Originally Published MDDI May 2005
Product Development Insight
Aesthetics shouldn't be an afterthought when designing medical devices.
William A. Hyman and Mary Beth Privitera
Texas A&M University and University of Cincinnati
|William A. Hyman and Mary Beth Privitera|
Does looking good matter? Can traditional aesthetics be applied to a field where functionality, safety, and durability seem to be the only things of importance? This article makes the case that, yes, looks are important—although the medical device industry might not want to admit it.
This article discusses the significance of aesthetics in medical product design. The opinions and ideas presented here are based on anecdotal conversations with practitioners in the fields of orthopedics, cardiothoracic surgery, general and trauma medicine, and gynecology. Additional feedback was gathered from cardiologists, anesthesiologists, pulmonologists, and interventional radiologists. Other findings are based on personal experience developing devices with both large corporations and start-up organizations.
The model in Figure 1 presents the core values or concerns of a practicing cross-functional development team. Note that the triangle equally balances function and appearance to create value for the consumer. In this model, all functions are equal and overlapping. While technical efficacy and reliability must be the foundation for any medical device, form has often been considered an afterthought. With the advent of more-complex clinical applications and the growth of a competitive marketplace, form has become both an enabling and a differentiating element in the design equation.
|Figure 1. Core values and concerns of a cross-functional development team. Courtesy of Dale Murray, assistant professor of industrial design, University of Cincinnati (click to enlarge).|
During the product-realization process, cross-functional development teams consider many attributes that make up a product, including looking at the specific requirements of the various stakeholders. All products have different stakeholders with varying levels of influence over the final product configuration. Each stakeholder has a unique perception of the product. A product's aesthetics can affect whether a product is perceived as having value or quality. For medical devices, stakeholders include, but are not necessarily limited to, users (healthcare providers and patients), purchase agents, a patient's family, and the development and marketing organization as well as their investors.
There are at least three distinct but overlapping elements of medical device design. These are the purely technical aspects of the design, the human factors aspects of the design (user interface), and the general aesthetic appearance of the device.
The first category addresses the assemblage of parts and systems that make the device capable of meeting its technical specifications or clinical needs. The device must be dependable and perform to its specifications. Moreover, it must do this every time it is used. To most development engineers, design means exactly this—both in terms of doing the task and in judging whether one design is better than another.
The second category addresses how well the user interface enables the user to interact with the device. Human factors can be thought of as the bridge between the device's technical capabilities and how well the design encourages correct user performance and discourages or prevents incorrect performance.
|Figure 2. These instruments are the standard surgical set for William Schneeberger, MD, a cardiothoracic surgeon.|
The third category, general appearance, also has human factors implications. Human factors often influence the shape of a device and the configuration of its controls. Aesthetic form can clearly communicate to the user exactly how and where to grasp or control a device to achieve a particular result. These qualities provide the foundation for understanding how a particular device is controlled or manipulated. They often are the ones that make the product easy to use.
Although the general appearance of a device doesn't affect its user interface, the appearance may have a strong psychological influence on the user. Donald Norman, author of Emotional Design, theorizes that there are three levels of beauty in design.1
The first is visceral beauty, which is biologic in nature and elicits responses that are involuntary and subconscious (also known as the wow response). The second is behavioral beauty, which is determined through learned skills. This is the most important level of beauty for medical devices in that it is the level at which users form their perceptions of the look and feel of a particular product through interaction.
The third is reflective beauty. This beauty is the eye-of-the-beholder beauty, which is highly subjective and interpretive. One can argue that aesthetics are a human factor. The psychology of beauty is inherent to human beings and is listed as the sixth need in Maslow's hierarchy of needs.2 This is the need for symmetry, order, and beauty. Aesthetic decisions may include attributes such as form, color, texture, user amenities, and others. For modern industrial designers, appearance issues often overlap with performance-related human factors issues.
Adequate technical design is a prerequisite to the general-appearance issue—a device that looks good on the outside but is dysfunctional on the inside is clearly not acceptable. Therefore, there is a strong overlap between all design elements.
From the user's perspective, all elements are generally regarded as working in concert to create value and to enhance the overall perceptions of quality. A well-designed medical device satisfies all the clinical design requirements and incorporates applied human factors. It is sensitive to aesthetics and to market perception.
Fulfilling clinical design requirements and making the device comfortable to use requires an understanding of feature options and potential design paths. This balance of the emotional response with clinical efficacy in applied technology is increasingly important to healthcare professionals.
For the purposes of this discussion, separating the human factors aspect of design from the general-appearance aspect enables us to ask the question, “Does looking good matter?” The question is asked only in the context of comparing designs in which both the technical and the user-performance issues are indistinguishable. This discussion addresses appearance as a value that is distinct from the merits of the user interface, at least insofar as these two elements are generally recognized and measured.
Where Does Appearance Matter?
|Figure 3. Alias renderings of the four final directions in increasing order of complexity. Injection device developed for Eric Wall, MD, of Cincinnati Children's Hospital Medical Center (click to enlarge).|
Beyond the direct merits of the user interface, the enhanced general appearance of a device might be beneficial in several ways. These include marketing, user perception, patient perception, and effect on the general public.
Marketing. The appearance, fit, and finish of a device are key components of its marketability. While this clearly applies to general consumer products, it also applies to industrial or work-related products, particularly when choosing between competing brands that offer essentially the same technical performance. A desire for products that look better is often a factor in choosing between competing medical products in much the same way that it is a factor for consumer products.
It is unlikely that most medical device designers would weight the preference for a better-looking device as highly as they would weight other attributes. The role of better-looking design is more likely to be a subconscious one. However, it may influence the designer's assessment of other, more-specific attributes such as reliability and provider sophistication.
People often equate style with timeliness and state-of-the-art quality. Whereas style is ephemeral in clothing fashion, it is temporal in product design. Beauty and classic aesthetic qualities go beyond style. Healthcare providers are affected by the culture in which they live and practice medicine. In general, their perception of a particular medical product can also be passed on from mentor to student, so training also greatly influences their opinions.
It must be noted that not everyone's perception of what looks better is the same, which Norman discusses as beauty level three.1 This is illustrated by the occasional appearance of designs, and even commercially successful designs, that are perceived as ugly by some. For instance, the Saab automobile tends to polarize the viewing public. Herein lies part of the challenge. Designs that have appropriate, classic, refined, and even technically superior looks are all perceptions commonly described by healthcare practitioners. Experienced industrial designers agree that inappropriate or poor aesthetic decisions create an intuitive response in users that a product is inferior and will not function well.
For years, function has dominated the focus while form has often been an afterthought. As clinical applications become more complex and the marketplace more competitive, form has become both an enabling and a differentiating element in design. Clinical outcomes cause new users to consider new tools and methods; however, long-term adoption relies on the user's belief that he or she can readily perform the procedure.
From the standpoint of development and marketing, aesthetic form and styling cues create strong brand identity. Aesthetic relationships between items in a product line combine to communicate a sense of unity and cohesiveness toward core competencies. The aesthetic quality that unifies a line of products, such as cardiac tools, makes them immediately recognizable as part of a brand.
User Perception. Assuming that measurable human factors attributes are equal among hypothetical comparative products, the question remains: are there subtle design attributes that may influence a user's (either medical professional or patient) desire to work with the device? For example, attributes may influence users to be more careful with a device, thereby achieving a better level of personal performance.
Aesthetic design can enhance user perception because it considers the social implications of the device. This is especially true with patient-use priority devices. For example, a patient requiring oxygen therapy would probably prefer a fashionable alternative to carrying a large oxygen canister with tubes connected to the nose.
Appearance cues can be used to guide user operation more than a purely human-factors approach might address. Attractive devices may also make a user feel that the workplace is enhanced and attractive. Better design may affect performance beyond the scope of the device itself if an attractive design compels a user to be more careful or more productive, for example.
The decision to purchase or use a device is ultimately related to the value and the perceived reputation of the manufacturer's representative or of a practicing colleague. Value encompasses the functional, cognitive, and emotional relationship users have with devices. Devices that are considered more valuable are the ones that can be used for alternative purposes or that can optimize procedure time. Randy Wolf, MD, director of the Center for Surgical Innovation at the University of Cincinnati (Cincinnati) states, “I love my Pediatric Yankour [a suction tool]. It allows me to do two things at once. I use it for all my dissection, and it clears the field while it works.”
It is widely accepted that, through mentorship, lead physicians can be a driving force in the success of a medical device. Physicians choose devices through interaction—whether in an office visit or in a clinical setting. Their evaluation not only considers the proven clinical efficacy, but also the intuitiveness and feel of a particular device. This ultimately gives them the perception of confidence in a device and in its ability to live up to its promises.
This confidence is gained through feedback provided by the device. Feedback includes all elements of perception, including visual, tactile, auditory, exertion, and product behavior. The coincidence of the “surgeon's specific set for a particular procedure,” speaks of the passionate and emotional relationship these users have with their tools. For example, Figures 2a and 2b are the standard surgical set for William Schneeberger, MD, a cardiothoracic surgeon. His set has multiple tools for various tasks. In describing these tools, he comments both positively and negatively on topics such as the smoothness of the surface finish, including a small manufacturing burr. Regarding one device, he notes, “This one has a little bump on it and it catches sometimes on small vessels.”
|Figure 4. Clinical study with children evaluating aesthetic shape.|
Patient Perception. A third potential benefit of better appearance is that a patient responds better to more-attractive medical equipment. It is assumed that a patient would not be the actual user. Studies of the role of environmental influences on the health and recovery of hospitalized patients have shown in general that a more-attractive physical environment is correlated with better patient outcomes.
Because the medical devices around a patient are part of the general environment, these devices become part of the overall environmental influence. More specifically, a well-designed device might give a patient a better sense of being well cared for. Equipment that appears old or unsophisticated may cause patients to assume the clinicians are less capable. For example, a set of industrial gray devices stacked on an industrial gray cart is much less likely to give a patient the sense of being well cared for than an integrated system on a custom cart with sleek lines and modern (yet medically appropriate) colors. The presence of attractive equipment that looks capable may also allow attributes of sophistication to accrue to the healthcare providers who work in that environment.
Children are especially challenging when considering aesthetic options. Figure 3 illustrates the design of an injection device currently under development at Cincinnati Children's Hospital Medical Center. A cross-functional student design team researched varying shapes and product configurations. The patient must not manipulate the device while it is attached. It is difficult to imagine a child between the ages of 18 months and 5 years not playing with something on their body (see Figure 4). The results of a clinical design research study concluded that a nondescript device—and one that was not fun—was the ideal overall configuration for this product. This project illustrates how aesthetic decisions drive the course of development.
A patient's imagination, upon seeing a large piece of equipment such as an MRI or a CT scanner, can create unnecessary stress to a potentially anxious experience. An example of this is when a children's hospital places cartoon stickers on CT equipment. This really doesn't tame the beast for 2–6-year-old children.
Recent changes have made patients more aware of the devices used on them. In particular, the advent of more home healthcare, such as self-administration of drugs or self-monitoring, has led to increased visibility of devices and has, in fact, made patients the primary users. In such cases, the attention to aesthetics and social considerations can provide distinct competitive advantage.
While it is unlikely that most medical devices will ever be described as cool, sleek, or sexy, there is merit to considering the emotional response to aesthetics and the increasing importance of brand identity. This is especially true with maturing markets. For mature products, manufacturers must be more aggressive in differentiating their products by using a feature-based approach. Both the functional characteristics and brand identity ultimately dictate styling cues.
Healthcare professionals have an immediate response when introduced to a new device (Norman's first beauty level).1 When presented with a new device or technology, physicians have the same response any other consumer would have: they are inquisitive and judgmental. For some hand tools, this can mean that a drastic change from traditional product configurations may be resisted. Or on first sight, users can sometimes detect challenges intuitively with the overall product configuration. These reactions reinforce the need to understand the target users, their expectations, current practices, and the intended-use environment. A well-designed medical device satisfies all the functional clinical design requirements and expresses its function by incorporating applied human factors and sensitivity toward aesthetics.
Multidisciplinary teams that develop devices should consider all the various stakeholders, including users, indirect beneficiaries of the device, patients, and the overall environment. It is the design team's ability to reconcile or integrate engineering requirements, usability requirements, and market perceptions within the product to ultimately prove success. As patient-controlled devices and home healthcare become more prevalent, aesthetics in product design will become more important for marketplace success.
1. Donald Norman, Emotional Design: Why We Love (or Hate) Everyday Things (New York: Basic Books, 2004).
2. Maslow's Hierarchy of Need [on-line] (Valdosta, GA: Valdosta State University, 2004 [cited February 2004]); available from Internet: http://chiron.valdosta.edu/whuitt/col/regsys/maslow.html.
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