The user experience

I was going to start this post by explaining how busy I’ve been, why I haven’t posted in a while, blah, blah, blah. Then I realized I would undercut that immediately by revealing that I’ve just finished reading Walter Isaacson’s biography of Steve Jobs. I read it on an iPad, of course, so didn’t realize it was over 600 pages long until I had finished it and saw it on display at a Detroit airport bookstore yesterday.

I highly recommend it. I enjoyed learning more of the story behind the personal computer revolution that still seems so recent to me (I vividly recall using the Commodore 64, and then the Mac, both of which were released while I was in college). But I mostly marveled at the fierce vision (and meanness) of Jobs, and how he was still able to motivate people and channel this vision into so many great products.

Does it contain any lessons for healthcare epidemiologists and infection preventionists? I hesitate now, because I hate facile comparisons of other industries with healthcare delivery (yes, I understand that we can learn lessons from the airline industry or FedEx, but I’ll be more receptive when FedEx starts delivery packages that arrive at their drop-boxes with multiple co-morbidities, or when Delta can fly me from Boston to Moline without a missed connection due to multiple small system failures—explaining why I was browsing Detroit airport bookstores yesterday afternoon). I was taken, though, with Jobs's laser-like focus on “end-to-end integration”, and maintaining control of the entire user experience (hardware, software, and content):

“His quest for perfection led to his compulsion for Apple to have end-to-end control of every product that it made…This ability to integrate hardware and software and content into one unified system enabled him to impose simplicity”

Simplicity means that users can actually enjoy, and benefit from, the products in an easy and intuitive way. While digital enthusiasts and computer geeks might want malleable open systems, most of us just want to be able to download that cool song we heard yesterday onto our music player without using too much profanity in front of our kids.

Meanwhile, the U.S. healthcare system might be the least integrated “system” in the world. Hence the “user experience”, to borrow one of Steve Jobs's favorite phrases, “truly sucks.” Having just navigated an elderly family member’s transition through acute care, assisted living, skilled care, and home again, I can honestly say that having some inside knowledge of the system doesn’t help much—it still sucks. Many patient safety initiatives, including infection prevention initiatives, are akin to software patches, temporary fixes to problems that wouldn’t exist if we had a truly integrated system—integrated not around RVUs, profits or operating margins, but around the patients’ simple goal: to get better, and not to be harmed in the process.