By Ann Kauth and Elizabeth de Montforth Walker Co-directors of Research HLB Design

“Using this hammer makes me feel like a rock star.” That's what an orthopedic surgeon exclaimed after using the suite of surgical tools developed by HLB Design for Smith & Nephew's Journey Bi-Cruciate Stabilized Knee System.

Achieving the Smith & Nephew's ‘rock star moment’ began with a research process that took a holistic view of knee-replacement surgeries. A team of researchers, designers, and engineers observed surgical preparations, the actual surgeries, and post-op briefings to see how surgeons and nurses use the tools, and how they interact with one another.

Interviews with the surgeons and nurses provided the team with a better understanding of what they saw. And opportunities to perform knee replacements on cadavers and in saw-bone laboratories provided the nonsurgical team with a firsthand understanding of the realities and challenges of knee-replacement surgery.

At the core of this holistic approach, based on human factors research and ethnographic inquiry, is the belief that asking the end-user, “What do you need?”, is only the beginning. While the answers are useful, it is often impossible for a medical care provider to imagine the possibilities of design and engineering. It is doubtful that when asked what he or she needs, a surgeon would answer, “To feel like a rock star.” Yet that unarticulated need is well met by design features that include specially shaped stainless steel handles with orange silicone over-molds. The over-molds enable better grips by latex glove-wearing surgical teams while the stainless steel handles “accented” in orange make it easier to spot tools that need be returned to their proper place.

Looking beyond the obvious functional needs are those less obvious:

• Cognitive needs such as the rock star feeling are critical. Research and design must take into consideration the mental model that shapes user expectations as well as learning curves and styles.

 

• Environmental considerations often play a key role. What are the storage considerations? Where is the product used? Are there lighting and noise requirements? What about cleaning? Will the product cause a change in protocol? And what are the reimbursement challenges?
• Social and emotional needs often provide opportunities for innovation that surprise and delight. How are caregivers interacting and sharing information with each other during a procedure? How are devices used throughout different shifts? How does the design impact perception and use? How do patients feel about using something that looks like a medical device in a public setting, or having something that looks like medical equipment in their homes? How can a surgeon show his or her mastery of a procedure in the operating room?

Not all research techniques are the same. Some situations call for ‘hanging back’ and ‘shadowing.’ Observations gained from these techniques are coupled with post-op debriefs involving members of the surgical team.

Group sessions are opportunities for teams of caregivers or patients to talk to one another about what may or may not be working. Often it is the first time they have discussed issues as a group. The cross talk generated in these sessions can help uncover issues that a one-on-one interview would miss.

Participatory design sessions serve as useful forums for evaluating existing solutions, workarounds, and mock-up of new possibilities. During these sessions medical team members or patients work with a set of materials to mock up new product ideas to address their needs. Designers are on hand to collaborate with participants. Working with designers to embody a set of internalized needs is sometimes the easiest way for a user to explain what it is they are trying to do with a device.

Cross-functional integrated teams provide multiple perspectives and ensure the right questions are asked. A team that considers what questions a designer, engineer, and researcher will ask helps strike a proper balance so the research can provide guidance on what to design, and how to design it.

Finally, keeping target users involved beyond an initial research phase is critical. User evaluations and feedback are important steps in ensuring that proposed designs actually fit the needs uncovered during the initial research process.

AWARD-WINNING TOOLS

HLB Design was recently named a Gold winner in the 2008 Industrial Design Excellence Awards (IDEA) for its Smith & Nephew Journey Bi Cruciate Artificial Knee System instruments.