Nurses in the Mist

What do you do when your boss tells you "go and invent a new product for us"? Lock yourself away and stare and stare out the window? Go for a walk, waiting for inspiration? The response of system engineers Pat Baird and Katie Hansbro was to do some anthropology.

Dian Fossey is perhaps the most famous anthropologist. She spent over a decade living in the jungle following and living with gorillas so that she could understand them in a way no one had done before - she started to see what it was really like to be a gorilla. As a result she showed that their fierce King Kong image was wrong and that they are actually gentle giants: social animals with individual personalities and strong family ties. Her book and the film, 'Gorillas in the Mist', tells the story.

Pat and Katie work for Baxter Healthcare. They are responsible for developing medical devices like the infusion pumps hospitals use to pump drugs into people to keep them alive or reduce their pain. Hospitals don't buy medical devices like we buy iPads or android phones, of course. They aren't bought just because they have lots of sexy new features. Hospitals buy new medical devices if they solve real problems. They want solutions that save lives, or save money, and if possible both! To invent something new that sells you ideally need to solve problems your competitors aren't even aware of. Challenged to come up with something new, Pat and Katie wondered if, given immersing herself in the jungle with gorillas was so productive for Dian Fossey, perhaps immersing themselves in hospitals with nurses would give the sort of competitive advantage their company was after. Their idea was that understanding what it was really like to be a nurse across lots of hospital situations would make a big difference to their ability to design medical devices. They would be able to design devices that helped with the real problems nurses had rather than those that the sales people said were the problems. After all the sales people only talk to the managers, and the managers don't work on the wards. It turned out they were right.

They took a team on a US tour of hospitals for 3 months, talking to people, watching them do their jobs and keeping notes of everything. They even noted what the environment was like: the layout of rooms and how big they were, recording the temperature, how noisy it was, how many flashing lights and so on. They spent a lot of time in the critical care wards as that was where infusion pumps were used the most - those nurses were their power users - but they also went to lots of other wards and found the pumps being used in different ways. They didn't just talk to nurses either. Patients are moved around to have scans or change wards, so they followed them, talking to the porters doing the pushing. They observed the rooms where the devices were cleaned and the cupboards where they were stored. They looked for places where people were doing ad hoc things like sticking post it note reminders on machines. That might be an opportunity for them to help. They looked at the machines around the pumps. That told them about opportunities for making the devices fit into the bigger tasks the nurses were using them as part of.

So did Katie and Pat come up with a new product as their boss had wanted? Well yes. In fact they ended up developing a whole new service that is bringing in the money, but they actually did much more. They showed that anthropology provided lots of advantages for medical device companies. One part of Pat's job, for example, is to troubleshoot when his customers are having problems. He found after the study that, because he understood so much more about the different ways and environments pumps were used, he could diagnose problems much more easily. That saved time and money for everyone. For example, one hospital kept having problems with water damaging the electronics of the pumps. By being in the hospital watching how they were used it was obvious it was because when sitting on the draining board to dry the bottom ended up being in a little pool of water that was getting inside. In another case touch screen pumps were being damaged. It was because when they were stored together on a shelf their clips were scratching the ones behind. They had also seen patients sitting outside in the ambulance bays with their pumps for long periods: smoking. Not their problem, apart from it was Texas and the temperature outside was higher than the known safe operating limit of the electronics. Hospitals shouldn't get that hot so no one imagined there might be a problem. Now they knew.

Pat and Katie also showed that to design a really good product you had to design for people you might not even think about, never mind talk to. By watching the porters they saw there was a problem when a patient was on lots of drugs each with its own pump. The porter pushing the bed also had to pull along a gaggle of pumps. How do you do that? Drag them behind by the tubes? Maybe the manufacturers can design in a way to make it easy. No one had ever bothered talking to the porters before. After all they are the low paid people, doing the grunt jobs, expected to be invisible. Except they are important and their problems matter to patient safety.

The advantages didn't stop there, either. Because of all that measuring, the company had the raw data to create models of lots of different ward environments that all the team could use when designing. It meant they could explore in a virtual environment how well introducing new technology might fix problems (or even see what problems it would cause), for example.

All in all the anthropology was a big success. It turns out observing the detail matters. Not only does it give a commercial advantage, all that mundane knowledge of what really goes on allowed the designers to redesign their pumps to fix potential problems. That makes the machines more reliable, and also saves money on repairs. It's better for everyone.

Talking to porters, observing cupboards, watching ambulance bays: sometimes it's the mundane things that make the difference. To be a great systems designer you have to deeply understand all the people and situations you are designing for, not just the power users and the normal situations. If you want to innovate, like Pat and Katie take a leaf out of Dian Fossey's book. Try anthropology.