Alex Barclay, founder and director of Fuzzy, talks about his career in human-centred design and how it's essential for healthcare technology

Make it usable: putting humans first will help openEHR deliver more impact  

Summary: Are human needs and drivers being overlooked in the healthcare technology sector? Is this why many technology-driven projects and programmes deliver sub-optimal results? Is there something openEHR can do about it? And save wasting money too? Yes! says our latest professional member Alex Barclay, founder and director of Fuzzy, a not-for profit, human-centred design-based value creation consultancy.

Opportunity doesn’t knock. It comes calling.

Before we dig into details around healthcare, please allow me to tell you the story of how I came to be here. Put simply, my career trajectory is down to three serendipitous phone calls…

Call 1: 
The first was from a friend of mine. We had just finished school, and he mentioned that Disney had set up a production in London for a film called ‘Who Framed Roger Rabbit,’ and they had job openings. ‘You just finished school. Let’s go for it,’ he said. So I went for an interview as an animator there and did ‘the pencil test’ where you have to draw a straight line using a pencil on a white piece of paper (try it!).

I got the position and began training initially in ‘paint and trace.’ Eventually, I graduated to doing the in-between drawings for characters like Jessica Rabbit and cartoon bullets.

What’s crucial here is that Disney was one of the first companies to digitise content. They incorporated live-action shots with actors like Bob Hoskins, who would interact with robot mannequins. They then combined live action and animation through a composite process.

The first key takeaway for me was the immense importance of storytelling. It’s a universal concept – people understand and love stories. Additionally, I learned about the potent combination of digital technology and creativity, bringing together the best artists and technologists globally to digitise content and create this captivating experience.

Finally, the third lesson was the power of teamwork. There was an industrialisation of creative technology and business, where individuals with diverse viewpoints and ways of thinking were collaborating. The mix of expertise in the room contributes to bringing a story to life and ensuring exceptional quality.

For a 19-year-old at that point, it was truly eye and soul-opening.

Call 2:
The second call came a bit later. Having completed a Master’s degree focused on leveraging emerging creative technology in businesses, my interest was particularly drawn to business strategy. One school of thought emphasised the importance of innovating and adapting to environmental conditions and available resources.

Anyway I got a call from a guy at the British Film Institute who had heard about my interest in redesigning and optimising services. He asked if I could assist in understanding – from a design strategy and user experience perspective – the areas where 13 separate businesses, all housed within the BFI building, were facing challenges. The goal was to identify how to use digital resources more effectively and explore additional opportunities for improvement.

My approach was to consider how these 13 businesses could collaborate and operate together. How could I create a cohesive strategy that would enhance their efficiency? And this marked my first foray into service experience, involving the redesign of user experiences for people entering the various businesses on the Southbank.

So, that phone call significantly shifted my perspective. It prompted me to ask myself, ‘What actions should I take? How can I examine the human-centred aspects on one hand, and on the other, consider what will please, delight, change a person’s behaviour, and motivate people to choose one option over another?’

Before that phone call, terms like ‘user experience design’ and ‘UX’ were not commonly used; the digital landscape was still in its formative stages. From a kind of digital perspective, digital was really growing up. It was beginning. 

Call 3:
I was working as a strategy director for quite a large consulting firm, incorporating human-centred design elements into our practice when I got the third call – it was a chap from Accenture, and initially, I thought it was a prank. Firms like Accenture and others in the consultancy realm were… unfamiliar territories for me. 

At the time, I’d already established a prototype version of my current company called the XD’s (Experience Design Group). It was born out of a hackathon and a number of agile-based communities, and stemmed from a desire to bridge the gap between well-trained technologists, designers, business strategists… and a yearning for creativity and social impact.

We picked our own projects. We’d started looking at how we could create better mental health services for young people suffering from depression and anxiety, for instance, or how we could help nurses manage their routine admin more efficiently. This was way before it became as challenging for the NHS as it is now. We put out stuff on our website, invited people in, and formed multidisciplinary teams, we collaborated with patient groups, healthcare staff groups, and others. We began finding each other online, but the physical aspect was crucial: a room with a brief to solve a specific problem required in-person chemistry and shared values, focusing on delivering impactful solutions rather than just money. It was more about learning, exploring technology’s potential, and making a positive impact.

The chap from Accenture believed we were so far ahead of the curve, that our network was key to a new business paradigm: where technology, business strategy and the human touch intersected.

Still I was sceptical about the culture of such firms. ‘I don’t think I’m what you’re looking for,’ I told him, but he was very persistent, so we talked and I agreed to take a tour of the Accenture offices on Fenchurch Street, London. He asked me, ‘If I gave you all of this and all of these people, what would you do with it?’

It was kind of mindblowing. To deliver fantastic services using technology, I saw the need to work across various domains simultaneously – considering behaviour change, the neuroscience of it, usability, user experience, and ensuring technology compatibility. And at the street-level of service or product design, we ensured things worked seamlessly. Beyond that, I could see a marketplace perspective emerging.

The Accenture call cemented all that. It paved the way for collaborations with both Accenture and Boston Consulting Group, marking my entry into consultancy types of business.

The industry was evolving, with early-stage investments in tech companies. This journey led from the XD’s experience design group to Fuzzy, a not-for-profit value creation consultancy in healthcare. We combine human-centred design, business strategy and digital technology, to rapidly deliver value in healthcare.

Designers aim to fix issues; to move from suboptimal to optimal states, and create fulfilling, desirable future states. The motivation lies in curiosity, passion, and the desire to deliver something that makes people feel good or at least makes using the service or product easier.

The need to put humans first in all healthcare-related activities

‘What does any of this have to do with openEHR?’ you may ask. Well, one challenge faced in any technology initiatives, including openEHR, is this lack of a human-first approach: it leads to potential failures or suboptimal delivery. Integrating human-centred design into programs, like the openEHR suite, is crucial. 

Whilst interoperability and excellent technical governance and clear standards are extremely important, if we’re actually going to be able to deliver the type of care we want, we can only do so if there’s a sufficient and accelerated uptake of new technology by users and humans. 

To ensure success, users must understand and value the technology, how it aligns with their work, mental models, and needs. If we don’t include that human perspective, then my concern is we’re not going to see the outcomes that we want for patients, healthcare staff, and organisations globally.

We don’t join the dots up between humans and machines very well at all. This is evident in the failure of many digital transformation programs: approximately 70% fall short of expectations, and over 60% of users defect after a single bad experience. Think about that. If you get it wrong the first time, 60% of those potential users will go back to whatever it was they were using before or they’ll use something else. We have amazing technology: why isn’t it delivering what we want it to deliver? 

Also think about the cost of failure. Not only is there a ‘money cost’ – billions in some cases – but also the wasted goodwill, energy and ensuing ‘innovation fatigue’ and re-entrenchment of the ‘if it ain’t broke don’t fix it’ mindset that can come as a result of substandard delivery.   

Service end users, including patients and healthcare staff, are often excluded from the design and implementation process, leading to frustration within the healthcare communities. And probably openEHR too. 

For technology to fulfil its promises, we need a human-first approach, creating experiences that surpass previous ones. The key is understanding and meeting unmet human needs, ensuring technology is usable, convenient, and quick. Beauty is in the eye of the beholder, and the success of technology adoption lies in the end user’s experience, particularly in high-pressure healthcare scenarios.

With openEHR, there’s an opportunity to consider healthcare delivery as ecosystem-based and to take a wider, more holistic and multidisciplinary approach to join things up and create a new culture, one in which acceptability of new technologies is heightened. This involves considering human-to-human, human-to-machine, and machine-to-machine interactions across various healthcare pathways. By examining the front and backstage elements, primary, secondary, and community pathways, and leveraging technology intelligently, suboptimal service delivery can transition to better clinical outcomes and enhanced patient and staff experiences.

openEHR could leverage its community to create tangible use cases that align with these principles: the goal is to showcase the value and potential of a human-first approach, combining technical and design standards, including ISOs related to user-centred design and accessibility. Collaboration on realistic, achievable use cases across different domains could demonstrate the transformative impact within the healthcare ecosystem.

The Fuzzy Open: be the change you want to see

And that brings me to the Fuzzy Open, which is essentially a non-profit open innovation initiative that connects, equips, and nurtures the most creative, expert, and community-minded innovators in healthcare.

In the Open, expert and passionate practitioners from technology, design, strategy, and gaming will come together in teams to create challenge briefs exploring specific healthcare challenges. The challenge lasts for one year.

Our goal is to make it an enjoyable experience, where participants can dig into a subject, conduct technology research, explore regulation and governance, but above all, interact with possible service users. I think this approach will allow for a comprehensive and enjoyable learning experience while connecting with other experts.

And for this first year, we’re running it as a prototype itself. Is it going to work? We’re using a meta question as a guide: How might we use emerging and immersive technologies to create empathetic, smart, human-centred health experiences and systems? We’re testing our own hypothesis that bringing together specialists from different disciplines in teams will result in healthcare solutions that are more usable, useful, and desirable, while leveraging technology for more effective and efficient healthcare outcomes. 

You might say we’ve ‘soft-launched’: some teams have already come together and started working on their briefs. Briefs cover specific conditions like cancer, diabetes, COPD, cardiovascular issues, mental health, autism, parenting autistic children, and more. There are also briefs addressing broader challenges, such as better communication throughout the healthcare pathway, greener or eco-friendly healthcare, increased access to healthcare, workforce training, clinical services, back office, supply chain, and workflows.

The common thread among all briefs is the focus on using immersive emerging tech, including data science, analytics, AI, machine learning, VR, AR – you name it – to deliver more effective and efficient healthcare. The plan is to select the most promising briefs and teams in the coming weeks. 

The aim is to have working proofs of concept at the end of the year – real pieces of intellectual property with a business case ready for the next stage of investment and development.

Apart from the challenge, The Fuzzy Open includes a second part: talks. These will cover various topics: new technology in healthcare and ethics, healthcare and immersive tech, technology challenges like interoperability, and best practices and standards in design and tech.

We’re also encouraging philosophical discussions about not just what could be done but also what should be done in both the public and private sectors. The emphasis is on keeping things open and diverse, fostering cognitive diversity and different opinions to build better products and services. 

There’s going to be a whole load of brain food and learning connected to it. You’re going to be making some great connections with other experts across a diverse set of disciplines and the kind of wider community practitioners there. Also, you’re going to be creating these investable proofs of concept.  

Participants will be able to add their narrative to the purpose-driven goal of increasing the capacity and capability of the healthcare sector, delivering culture change, generating new ideas for significant impacts on people’s health and wellbeing….

You’ll help deliver some culture change and those new ideas that have the potential to make a significant impact on people’s health and wellbeing. And that’s what I mean about what I see in healthcare workers, whether they’re technologists or clinicians, back-office staff, designers or, whoever they are, they are driven by that desire to make the world a better place to live in. 

If you’re up for that, then please do say ‘hello’.


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