Do we need to drop the ‘user’?

User research is the evidence base that enables robust decisions and delivery of outcomes. It is an essential part of the initial exploratory and ideation stage of a service to delivery and beyond. It follows the same principles, ethics, safety guidelines and research methods that are at the core of other types of qualitative and quantitative research (for example academic and social). The main difference is in its focus on observing how people interact with specific processes, products and services in the real world.

The term “user” has caused a lot of debate. Using user research as our foundation and evidence for making decisions about a product or service can lead to a challenge from colleagues who ask what about clinical risk? What about other constraints such as technology, policy, cost? How are these considered in our decision making as they cannot be ignored? Some of this debate comes from the tendency when hearing the word “users” to think that we only mean “members of the public” or “patients”. However, whilst these categories are part of the wider group of what we call “users”, they are not the only people in it. 

When we say ‘user’ we mean everyone that uses a product or service from end to end, front to back. We mean humans, people. The ISO 9241-210 standard we work to is titled “Human-centred design for interactive systems” for this very reason.  In health and care this means patients and the public and equally health and care professionals, support staff, quality assurance, data analysts, policy people, developers, suppliers, and anyone else that might be involved with that area of care.

For example, when we used user research to understand the needs relating to a cervical screening service, the research participants included:

All these people together deliver the service and support the development and delivery of excellence in care. Our role is to understand what is needed by all these users and work towards a solution that balances them in a clinically safe, effective and efficient way.

Doing research with users is not about preferences or what people say they want. It is about understanding what a service has to be able to do in order to meet people’s needs and help them achieve their goals.

An example of this, is when as part of user research in a hospital, I observed administrative staff using a digital tool. The user said ‘what we would like is a button here so we can just print it so we don’t have to screen shot it’.

We could have noted this as a requirement and put it on our backlog but instead, I kept watching and observing what happened next. They printed the screen shot, put it in a pile of others and the pile was picked up by a colleague who had the role of scanning each of them and uploading them it to a document management system so they could then be attached to a patient record. The user did not need a button that says print. They needed to easily transfer whatever is on the screen, to the patient’s record.

Every day, experienced user researchers across the world are doing the same thing, helping people to understand the outcomes that services need to deliver to enable better care. As user researchers at NHS Digital, we don’t seek to capture opinions; instead we seek to listen to people to understand what the barriers are to them being easily able to deliver and access the appropriate pathway, interaction and tech solutions in context.

Most of the time, the underlying need or barrier to delivery isn’t as obvious as the example I just outlined but this is what user researchers do. They listen, observe and understand, then use their research and analysis skills to make recommendations, and keep on testing these until the outcomes are met.

The data collection is one small part. The reflection and analysis of what has been observed is just as important, as is the work to figure out the best method to get the data in the first place.

What we need to do is to recognise that everyone that interacts with a product or service is a human we should conduct user research with to understand what they are aiming to achieve, and what might help them to achieve it.

We also need to recognise that user research is not about gathering a wish list, preferences, or attitudes. We need to recognise it as a skill and a specialism vital to delivering outcomes for patients and health professionals. Without it, we risk not knowing what outcomes we need to deliver and how we are going to deliver them.