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Personas and scenarios to help design, training and procurement

Key Points

  • Technology is not always used in ways that those who designed it expected and this can lead to both frustration for those involved and raise safety issues. We have shown how a simple but powerful approach can help avoid the problem.
  • It is based on giving fictional but realistic accounts of the people who use the technology, and of the situations they find themselves in.
  • These accounts are based on substantive evidence, including interviews and observation of the actual work of real people. They give a powerful way to communicate to designers the day-to-day reality they are designing for.
  • The approach has been used as a powerful way to train nurses about how poor design can lead to incidents, ways to deal with it, as well as the importance of avoiding blame culture.

Technology is not always used in the ways that those who designed it expected. For example, devices that were designed to be plugged in most of the time may be run for extended periods on battery power; functions that are used frequently may be buried deep in menu structures. This is likely to happen unless the manufacturers as well as those responsible for buying equipment have a deep understanding of the work the people using the technology do and the way they do their jobs. In a hospital this can change from one ward to another, even for people doing apparently similar tasks. For those using technology, mismatches like this can result in simple tasks being frustratingly hard to do and lead, in a healthcare context, to lost time that could better be spent on patient care. Those responsible for getting a job done are likely to develop workarounds. Sometimes such workarounds can have unforeseen safety implications, however. For example, porters moving patients may remove and reinsert batteries from devices that have low battery in transit; this gets the device working again for long enough to get the patient safely to their destination, but also stops the reminder message that the battery needs replacing or charging, so the device is likely to stop working again in the near future – possibly when no-one is alert to the possibility.

Simple tools to help
To overcome this problem those that design, develop and deploy medical equipment need a way to easily understand the reality of who will use a device, and how they will use it. Relatively simple and adaptable ways do exist that let those from different professional backgrounds share views on who will use a device and how. However their use is not currently widespread.

Two such complementary approaches are the use of Personas and Scenarios. Personas describe fictional people that new technology is intended to help. Though fictional, they are based on observational studies and interviews with a variety of real people in relevant roles. Personas are described in enough detail to make them feel like real people, with photos, personal lives, descriptions of the jobs they do, and their motivations for doing them as well as their personal goals and needs. Scenarios describe in detail typical situations in which those people use the technology of interest, or do the jobs it is intended to support. They describe the work being done, how it is done and why. Again they are based on detailed studies with real people.

Both personas and scenarios have been advocated as a way to avoid design being done in isolation. They encourage designers to think about different design possibilities and discuss what products should do and why. They do this in a way that is very accessible as it is essentially based on descriptions of realistic people and their lives. They can also be a useful tool to help designers communicate with the end-users.


We collaborate with nurses and patients through participatory design. ... For instance, if we have to identify risk factors, instead of asking our collaborators to identify risks, we ask them to help us design a persona first; once that is established, they can use it as a surrogate to talk about their own experience. And that makes dialogue easier.” - Karen Li, CHI+MED researcher.


A set of personas and scenarios on infusion pump use
To illustrate the possibilities, we developed a set of scenarios and personas around the use of infusion pumps, based on data from a limited set of UK hospitals. The personas include characters in different roles: a Staff Nurse in Oncology, a Clinical Engineer and Device Trainer, a patient, a Hospital Pharmacist, a Consultant Anaesthetist, and an agency Nurse.

For example:

"Mary, age 42 is a staff nurse in Oncology…
She has been working for the health service for two years. She normally works alongside four nurses and one nurse manager …

When using infusion pumps, Mary aims to quickly and reliably program the pump, whilst making sure that the patient is comfortable. Pumps alarm frequently and she is sometimes distracted when attending to a device. During a given day, Mary will need to program several infusions, sometimes using multiple devices simultaneously."


The scenarios describe situations such as the staff nurse administering treatment, the engineer setting up a pump, the equipment library running out of pumps, and the trauma team needing to rapidly infuse blood. The following is a fragment from the latter scenario:


"An elderly patient has been brought into A&E. A car travelling at about 40mph hit them. …
The nurse, Sam, opens the pump door and then aligns the plastic guides ... There are three of these, the first two go in easily, but the third seems to be stuck. Something is not right and she feels like she is forcing the clip into the pump mechanism. …"


Personas and Scenarios provide powerful ways for designers and procurement staff to see the lives of people who will use technology and so design for their specific needs rather than some idealised situation that rarely occurs in practice. They help make design opportunities visible so they can also lead to innovative design. We have been given positive feedback from manufacturers about them.

Use beyond medical devices
This work has also led to a government laboratory working in a related area that we supported adopting the persona approach:


"We are looking at the use of personas to help manufacturers understand the different ways different people are using their equipment, so [CHI+MED] has helped me a lot with understanding what a persona is and how it relates to user profiles, and [CHI+MED] has helped me put together interview questions on how the military use the equipment. ... with so much of the groundwork done, we can just draw on and reference the medical work." - government laboratory stakeholder.

A training game
The CHI+MED developed a role-playing game based on scenarios and personas around a fictionalized version of a real incident. It was originally intended as an activity for science festivals, but was picked up by Paul Lee, one of the project's advisory team who is responsible for training in South Wales. He adapted the game and used it as part of his education and training programme for nurses in Wales. It proved a powerful way to raise issues around a blame culture and how design can be the cause of incidents that the nurses had not previously thought about. It has proved to be a very good way to encourage reflection in professionals about these and related issues. It is now used regularly as part of the training programme.