pay me a good salary so I can live. But exactly what that was, I didn’t know. I just knew that let’s take a journey into digital health.

And ultimately it was the right one. The first job I had was as a clinical analyst. So similar to a business analyst, but coming from a clinical background. And it’s whilst I was in that role about six months into that role, I was already taking requests for changes to the electronic health record system, investigating the request, exploring potential solutions, which were quite restricted with the electronic health record system we were using, but then you test out the solution and when it’s rolled out you do some more testing to make sure everything is working the way it should.

And it was around February of 2015. I was on a training course to learn how to use the prototyping tool, Axiom. So it’s come a long way since 2015, but those three days of training opened my eyes to what was possible as a UX professional, because the gentleman giving the training, Dr. Richard Mayfield, really made it clear that there’s a career path here because that’s what he does. He works as a UX professional. And when I realized that it’s a unique blend coming from a medical background doing UX. I then decided to find a variety of mentors, become well read on the topic. I decided to do a master’s in human computer interaction, which I did part time so I could put what I learned into the day job to actually speed up my ability to put theory into practice within a business context, because not that dissimilar to when you work as a doctor, it’s one thing to know how to take blood and how to even make a diagnosis about patients. How do you do it in the context of: there’s loads of other patients that have to be seen. There’s emergencies. Who do you prioritize? It’s just doing stuff in a more real life situation. And yeah, flash forward now to 2022. And I teach on the topic, which is still a great way to continue learning because you can’t teach what you don’t know, and it encourages you to continue your own professional development and work on a variety of international projects with different clients as well, speaking at conferences. And being a champion for working in this field.

[00:08:40] Tina Ličková: And you mentioned briefly that this is where, for me, the journey of digital health products really starts. And you were mentioning also in our initial call, the diagnosing, and we were talking about how tricky can diagnosing be and how long can it take to get your diagnosis. Sometimes you are misdiagnosed. And this is where digital healthcare comes into play with all the tools that we have right now, including, for example, the AI. Can you maybe explicate on that one a little bit more?

[00:09:17] Gyles Morrison: Yeah, the diagnosis process. So formally, it’s where someone has presented a variety of symptoms. So it’s what they report or issue. For example, someone saying, Oh, I’ve got a cough. I’ve got back pain, as opposed to symptoms. So you go to the doctor and you might complain of a rash, but when they examine you, they look and see exactly does that rash actually go away when you press down on it.

And it’s a combination of signs and symptoms, then leading to a process of investigation to determine what’s wrong with this person. And a lot of times when we make a diagnosis, it’s what’s known as a differential diagnosis, where there’s two or more potential diagnoses. or it’s a so-called working diagnosis where this is what we think is wrong, but we’ve got to do further investigations to confirm it and even ensure that treatment that is suggested by the diagnosis actually does anything or not.

So that whole diagnosis process is the main crux of being a doctor. Obviously we do surgical procedures. Heimlich maneuvers and first aid and all that sort of stuff. There’s all these wonderful practical things that are done. But if the diagnosis is not right, all those interventions can be a complete waste of time.

And so the diagnosis process is the most important thing. Now, AI has a great opportunity to help us with the diagnosis process. In fact, it has proven to help, but more often than not, it’s not really AI that’s helping, it’s algorithms. It’s just as a doctor has to take in information, process it systematically and then draw conclusions based on the likelihood of a particular diagnosis being true versus another one.

You’re seeing how many risk factors are present, or how many definitive science symptoms, investigation findings, confirm this diagnosis. Artificial intelligence can do this. Even just collecting the data and you’re not a trained professional. If you’re able to check off a list that you found the right findings, you’ll be like, yeah, we’ve come to a diagnosis.

But I think the problem that we’ve got with using AI is that what if it’s not given enough information, even as doctors, there’s so many times, like the classic example, it’s a Friday evening. So it’s outside of working hours. The GP surgery (general practitioner surgery), family physician has closed, so we know that this patient is on, say, a variety of medication for diabetes and maybe high blood pressure, cardiovascular disease.

And the patient knows that they’re on a variety of drugs, but they didn’t come to the hospital with a list of their drugs. Unless we have… a clear set of instructions of what the medication was before that patient came in. So often, the patient may not have any drugs prescribed for them, apart from ones that are clearly going to help.

So if someone says they’re type 1 diabetic, we’re going to give them insulin. If they’re type 2 diabetic, we might give them some metformin, first line anti-diabetic medication. But it could be the smallest of those that’s not going to do enough, or because we don’t have that source of truth. And this is where things go wrong with AI in particular is where’s the data that’s informing the decision process.

Because if a human is already going to struggle. To come to a diagnosis or enforce the best treatment plan, but it doesn’t have all the data. Why would AI be any better? The other problem is there can be an over reliance on AI, which again may not have all the data points. And a lack of appreciation that we’re dealing with a human being, as much as the AI knows that it’s getting data from a human, it’s not going to process it the way that a human would.

It wouldn’t present the information unless it’s been trained, instructed to present it in the right way to support a human being. So it’s that dialogue back to the patient, for example. If you’ve made a diagnosis that someone is terminally ill, There’s a way of communicating the information to the patient where it’s still going to be devastating and they technically don’t have hope of recovery, but you can give them some level of comfort and reassurance of what’s going to happen before they pass away.

And AI automatically is going to be able to do that unless it’s trained to do and even the training process is going to be complicated. It’s not a human being, it doesn’t have a mind. So I think we need a lot more work done in AI because, as we’ve already noticed, definitely in the NHS, and it’s a global phenomenon, we don’t have enough clinicians providing healthcare services to patients.

And we need to find ways that people can be diagnosed and supported without even having to go to a hospital. That’s where AI can help, that’s where technology in particular can help bring healthcare to people rather than bringing people to healthcare.

[00:14:32] Tina Ličková: So when I understand it, if there is a presence of AI in the diagnosing process, it should be already put into work before visiting a doctor or visiting a doctor, maybe remotely. And if I understand it I imagine it may be very easy or nightly. It’s also that AI should be a tool for the doctor to help him in the diagnosis, but the human work still has to be done by the doctor.

[00:15:03] Gyles Morrison: That’s my opinion. I think there will be a time where what we’ve been seeing in Star Trek, in Star Wars, a variety of sci-fi entertainment, will be a time where we can rely more on technology without interacting with humans. I just don’t think that this is a time, really, that we’re ready for it as a human race.

Even just looking at the fact that technology has a price, there’s a financial price associated with technology. There’s many people across the planet who simply won’t be able to benefit from an AI enhanced service because they can’t pay for it. Their government can’t pay for it. They don’t have a shelf insurance policy that can cover the cost for it.

With that said, I think there is a growing interest. We look at Elon Musk and a variety of other people, startups, companies looking at how we can have implants in people’s brains. People putting chips in their hands so that they can open doors around their house and have all these different functions around them, there is this growing trend towards having technology be very intimately on a physical level, intimately involved in what we do in the day to day. But this isn’t for the whole general public, again, because of the price, but also a lot of people are a bit freaked out by that.

[00:16:30] Tina Ličková: Yeah. Including me. Yeah. Yeah. But I jumped to diagnosing because I’m always fascinated – also coming from a family history.

How long it took to diagnose my dad for the type of cancer he had. How long it took to diagnose me with my thyroiditis, and stuff like that. And now I’m also trying to figure out something which isn’t really right for my health. But there is a big topic of prevention and I think this is where behavioral science comes into play.

[00:17:04] Gyles Morrison: The prevention side is still very neglected. We went from a huge shift partly because there’s been a population increase. Since the second world war, but when the NHS (The National Health Service) was set up, the vast majority of the budget was spent on preventative care and what we call primary care. So seeing your family physician, your GP, and definitely over a 50 year period, it switched to the majority of the budget, which dramatically increased by the way, but the majority of that budget, is then shifted to secondary care. So where people are already sick. I think there’s a lot at play, which means we have a healthcare system globally, not just in the UK where focusing on curing people is at the forefront then prevention. I think part of it is that we just have so many people, quite frankly, who are already sick.

Trying to focus on prevention is only supporting the future. It’s not dealing with the present. So there’s the worst situation to deal with in the worst situation is people actively being sick and dying now. I think the other problem, quite frankly, is that there’s still too much of a parental nature to healthcare, where, oh, if you’re sick, come to me, I will make you better, rather than people being able to take ownership of their health and do what’s best for their health on their own.

We start to see improvements on that now, I think. particularly with the pandemic. People are like actually I am in control of my body. I don’t fear COVID. I’m going to go out and do what I’m going to do. Or actually I’m going to take a particular vaccine or I’m going to do this. I’m going to do that.

People can have more vocal opinions about what they’re doing with their health. but this may not necessarily permeate all aspects of their health and depending on the potential or actual diagnosis someone has, the treatment options are going to be gated by clinicians. So there’s so many medications particularly in the UK, across the US, across most parts of the world where there’s a very established healthcare system, most medications have to be provided with a prescription, otherwise you can’t get it from a pharmacist.

So you know you’ve got a chest infection because you’re used to getting chest infections. You know what it means to get a bacterial chest infection. You’ve had them diagnosed for years because you’ve got a chronic lung illness. You still have to go to the doctor to get the prescription. Even though, here’s a 99 percent chance that is definitely the right course of action, you’re still limited in your ability to manage your health unless you deal with a clinician. What if you can’t get an appointment for a few weeks? Even for a few days can make all the difference.

[00:20:04] Tina Ličková: That’s true.

[00:20:04] Gyles Morrison: And so I think it’s a big issue where we’re not focusing on how we can empower people through technology, through public health initiatives to encourage them to actually take more ownership of their health, but also have a healthcare system that is more flexible. That where someone has got a definitive diagnosis already, we can prevent them having flare ups of that condition. And even providing people just a little bit more knowledge about disease, so that they can make more informed decisions about their lifestyle and about how to get the best healthcare support that they need at a given time.

[00:20:43] Tina Ličková: And how could I imagine it you say tech, there is technology we could handle it with, on the principles of behavior or science or triggering some behavior that is wished for. Could you maybe name some examples, because it’s for me a little bit hard to grasp.

[00:20:59] Gyles Morrison: So a good example would be the whole process that a lot of people actually go through and they might have the equivalent of an MOT, a review of your car, but you do it for yourself. You go to the GP and say let’s just check height and weight, let’s check your dietary habits. Let’s do a variety of blood tests. Let’s actually do a physical examination of your heart, lungs, abdomen to listen to your digestive tract and the like. Just that review, every year, can already be done, mostly, not completely, the physical examination in particular. But a lot of those reviews can be done on your own. You don’t need to see a doctor to check your heart rate, your blood pressure, to get your blood sugar readings, or even urine dipstick. These are stuff you can all buy online for yourself, in most parts of the world.

You can do these checks. What’s the problem though, is that people don’t always know how to interpret this information. And I think the other part of this is that there’s still a review of specific signs, symptoms, which clinicians are doing, which could be done by pharmacists. That can be done even by yourself if you’re given the right questions to ask.

So this is where the role of patient recorded outcome measures, or PROMs for short, are really powerful. So there’s a health questionnaire completed by a patient or general public member, that just reviews their health. Could be physical health, mental health. It could be for a specific disease. It could just be for general health and wellbeing.

But the answers will then dictate whether someone actually has got a diagnosis, whether their health status is improving, getting worse, staying the same. But all of this can work alongside data that comes from a variety of investigations, such as checking your blood pressure, checking your blood sugar readings or more vital lab tests done in a lab environment that a doctor has to request.

And then just getting people to be able to do this more often already can get them to know you’re pre diabetic, or we’ve got concerns about cardiovascular disease, or you’re at risk of rheumatoid arthritis, or, there’s just stuff that starts getting detected sooner, or at least allows you to just think about what you’re doing, which is supporting you being healthy or unhealthy.

[00:23:24] Tina Ličková: It’s funny because of two points that I’m thinking about. One is that if you are actually becoming your own researcher on your own health, like repeatedly asking and constantly asking with these tests questions like: am I okay? Should I be doing something? And also I like this, the move from Google diagnostics, what I call it, if you go to the internet and you have a cause and you immediately Google yourself cancer and you are dying in two days and you freak out to something more informed. But I’m also thinking about the, as you were saying, the interpretation of these tests, because I could still be very worried about it, what comes out, and I could still, sometimes, when you do mental tests, mental health tests on the internet, you get depression score of that high that you’re like, I should be killing myself right now, sorry for a stupid joke. And that’s where I’m like, okay, how do we then handle the interpretation whole, I would say, what would be your suggestions?

[00:24:41] Gyles Morrison: Yeah, so I think the big thing to keep in mind here is that this works really well on an individual level if you’ve onboarded someone individually to be aware of all of this. When you tell a whole population to go ahead and start using this technology, that’s when chaos ensues. If you’re familiar with the film Men in Black, Tommy Lee Jones and Will Smith film and Will Smith’s character, why don’t we just tell everybody that there’s aliens?

Tommy Lee Jones says that you can obviously explain it to an individual, but people are basically crazy. They’ll just act like hooligans if they hear they’re being hysterical and you will get a similar response with technology if everybody is now suddenly in a position to start diagnosing themselves, but they’re not given appropriate guidance on how to do this on an individual level.

Not just a generic level, I’m talking about individual level, there’s more likely a chance of interpretation. And when people interpret on topics that they are not familiar with, you get chaos. I liken it to working as a UX professional. Developers are highly intelligent, capable professionals on mass, right?

They are not UX researchers. They’re not UX designers. When a developer says, I’m going to design this dashboard. It’s not going to likely be as good as if a UX designer did it. Because it’s a complete other discipline. And interpreting based on their own experience is a knowledge base. So we need to use certain solutions, whether it’s one that is still involving a human being, which I think is still useful.

So it involves a clinician at points, or a technology that’s just using AI, but it still needs to be personalized. And you need to start small, you need to start with people who are already emotionally invested. in actually using such technology. Again, you look at these track and trace apps. There’s loads of people that chose not to use the track and trace app because they don’t believe that COVID is that big a deal.

So you can’t just give technology expecting that it will have a response to someone’s life. You have to target who is going to use it. And as UX professionals, we strive to provide solutions that as many users as possible could use. But there is a behavioral science aspect. There’s a sociology aspect at play here where not everybody is going to be ready to use this technology.

And that’s okay. We should actually accept this. And then choose to deal with people who are going to respond in a beneficial way to this technology.

[00:27:23] Tina Ličková: Very interesting because I was just speaking with my dad. I come from Slovakia and Slovakia is trying to run its own digital government and it’s a disaster.

And Slovakia Digital, which is an NGO, is just rebuilding one thing where you’re supposed to digitally put some data into your company details. So they want to, and I was thinking they are pushing everybody to do it. And I wasn’t able to do it, although I was installing like five apps to be able to do it.

And then my dad was just like, Oh, but I could do it, go to the institution, like to the house, to the building and tell them, I was like, no, you can’t. And that’s where, we are all the UXers also are enthusiastic about okay, let’s put this new technology into life, but we still, and I like the point you were putting there, we still need to have different solution for different target groups and be really good in the targeting. And maybe if you look at the theories, go with the innovators, with the early adopters, early majority to test it, rather than not to roll it out en masse, so it’s really the principle of stage rolling, it’s repeating itself.

[00:28:41] Gyles Morrison: I think what comes to mind with this is where there’s this tendency to be like ageism is a thing, we need to think of how we’re going to get technology to be used by the elderly. And obviously as time has gone by, there’s an increasing number of people who go into that category of elderly or pensioner who are very confident using technology, right?

But sometimes it just isn’t appropriate. There can be this assumption that, oh this elderly 80 year old woman might just get their grandson to help them out. What if they never had children? What if they don’t actually have a good relationship with neighbors? What if there isn’t another person that can help them?

What do they do then? Oh and that’s what happened, and so it does upset me where there’s still so much of a reliance on technology where actually sometimes people just need to make a phone call or write a letter that even just, getting married, becoming a father, people want to give gifts.

So often I still, like an elderly friend, would want to give me a check. I’ve, I cannot remember the last time I wrote a check, rely on this technology and it should actually work. And so we need to think about it, we’ve got a huge population that we need to serve. Whether we’re looking at this on a local level or global level or anything in between.

What is it about the limiting users in that community who have to have either an adjustment to the existing product or service that you’re working on, or a completely different one, because the limiting user, they are going to have something about their personality, about their personal qualities, about their abilities, which limits their experience. And we can’t just say to them because you’re old, you’re not allowed to actually send money to somebody. You’re not allowed to access healthcare services using this app. We should think, is there some sort of adjustment we can make for them? And if the adjustment isn’t good enough, then we have to think what’s the alternative for them as a complete other product that isn’t a loss. That’s you just solving a new problem.

[00:31:00] Tina Ličková: And that brings me to. Okay. We have the new products out, the new technologies, or even a combination of the older technologies with the new ones. And you were mentioning in the beginning that this business is highly regulated anywhere in any market. How does the testing or validation of the products look like in this environment for you and how do you proceed in that one?

[00:31:26] Gyles Morrison: Yeah, I personally think that testing is still not good enough or done often enough. There’s a lot of products out on the market where the testing has been very minimal. Generally speaking, if it’s a solution that is regulated and classed as a medical device or software as a medical device or software that actually treats, prevents, manages disease in some way, it can diagnose a patient, right?

Or the technology, physical technology does it. Either situation, generally speaking, you would need to have some sort of clinical trial to prove that the product, digital or physical, can do what it claims to do. Without this, the product won’t go on sale. So as a result, you will get like a randomized control group control trial, sorry, where there’s a control group.

and a group that actually is the active arm that has the actual intervention and you can compare and if there’s an improvement or if there’s a placebo effect, so on and so forth. So that’s good, but there are many solutions that are not being regulated that are just starting out and the testing is being used on super users.

So people that don’t have any disabilities. They are very confident with technology that is already emotionally, if not financially invested in this product that they’re utilizing. Ah, okay. So you just keep hearing those positive responses. And it’s if you only unanimously get positive responses from a design, it’s that either someone is lying or you’ve not solved the right problem.

And everybody is just missing something as a result. It’s normal for design to go through a variety of iterations and testing should reveal that. And so as much as we are seeing clinical trials and very regulated products, as I said, we don’t see that so much on products that are not regulated and I’ve even had times where we’ve been told we don’t have time, you tight deadline, do the best that you can, because you’re the UX professionals like even as a doctor with three years of experience, I’ve been working in clinical UX now for eight years.

At best, I can hit the ground jogging. It doesn’t mean that I’ve got all the knowledge that’s needed to make the best solution. I’ve got the knowledge that is going to help me reduce as much risk as possible with the first solution I create, but I still have to make sure I’ve got clarity over the requirements.

And that when I’ve tested it, I’ve got evidence to back up that I did the right thing. There’s often an excuse that we don’t have access to participants. I always consider this a lie because if you never had access to participants, why do you believe you will have customers? They have to exist. How can they suddenly exist when the product is finished and you’re getting money for it?

So it’s always a lie. There may be times where there’s a cost implication to get access to the participants, or that it takes a long time because of the legal paperwork that needs to be processed to get access to the participants. But it’s a lie to say that it’s not possible. And this is something that UX professionals really need to challenge when they’re working in healthcare.

You have to test your solutions. Especially if you know that failure or a mistake could cause harm or death. You should consider it a moral obligation. And definitely if this is a regulated product, there’s a legal obligation. for you to prove that you’ve tested to see that the chances of harm or death is slim if not completely absent and impossible.

[00:35:19] Tina Ličková: And I’m wondering how you challenge stakeholders because I can imagine that in the medical field and with pharma companies or medical companies, they invest a lot of money into the trials of some certain drugs. But even there you see a lot of bias. John Oliver had this one episode of one drug being tested and implications on the uterus and it was tested with men.

But that’s extreme of course, but also when you look into – okay, nutrition, I think I was mentioning it already in the last episode, but nutrition studies women are not participating as much because it’s just, they have the period and the cyclism influencing and it’s a lot of money.

And then you, then some UX person, some UX strategist comes and says: Oh, we need to test it and iteratively like more times. And you were saying we need to challenge this. How are you challenged? What would you advise?

[00:36:17] Gyles Morrison: There’s a few motivators that are at play in all business endeavors, whether it’s healthcare or not. The primary motivator is how do we make money? The point of business is to generate profit. Okay. And profit is the results of sales, actual users using a product buying, but it’s also a result of how much is spent to create the solution and also how much savings can be made- based on some sort of additional expense that comes from running the service, particularly if there’s a problem.

So for example, litigation for someone being harmed during surgery, there’s literally a pot of money that most healthcare systems set aside just to pay off claims so they don’t have to go to court. But back to the point though, these motivators, it all still revolves around a core theme of money.

You should always link back the work that you’re doing to the financial implications to the business. If we don’t do this user research, we are at risk of such and such problems happening, which then can prevent us from having a sale. It could cause these legal implications, which has a financial cost. It will harm us marketing wise, preventing us from getting sales, so on and so forth.

It’s really important to link back how a failure to do the right thing is going to have a financial impact. As much as we think that when we’re working in healthcare, we’re doing what’s right for people, that people are going to do what they know to be morally right, this isn’t the case. If money is such a significant motivator, just saying people deserve to have a better product is not going to change their hearts and minds generally speaking.

If it was as simple as that, we wouldn’t have anywhere near as many atrocities as we do in the world. It’s just a simple fact that businesses are governed by money, not by morality. And like I said, look at what it is about? Your testing and what you’re trying to prevent through the testing from happening how that’s going to affect the business Financially and if you’re working on the products from the beginning, you should be getting insights about those measures of success Key performance indicators, whatever the success metrics are always find out what’s the financial component to this. And how does your work directly impact it?

So you can be planting the seed of that narrative of, if we don’t do the UX properly, it’s going to have this financial cost to you, loss of profit more costs associated with delivering this product or failure, which is a huge waste of sometimes millions of pounds, dollars, euro, whatever the currency is being utilized.

[00:39:10] Tina Ličková: I really like that you are mentioning this as one of the biggest arguments, especially from the medical field, where Honestly, I wouldn’t expect it because there’s this as you were saying, this big question of morality and ethics, but as you are pointing it out in this medical field, I find it really interesting and powerful. So thank you for that.

[00:39:34] Gyles Morrison: Yeah. No it’s important to raise this because we have to keep in mind, healthcare is a business. UnitedHealth is a Fortune 5 company at the moment. It’s worth so many billions. It’s one of the wealthiest companies in the entire world. It delivers healthcare insurance and healthcare services through its own insurance policies as well.

It’s a business. It’s not here just to heal the sick, just like any other healthcare system. If it was, then there wouldn’t be checklists which allow, for example, in Lebanon, where if this child even, a newborn baby, if their health insurance is only a government provided one, that if the hospital doesn’t have any more beds for that type of health insurance, they’ll deny seeing the patient.

You’re an immigrant that comes to certain countries, you’re denied public health services because you’re not paid into the government’s tax system, where there’s still loads of people dying of easily treatable diseases across Africa and Asia. If it really was as simple as morality, we wouldn’t be an issue. People would be healed now.

[00:40:48] Tina Ličková: Yeah. I think I’m also coming from that. We were also discussing this in the last podcast with Tjaša, that it’s also the different healthcare systems that we have across continents. And as a European, I’m used to this public healthcare. I don’t say it’s super functioning, but everything is for free. Because when I was a kid, my parents were paying for it in their taxes. Or money that was taken from them, from their wages. Now I am paying and it’s okay, you don’t see. And then you, but you don’t have so much access. You have to wait for the dates to visit the doctors. So it’s interesting.

And but here you are also mentioning, and this is maybe a great topic to close off with. The inclusion, which is, I am emphasizing it through the special, even more important in healthcare, like how do we actually make sure with digital tools to include more people, to make it more accessible, more available to them? What would you, what would be your intake of it?

[00:41:54] Gyles Morrison: Yeah, there’s two broad topics that come to mind for this. One of them is what I call the clinical UX design pillars, which I’ll go into in a moment. But the other thing is actually how proactive are we in ensuring that the people that are involved in creating solutions and delivering them, whether they’re any type of digital, physical product or service, how diverse is that workforce?

And diversity isn’t just about ethnicity, it isn’t just about sexuality, it’s about age, it’s about professional backgrounds. This is why we have what we call multidisciplinary teams in medicine. You’ve got the doctors, the nurses, the physiotherapists, the pharmacists, the occupational therapists, so on and so forth, all working together to do what’s best for the patient.

And the same thing is needed in digital health. In any industry, really, it’s not just that we have different professionals, the UXs, the developers, the project managers, and so on and so forth. There is that diversity of ethnicity, sexuality, age, disability, because ableism is a real thing. There’s just an assumption that because all of us can understand how to use a computer that our end user will, which is not always the case.

And if using a computer is a prerequisite of using your product, then there’s so many people who may already be alienated. Who should be able to use this solution? So I think that the first thing is we need to have representation amongst the people creating solutions, who represent those we are serving through those solutions.

And with regards to the clinical UX design pillars, it’s humanitarian, people centered, cyclical, evidence based and ethical design. So if humanitarian as the name suggests, what is it about the way we’re serving this end user that is recognising that they’re a human being, recognises their humanity, that they deserve to be treated with dignity and respect.

So why in Europe we will talk about electricity gas to provide us with fuel, but in certain parts of Africa and Asia we’re telling people to take their own faeces and make energy out of it. But we don’t do that routinely in Europe. I’m not saying it’s wrong. For them to be using their feces to make energy if it’s known as an efficient way, that’s great.

But why is it okay for them to do that, but we’re never exposed in the West to have to do something like that. Then there’s people selling design just building on the concept of user centered design recognizing that people isn’t just the fact that there’s different types of users, but it’s also a group of people who have to maintain the solutions that we create and that there’s different levels of complexity amongst the different types of users and who they have to interact with to truly benefit from the products and services.

So it’s just taking a big picture approach to when we create products and solutions. Recognizing it’s not just one end user or different types of end users, but there’s more complexity in the interaction with other people and the people who serve them. And cyclical design is basically we’ve gone through rounds of iteration.

We’ve made this solution from research to design. Let’s see what is it now about the product and the environment it sits in that means we can do better. Let’s start again, not from scratch. We’re going to leverage where we’re at now, but let’s continuously try to improve as a cycle. And then with ethical design, we should be doing what is morally right.

If you know that what you’re doing has no evidence to back up that it works, that should be considered morally wrong. The whole concept of deceptive patterns, for example, as well, comes into play with this. And then evidence based, linked to ethical design, but whatever we’re creating should have evidence for it.

Just like with medicine, if someone’s going to take a drug, have a new surgical intervention, there should be concrete evidence from a clinical trial to say we can trust this. And so I find few humanitarian, people centered, cyclical, ethical, and evidence design. We can already ensure that we are inclusive, that we’re doing what’s right for people, that we’re really considering the true problems that they have, and ensure that we’ve got evidence to back up that we’ve found the right solution.

[00:46:28] Tina Ličková: But thank you for mentioning the four pillars of clinical UX, because I think it’s a very helpful framework for anybody out there in health care, digital healthcare. Is there anything that you would say? Oh, Tina, why didn’t you ask me this? When it comes to digital healthcare?

[00:46:47] Gyles Morrison: I don’t think I could answer that question.

I think what we’ve covered here should be a good way of getting people who are just starting a journey in this field to start Picking their interest and just to get them to understand that there’s a lot more to learn here But if you focus on those five clinical UX design pillars If you think about the fact that there are going to be people out there who are going to be underserved that we need to focus on, so called limiting users, and that actually healthcare is a business.

We can’t just think about doing what’s right. We’ve got to think about what’s going to make this business solution sustainable. I hope if people get that as a take home message, I think we’ve done a great job.

[00:47:33] Tina Ličková: Where can people actually follow you and your work? Yeah, I’m on LinkedIn most days. I try to take a break for my wedding anniversary and my birthday.

[00:47:45] Gyles Morrison: You can find me on LinkedIn. Just look for Dr. Gyles Morrison, Gyles. And my own website, drgylesmorrison.com, there’s different talks I’m giving at conferences around the world. There’s also the clinical UX course. You can find out more about that at clinicalux.org, but yeah just reach out to me. I’m happy to connect and talk.

[00:48:07] Tina Ličková: Thank you very much for your time.

[00:48:09] Gyles Morrison: Thank you.

[00:48:11] Tina Ličková: Hi there. So this is actually the end to the first season of UX Research Geeks, where we interview 12 very interesting people and discuss many interesting topics. We don’t plan to stop anytime soon, but we will take a short break to rejuvenate and to plan for the future.

So we can start a new season very soon, rested and fresh, and interview even more great researchers from all around the world. Thank you very much for your support, for your listening. And we would like to encourage you, if you have any feedback or suggestions for new speakers that you would like to listen to in the discussions with us, please feel free to reach out to geek podcasts at UXtweak.com. Thank you, and we’re looking forward to meeting you again.

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