I like to think of Interaction Design in its purest form as being about shaping the perception of an environment of any kind. Yes, today the discipline is so closely tied to visual displays and software that it almost seems to revolve around that medium alone, but that’s only because as of now, that’s pretty much the only part of our environment over which we have complete control.

The one field that has come closest to overcoming this limitation is the video game industry whose 3D games are the most vivid and complete alternate realities technology has been able to achieve. Game designers have control over more aspects of an environment, albeit a virtual one, than anyone else.

Lately I’ve been thinking a lot about this idea that interfaces can be more closely integrated with the environment in which they operate. I’d like to share some of what I’ve learned from the universe of video games and how it might be applicable to other kinds of designed experiences.

In Designing for the Digital Age, Kim Goodwin criticizes the term “Experience design” as being too presumptuous because we don’t really have the power to determine exactly what kind of experience each person with their own beliefs and perceptions has. Even when we work across an entire event from start (e.g. booking a flight) to finish (arriving at the door), there are still countless factors outside our control that can significantly impact how a person will experience it.

Video game designers on the other hand can orchestrate a precise scenario since almost every detail in their virtual world is for them to determine. They can arrange exactly what kind of person sits next to you on a flight no matter who you are or how many times you take that flight.

That isn’t to say that videogames don't have their limitations. Of course, it isn’t completely true that game designers can determine who sits next to you. They can only determine who your avatar sits next to. The most significant weakness of videogames is the inability to truly inhabit a designed environment or narrative. As much control as we may have over a virtual world, as long as we are confined to experiencing it through television screens and speakers, it won’t be anywhere near comparable to our real world.

Fortunately, there’s a growing effort to address this lack of immersion.

A key area of the problem lies in how we’re presented and interact with complex information diegetically, that is, interfaces that actually exist within the game world itself.

Before continuing, it helps to be familiar with some basic concepts and terminology around diegesis in computer graphics, the different spaces of representation between the actual player and their avatar. The diagram above illustrates the four main types of information representation in games.

Non-diegetic representations remain the most common type of interface in games. In first person shooters, arguably the most immersive type of game since we usually see the scenery through our avatar’s view, the head-up display has remained an expected element since Wolfenstein 3D first created the genre.

We’ve all got our own personal benchmarks for what makes a good user experience. My personal list includes a few: Does it delight me? Will I recommend it to my friends and colleagues? Would I have used the same approach if I had designed the product? I’ve found among some product executives one particular pattern for this subjective evaluation criteria that is both humorous and troublesome: “Would my mother/grandmother/Luddite Uncle Bill be able to use this product on the first try?”

While there is a sort of noble aspirational quality to this kind of thinking—let’s make everything so dead simple that any person can use every product—it also sets the bar for the experience rather low. I imagine a sea of step-by-step wizard dialogs that target the lowest common denominator and force everyone else to step through the same predefined (and very explicit) experience. If I’m designing a product for people who have specialized knowledge, I want to leverage that knowledge in the product. Why force people to walk when they can run? I’ll want to provide these people with clear, appropriate pathways through the product, but I also want these specialized users to be able to forge a variety of their own pathways through the interface, dependent on the specifics of their situation or how they want to do things.

I once worked with a client to design an intravenous medication delivery device called an infusion pump. This is a machine that nurses in hospitals use to administer drugs to patients by attaching a bag of medication to the device and specifying delivery parameters such as how long and how fast to dispense the medicine. This is critical stuff; the consequences of a mistake could be catastrophic.

When I picked up Jerome’s Groopman’s How Doctors Think, I imagined that it would give me a useful window into the mind of the busy clinician. On medical projects we often find it a bit challenging to get enough research time with physicians. (Aside from maybe lawyers and CEO’s, there are no better exemplars of the “time is money” mentality—American doctors, in particular.)

Dave, Doug and Noah learning how surgeons think.

While I appreciated the informal history of medical education, interesting anecdotes of diagnostic challenges and satisfying dose of medical atmosphere, I learned just as much about design and design research as I did about medicine. (I'm not surprised to discover that I'm not the first to make this connection. In her blog, Elegant Hack, Christina Wodke discusses how she thinks design education should be thought of more like medical education, with a focus on gaining experience over several years in industry, rather than just technical skill in a design program. She'll get no argument out of me there.)

The part of the book that I found most striking is Groopman's discussion of what he calls "classic cognitive errors" in diagnosing and treating medical conditions. I have made and seen each of these errors in understanding people and devising products and services to meet their needs. While explicit knowledge of these categories of flawed thinking isn't a guarantee against them, I do think that by naming them and affirming their reality (often by reference to the work of psychologists), this book can help us remember the kind of mistakes that top-notch professionals make when they're tired, stressed, egotistical, or just lazy.

Healthcare is a target-rich environment for design. Discussing even the smallest design challenge quickly exposes the hacked-together systems and processes that somehow function to help us stay healthy. Designers must understand the context in which they work, yet confronting the complexity of healthcare can be paralyzing. It seems impossible, for example, to discuss the viability of mobile devices at the point of care without discussing the Byzantine network of roles, regulations, and workflows that the device touches: nurse assistants, the lab, the patient, receptionists, regulatory bodies, HIPAA, hospital and lab information systems, IT departments, point-of-care coordinators, ADT systems, and so on.

While it’s important to understand the knotty context of a healthcare design problem, it’s just as important to know when to reach for the sword of methodology to cut through it. To illustrate this point, I’ll discuss some healthcare design challenges I’ve seen during my research and design work and the methods I’ve used to tame the complexity.

In the mid-1980's, a team of physicians, lawyers, and public health experts conducted a lengthy study of the nature and causes of medical errors. They published their findings, entitled "Incidence of adverse events and negligence in hospitalized patients," in the New England Journal of Medicine in 1991.[1] Their research indicated that "there is a substantial amount of injury to patients from medical management, and many injuries are the result of substandard care." While the industry evaluations and renovations sparked by these findings have taken effect, physicians and clinicians have simultaneously adopted more sophisticated technologies to provide more accurate and efficient care. [2]