I’ve been musing recently on the term ‘desire’, when it comes to the design of services in health and care. It’s a relatively old term in user experience and eCommerce that I remember from my days working on selling internet and mobile phone packages.
Desire is your measure of how much a user will persist, in getting your product. Or to put it another way, how much nonsense they’re willing to withstand, in order to get your product. People will suffer poor user experience, dark patterns, or other frustrations, if it is outweighed by their desire for the thing you’re offering.
Amazon is very cheap and very convenient. People will run the gauntlet of avoiding accidentally signing up to Prime, and even overlook their anxieties over reports of poor treatment of staff, if it means they can get an egg whisk brought to their doorstep. It has high desire.
10 years ago, the desire to fly to another country as cheaply as possible, had high desire, which is why Ryanair was still successful despite it once having the least usable travel website around. People would keep plugging away, and actively despise the brand, because it meant they could fly to Prague for nine quid.
But that’s commercialism for you. CEOs and directors can evaluate the level of desire of their product or service, against their customers’ chance of sacking it off and going elsewhere. In highly competitive markets, desire is lower, because there are more options. Companies have to streamline their experience, remove the friction, and funnel their users through before they lose their patience. I learned a lot about this when selling broadband and mobile packages. Assume low desire, make things simple (don’t have too many packages to choose from), make the costs clear. As few steps as possible.
What about health?
But I don’t work in that world anymore. I work for the National Health Service. We don’t use crass terms such as ‘desire’, but I wonder whether we should. It’s a valuable lens through which to view services and decide how successful they are.
For people’s health and care, someone’s desire to be well is very high, but their available options are low, or non-existent. So they will persist in navigating a fragmented system. Or they will do other things that they would not normally do, in order to get the outcome they want. Perhaps they will try and do everything online, when they’d really be happier just talking to someone. Perhaps they will give up more about their personal circumstances than they are comfortable with, because they can’t proceed without doing so. Maybe they will travel further than they would like, or can really afford to.
When evaluating a service, we may look at the numbers of people using the service, and see it as a success. Sure, it’s a bit wonky in places, and that bit there could do with a redesign at some point, but plenty of people are managing, so why worry, when we have 1001 other things that also need fixing?
We should worry, because for the majority of the country, we’re the only option. It is easy to mistake a lack of viable alternatives, as an endorsement of the only game in town. It would be unethical to view a service purely by its traffic, as it gives an imbalanced picture of people’s lived experiences. And it would be unethical to disregard the worries and frustrations of users, as simply the price of admission to getting well.
Luckily, we have incredible user researchers who are very good at finding the frustrations in services, the anxieties people suffer, and the opportunities to improve them. We have product managers who can define what a successful service looks like, and how we measure it. We have designers, content people and developers who understand the steps needed to deliver a service in a way that meets the needs of users, and the organisational objectives behind them. And increasingly, we have senior management who recognise the value in human-centred service design, as a means of supporting large-scale public health outcomes.
So this work continues. I’ve been working at NHS Digital for exactly three years now. Our progress is often hard-won. It is difficult work. But my desire to do it, is greater than my desire for an easy job, or hair that isn’t greying at an alarming rate.
P.S. the image at the top is taken from an NHS-themed squirrel assault course, which I thought was a good metaphor.