Look-out ICE iPhone Lock-out! A design proposal for easily reaching loved ones ‘In Case of Emergency’

Since the London 7/7 bombings in 2005 I have had an ICE number on my mobile phone. This is a widely recognised number to ring ‘In Case of an Emergency’. I hadn’t heard of this practice before but thought it was a great idea. If you have an accident, and are unable to contact someone yourself, then someone can locate and ring this number on your phone. Nearly everyone has a mobile phone nowadays and so in terms of identifying someone or letting a loved one know this seems like a great idea.

It was only the other day that my girlfriend pointed out that this was next to useless. I have my iPhone password protected for security reasons. So if anyone steals or picks up my phone then they can’t access any information on it – great eh? Well, not so great if they want to access the ICE number!

So there is a conflict here between the safety requirements of being able to access needed information in an emergency, and keeping the iPhone’s information secure when the main user is not the person accessing it the information.

There is a solution, and it’s not too dissimilar to the iPhone’s ability to allow someone to make an emergency call without knowing the security code for the phone. Why can’t there also be an ICE number at this level? So someone picking up the phone can make an emergency call not only to the emergency services but also to an emergency ICE number that is set by the user. This could let people call a loved one if an accident has happened, but still keep the iPhone secure.

There are other benefits to this idea too:

1. At the moment ICE numbers are a workaround, i.e. the iPhone does not officially support this functionality and someone came up with the idea of creating this number and putting it as ICE in the contacts. If the designer’s of iPhones design this feature in then it’d presumably be more widespread and easier to use too!
2. This number could come in handy outside of emergency cases: ever left your phone in a cafe, a cab or somewhere else? What can the person who finds it do with it if it is password protected – not alot eh? With this number people would know exactly who to contact – they could contact your ICE contact, or a forgotten number (no good calling your own number of course ).

I think this is a great idea, and like all great ideas others seem to have thought of it too (damn!). After drafting this blog I have seen the lock out issue is referred to here.  So if this idea is known then why hasn’t it been implemented?? This issue has been brought up on Apple’s forums too. Even if people have thought of this before me then it is still worth talking about and drawing attention too. I would expect something to be on this page after someone has pressed the emergency call button on the password screen:

Here is another enlightening blog around these issues that I’ve outlined above with some inventive processes and workarounds. A seemingly easier and more practical invention to solve these issues is to stick an ICE sticker on your phone. To me the need for these inventive workarounds should dissolve away if the designers actively designed in these features.

2012 in review

The WordPress.com stats helper monkeys prepared a 2012 annual report for this blog.

Here’s an excerpt:

600 people reached the top of Mt. Everest in 2012. This blog got about 2,300 views in 2012. If every person who reached the top of Mt. Everest viewed this blog, it would have taken 4 years to get that many views.

Click here to see the complete report.

4th Clinical Human Factors Group Seminar, Cambridge 23.10.12

I’m just heading back from the 4th Clinical Human Factors Group meeting in Cambridge and again it didn’t disappoint. I’ve been to three now and each time I am impressed with the passion that people show at this meeting, and particularly the engagement of the clinical community.

Suzette Woodward, @SuzetteWoodward, gave a very inspiring talk to kick things off. She had been one of the London Gamesmakers and outlined what an important role they played: lots of different people had come together to inspire, to be alert, open, consistent, part of the team and to have fun. Being from London and attending the games I had witnessed what a difference they made – and it was remarkable. Suzette brought forward her learnings from the experience and made a case for how we each need to be inspiring ambassadors for Human Factors in healthcare. I think I will promote Human Factors work I do to the clinicians I encounter in my research as a result of this, but one question still remains: should we have Adidas uniforms for this?

This was followed by Peter Buckle and Janet Anderson who explained the limitations of standardisation in dynamic complex systems; followed by Lauren Morgan and Matt Inada-Kim who explained the importance and success stories of standardisation in complex systems. This tension was intentional as there doesn’t seem to be a straight forward answer in determining the degree of autonomy and flexibility or strict adherence to rules and procedures in complex systems. The correct answer will be revealed in hindsight… and if everything goes right no one will care anyway as this is what the system is meant to do.

My own lunchtime market place presentation of www.errordiary.org was well received, but it would have been nice speaking to more people. I outlined the purpose of Errordiary as threefold: 1) to raise awareness about the pervasiveness of human error in a non-threatening way, which seems to be particularly effective as an ice-breaker in healthcare where human error is so serious and can have far reaching repercussions e.g. people can associate with putting their red pants in the white wash and locking themselves out of the house; 2) in terms of teaching so students learning about human error can try to categories this real data in class exercises; and 3) in research as we can learn more about human error but also resilience strategies – I shared our paper on the topic (click here for the paper). The people loved Errordiary as a simple concept for starting debate about human error in an engaging way. Interesting points were brought forward for Errordiary: how to transfer this value to healthcare, whether it would be anonymous for clinical staff, if errors and resilience strategies can be directly linked, if we could test/prove that a wider knowledge of resilience strategies could actually improve performance.

For those doing training, and who are interested in engaging material for spreading the Human Factors word, I pointed them in the direction of Microwave Racing so people can see what a difference the design of devices make. I heard that the Institute of Ergonomics and Human Factors were using this in presentations to school children and it had great feedback. A complementary video that I really like shows the poor usability of some medical device and software design, and the real trouble that users have using it.

In the afternoon workshops I attended the resilience themed events. Both were looking at resilience and high reliability organisations (HRO) at a management/organisational level, which is fine but to the initiated this can fall into a lot of management speak about communicating better, being preoccupied with risk, monitoring, anticipating, etc. etc. They did a good job and it served their purpose in inspiring debate and offering a different approach to traditional forms of safety management. However, it still feels like concrete examples are missing from these talks.  What are the limitations of a resilience view or HRO view? Is there a difference between resilience and HRO? Is there an alternative and what is it? What is the one thing we would recommend people do in their work tomorrow to start to realise these approaches? One interesting idea is that healthcare organisations are constantly resilient and that instances of this should be distilled, celebrated and shared.

I started the day by tweeting that I had forgotten my business cards at home which was my first errordiary tweet of the day… it seems I’ll end it with forgetting my poster on the train from Cambridge to London. I was engrossed with writing this so when I left the train I grabbed my coat and my bag and left it behind. I’ll fill out a lost property form tomorrow but I doubt we’ll be reunited again

Resilience in the Face of Funny, Frustrating and Fatal Human Error

Ever left your keys at home? Have you ever got in the bath with your socks on? Ever heard of surgeons leaving swabs in patients or that pilot that mistook Venus for an aircraft? Many of these trivial errors will be familiar to people. The others show that errors happen everywhere as even the most highly trained people make slips and mistakes in safety-critical situations.

We believe we can all learn more from each other’s mistakes, like understanding the tricks that people use to reduce error. These ‘tricks’ form part of an emerging area of research called ‘cognitive resilience’ (further details can be found in this paper).

At UCL we’ve been developing a website (Errordiary, www.errordiary.org) where anyone can share human errors that they come across on a daily basis. The site automatically harvests tweets including the hashtag #errordiary and site visitors can add comments. We’ve collected a wide variety of examples from typos that have left the letter L out of ‘Public Meeting’ to police officers that have shot people with live ammunition when they intended to only stun with less lethal beanbag rounds or a taser device. Errordiary can help us understand the variety of funny, frustrating and fatal errors people make and the similar psychological causes between them.

Examples

• An example of a funny error is someone that was preparing her lunch but got her olives mixed up with her grapes. This was an unexpected culinary combination with her hummus that she’s hoping not to repeat.
• More frustratingly the Metropolitan Police shared 1,000s of victims’ contact details with each other as the sender copied and pasted all the email addresses into the CC list rather than the BCC list, which caused a huge breach in confidentiality. As an aside, why aren’t email systems designed to warn about this confusion? I can’t imagine many situations where the sender wants to share 100s or 1,000s of email addresses with their recipients. Here, an email system that is designed to flag up suspiciously large numbers of CCed addresses could help reduce human error.
• The fatal example is of a chemistry student who was dipping their bubble gum into some sour powder to give it a kick of flavour. The kick proved to be too much when the student mistook the sour powder for the explosive powder he was using for work, which had tragic consequences.

All three of these examples involve performing the right actions on the wrong objects. These confusions are encouraged by mundane tasks and not feeling the need to pay much attention whilst handling things that look similar.

To err is human but let’s not helplessly submit ourselves to this. People can create and apply strategies to prevent and minimise error. By reflecting on our own cognitive frailties we can create tricks to improve our performance. Everyday examples of cognitive resilience include someone leaving an umbrella by the door so it is not forgotten, or checking they have all the parts of their IKEA flat-pack furniture before they attempt to assemble it.

There are many examples resilience that are also recorded on Errordiary to complement the error posts, this time by including the hashtag #rsdiary in tweets. With others at UCL we’ve started to analyse these and have identified different types of strategy, which include strategies for not mixing things up: (1) Pre-emptive Separation is where someone separates things that might get mixed up in a task, like placing permanent markers well away from whiteboard markers to avoid mixing them up; and (2) Disambiguation involves strategies to differentiate similar things such as labelling keys on a bunch so the right one can be found easily (further details can be found in this paper).

These sorts of strategy are also used in safety-critical situations. For example, extra care is taken to make sure that John F Smith’s appendix removal isn’t confused with John A Smith’s heart op by checking their date of births and nurses draw each other’s attention to similar names when changing shifts on the ward. Also, when nurses prepare two forms of treatment at the same time they often separate the medication, their instructions and the way they perform the task to reduce the chance of confusing them (further details can be found in this paper). Like how some people check they have all the pieces of their IKEA flat pack furniture, nurses will check they have all the ‘stuff’ for treating a patient before they go to them (both are an example of a pre-commitment check). In the nurse’s case this might be complemented by a different nurse doing a formal double check too.

Resilient strategies can be seen as tricks of the trade to combat human error. They can evolve over long periods of time or in reaction to sudden changes in the workplace. Once these strategies are recognised we can make sense of them and share them more explicitly.

The emerging field of cognitive resilience aims to understand how we can guard against mistakes to make life easier and to save lives. The CHI+MED project (http://www.chi-med.ac.uk) is leading research in this area with a focus on improving patient safety through better medical device design. You can get involved by visiting Errordiary – tweet your errors and resilience strategies so we can all learn more about them and further the field of ‘cognitive resilience’.

Thanks to @jobrodie for her comments on an earlier version of this blog.

The Alarmingly Seductive Magic Belsize Button #cabb

Perhaps the most seductive button in the world is located in Zone 2 North West London. This button is irresistible to some despite big warnings to stay away. Similar to how mermaids draw sailors toward rocks, or how mosquitos are drawn to bright lights, this button has a magical pull that challenges normal notions of rational behaviour. But enough build up, let’s take a look.

Oooooo nice eh? It’s a button to activate the alarm in the lift at Belsize Park tube station. It sits in one corner of the lift, at chest height. On the opposite side of the lift is a much more normal looking button, hereafter referred to as the lift button. On entering the lift a voice announces, “To operate the lift please push the button.” It seems to repeat this a number of times regardless of whether the lift button is pressed or not. But this story isn’t about the poor feedback or poor interaction of the lift button, it is about the alarmingly seductive button opposite that still attracts people to press it even normal situations when layers of signage to indicate not to.

Just the other day I was in the lift: “To operate the lift please push the button”  the automated lift voice announced again despite me having pressed it already. A newcomer to the lift pressed the lift button not knowing I had already pressed it; I said nothing. As we waited the lift filled up further and eventually the voice went again, ”To operate the lift please push the button”. This time a different newcomer ushered to a person toward the front of the lift, “Could you push that button please?” pointing to the alarm button. “No!” I exclaimed, “That’s the alarm.” Surely this guy could read though??

If we look at the picture of the alarm button it certainly seems pretty damn obvious that it’s an alarm button that should only be pressed in an emergency. The actual button has a yellow bell on, there is an official warning in blue, and presumably because these two have previously failed staff have added their own not so subtle ‘ALARM ONLY’ sign. What sort of an idiot could miss this? The signs are so salient that we’d expect only a special kind of idiot would miss them – perhaps even a level 5. But no, I’d argue that this isn’t too out of the ordinary. Infact, you or I could do it. It happens when our body engages with interaction but our conscious mind does not. Apologies to the psychologists for the loose terminology here – what we’re trying to get across is that there are different levels of thinking in the mind, and that you can find your body doing things in the world at lower levels of thinking, long before higher levels of thinking like conscious thought have kicked in. These different levels of thinking and action are displayed in Norman’s Perception-Action Cycle.

So what we believe happens is that the mind is operating at some basic level of thinking and we have a sequence that looks roughly like the following:  1) push button request; 2) where is button; 3) oooo found button; 4) press button. This sequence will activate unless something stops it causing the mind to reflect, e.g. someone else interrupts by shouting “No!” or some higher level processing in their mind interrupts and says “No!” because it has picked up on the alarming signs. This of course doesn’t always happen.

We see this lower level thinking happen when an object affords some action but we are told to do something else. Norman, in The Design of Everyday Things, draws our attention to doors that afford pulling because they have a handle, so we pull it. It is only when we fail that we look and read the door that it says push, so we push it. We think we’re dumb because we should have seen it but actually a different affordance would have helped our lower level processing have the correct interaction style in the first place, e.g. a flat plate to push the door so we couldn’t pull it.

Our minds rely a lot on lower level thinking. We just don’t realise it because we’re not consciously in the driving seat so to speak. Like when we find ourselves looking into the fridge with no idea why we’re there, or when we find ourselves at work but we can’t recall the details of the journey that we’ve just made to get us there.

Rather than ever more signage I think the button should have a clear plastic shield placed over it. This would prevent anyone actually pressing it even if they tried to, this’d bring their higher level thinking into play to realise it’s actually an alarm button, and if it is needed for an alarm then it should be easily removed or broken so it could be pressed.

You can see an update of the button and its signage to your right, which reminds me of a phrase: If you keep doing what you’ve always done, you’ll keep getting what you’ve always got. The story of the man that wanted the button pressed above actually involved this extra supa dupa salient signage!

Button Affordance 2(two) V Button Signage Salience 0(nil)

This blog was brought to you by CABB: Campaign Against Bad Buttons. See the video Why Buttons Go Bad. We think the world should be full of better buttons and less idiots.

N.B. Mistakes such as these are shared on www.errordiary.org

Why the hell have two buttons on a train door in the first place? #cabb

Half asleep, with my mind numbed and elsewhere by a monotonous commute, I find myself looking like a complete numpty as I hammer the closed button to open the train door. With 20-30 people waiting to get off behind me, someone reaches over my shoulder and presses the open button. There was a collective sigh from the other passengers that confirmed my status as the first moron of the day: maybe even an early contender for plonker de jour.

There was little recovery from this embarrassment BUT like any good HCI and interaction designer I have tried to find a way of blaming the design rather than me, the user. How could you improve such a simple system? Surely there’s no way you can get out of being such an idiot here?

Well, I think I have an answer: why the hell have two buttons on a train door in the first place? Surely just one button would do, and it would do better: push to open when it is shut, and push to shut when it is open. If you can think of a good reason to have two buttons please tell me because I can’t think of one.

Whilst you ponder that also ponder my new design for a light switch (picture below). The left switch turns on the light, and the right switch turns off the light. Neat eh?

This blog was brought to you by CABB: Campaign Against Bad Buttons. See the video Why Buttons Go Bad. We think the world should be full of better buttons and less idiots.

N.B. Mistakes such as these are shared on www.errordiary.org

Why paper-based field notes just work

I find myself writing this blog as more is being demanded of the field notes that I write, and I’d like to do more with them if possible. However, promises of technological solutions for digital note-taking whilst doing ethnographic observational work don’t hit the mark (yet). I’ve tried to highlight some factors of why paper-based field notes just work:

Ease of use - Handwriting is a beautiful thing (even though in my case it is hard to read). With a pen and paper we can write, scribble, change and embellish previous notes, diagrams, and drawings. At the moment the tablet apps just don’t cut it. Even a delay of milliseconds between digital pen and digital ink can throw you off, let alone avoiding the feeling of having something akin to a digital crayon in your hand rather than a pen. Will the latest Microsoft Surface make progress here, some say so, but we have heard and seen the adverts many a time before and so far we haven’t got what we’ve been promised. Pen and paper works so well, in subtle but important ways that we barely think about it.

Flexibility (for non-linear processing) - I can flick back and forth through my field notes, circle things, make extra notes, feed forward questions from previous notes by creating new sections and writing further the questions. Field notes support the non-linear thinking and engagement with context – we don’t get a full set of notes the first time we see something, we don’t even ask all the right questions, we look back and reflect after seeing many different examples, sometimes embellishing those old field notes, sometimes creating new notes further on and sometimes both! Flicking through paper in an easy way supports this.

Accessibility – Without powering up I can flick through my field note book and conveniently see what’s happened most recently and in the past, depending how many pages away the notes are – so natural it seems funny to describe it this way.

Cost – How much does pen and paper cost? Not a lot.

Convenience – We can buy note pads of different sizes – ones for the pocket and larger ones for a bag.

But also where they don’t or fall short:

Collaboration – I find myself approaching a study where I need to work more collaboratively with a remote partner so my paper-based field notes become almost a barrier to sharing work. I can barely make sense of them some of the time, and he can’t even see them.

Extensive and complex field notes over a long period - When the study you’re engaged in is complex, long and perhaps not your only focus then it can be easy to lose your way in masses and masses of notes. All of a sudden the flexibility of flicking backwards and forwards doesn’t seem like a benefit. You will sometimes find yourself scrabbling through books trying to find where you made notes on incident X which shows what you’re looking for – wouldn’t it be nice if they could be searched like a typed doc!

Organisation and structuring – With typed text it is much easier to copy, paste and restructure things and this can be a real benefit as you’re working through and making sense of the data you’ve gathered.

Multimedia – Wouldn’t it be nice to embellish field notes with audio, pictures and video – surely this would bring your notes to life more.

In the fieldwork I do I need to make notes on people using technology as I watch them and ask them questions. Currently I use pen and paper to write personal notes that I’ll sift through and reflect upon whilst I’m still doing the observations to check my understanding and generate new questions (it’s not just a recording device it supports reflection and thinking). These notes will be analysed and organised more thoroughly when I’m back in the office. However, I need to share these notes with an expert in a different domain so they can give me input into the ongoing fieldwork too.

I like the idea of going digital but a wholehearted change to taking raw field notes in digital form seems premature and beyond reach at the moment. Perhaps there is a hybrid version where paper-based and digital notes (via a tablet) can co-exist side-by-side in the field so we have the benefits of paper but some of the advantage of digital too.