Integrating human factors into health design
Submitting InstitutionCoventry University
Unit of AssessmentArt and Design: History, Practice and Theory
Summary Impact TypeSocietal
Research Subject Area(s)
Medical and Health Sciences: Public Health and Health Services
Education: Specialist Studies In Education
Summary of the impact
This case study highlights research excellence in health design by a
Group of four multi-disciplinary researchers. Collectively the Group of
researchers apply user-centred approaches to design and evaluation of
products and services which improve health and wellbeing. The Group
employs user-engagement throughout the design lifecycle to achieve
societal benefits through improved products, information, services, and
systems. The research has delivered:
Economic Impact: by working with companies and organisations to
deliver new products for the growing market in assistive technologies
and services which support health and lifestyle improvements
Health Impacts: by improving health and quality of life for
those with specific conditions and disabilities. This includes working
with medical practitioners to translate ideas into products.
Impact on User Engagement in Policy Making: by addressing the
challenges of collecting the needs and views of hard-to-reach groups and
by using their techniques to develop Europe-wide guidelines for
telehealth care services.
Beneficiaries include end-users of assistive technology, patients
with long-term conditions and their carers, medical practitioners, policy
makers and commercial organisations.
The Health Design Technology Institute (HDTI) [A] hosts both commercial
and academic research in health design with a particular, but not
exclusive, focus on assistive technologies. The HDTI provides testing and
prototyping facilities. This focus on health design has brought together
an interdisciplinary group consisting of Shippen (Biomechanics of
Human Movement), Woodcock (Educational Ergonomics and Design), Moody
(User-Centred Health Design) and Ward (Assistive Technology).
Shippen joined Coventry University in 2006, Woodcock in 1999, Moody in
2006 and Ward in 1999 and all remain in post.
The research integrates understanding of the physiology, biomechanics and
psychology of humans and the implications for the application of
technology. The Human Factors focus has developed from Shippen's research
on human physiology , [F]. He has applied this to calculate muscle
loadings determined by certain movements and product interactions e.g.
opening a car door. This biomechanical analysis and anatomy expertise was
brought together in the development of new human modelling software, which
has since been applied to design and performance improvements in areas as
diverse as dance, sport and vehicle design. Woodcock's, Moody's and Ward's
research has led to a richer understanding of the Human Factors of
specific groups, such as those with specific disabilities e.g.  or
conditions associated with old age [C], [F].
The advantages of undertaking a User-Centred Design approach to product
and system development has been well articulated by ergonomists over many
years. However, the Group's research with Small to Medium-sized
Enterprises (SMEs) has shown that, although the need is understood, the
practice of User-Centred Design may not be followed as thoroughly as
articulated in ISO 13407. The reasons for this are varied but are mainly
due to lack of knowledge, limited choice of methods and inappropriate
tools. To ensure the user is central to the design process, the Group has
applied its members' research knowledge and expertise in ergonomics and
design directly to industry, through research and consultancy supported by
The Group has developed new models and methods of working such as the
Hexagon-Spindle model . In addition, the Group has undertaken
interdisciplinary research with engineers, clinicians and human
geographers to support projects with large organisations, SMEs and others
to engage meaningfully with wider and previously excluded groups e.g.
children, older people and those with disabilities , [D].
The practical application of the new research models developed by the
Group has focused on the design of products and services for new markets.
The Group developed expertise in delivering health and lifestyle
improvements especially to under-represented or hard to reach communities.
This research has been supported by funding from TSB in particular [C].
Such projects have involved the Group and companies working together to
determine the needs of new markets, and developing products to meet the
functional and emotional needs of the user Group. The Group research has
been recognised by other companies and organisations which have engaged
Group members to tackle work in related areas , [B].
References to the research
1) Ward, G., Holliday, N., Fielden, S and Williams, S. (2012) "Fall
detectors: a review of the literature", Journal of Assistive Technologies,
Vol. 6 (3) pp. 202 - 215. ISSN: 1754-9450. DOI: http://dx.doi.org/10.1108/17549451211261326.
IF = 0.273 (SJR) IF = 0.466 (SNIP).
3) Shippen, J., and May, B. (2010) Calculation of muscle loading and
joint contact forces during the rock step in Irish dance. Journal of Dance
Medicine and Science. Vol. 14 (1) pp 11-18. ISSN 1089-313x. IF = 0.164
(SJR). Citations = 3
4) Moody, L. (2010) Development of a Crisis Competency Profile and
Evaluation of Crisis Workshops. Confidential Report for Unilever
5) Woodcock, A., Woolner, A. and Benedyk, R. (2009) Applying the
Hexagon-Spindle Model to the design of school environments for children
with Autistic spectrum disorders. Work: A Journal of Prevention,
Assessment and Rehabilitation 32 (3) pp 249-59. ISSN 1051-9815. DOI: http://dx.doi.org/10.3233/WOR-2009-0823
IF = 0.271 (SJR) IF = 0.949 (SNIP) IF = 0.513
Key Research grants
A. PI: A. Woodcock, Title: Health Design Technology Institute (HDTI)
Sponsor: HEFCE and Advantage West Midlands (AWM), Period: 2006 Funding:
£19.5m (HEFCE £15m, AWM £4.5m)
B. PI: L Moody Title: Identification Of Global Crisis Training Providers
& Development of Crisis Training Materials & Scenario Bank.
Sponsor: Unilever, Period: 01/11/2008 - 30/11/2009 Funding: £35,943
(original plus follow on)
C. PI: Gillian Ward Title: i-Focus Warm Neighbourhoods Service Design,
Sponsor: The Advanced Digital Institute (ADI) through the TSB, Period:
1/6/12 - 31/1/13, Funding: £65,000
D. PI: L. Moody, Title: Exploring Parental Experiences Of Receiving False
Positive Screening Results, Sponsor: Sheffield Hospitals Charity Period:
2012-2014, Funding: £23,744.00
E. PI: A. Woodcock Title: The use of digital technologies by connected
communities, Sponsor: AHRC, Period: 2010, Funding: £32,000 to Coventry
F. PI: J. Shippen, Title: Biomechanical analysis of dancers to reduce
injuries Sponsor: Leverhulme Trust, Period: 30/9/07 - 31/8/10 Funding:
Details of the impact
The group's research has made tangible improvements in wellbeing, health
and quality of life, by progressing the design, development and
implementation of products, services and policy guidelines. The research
has also supported companies and organisations to unlock new markets and
strengthen the quality of products and services in the assisted living
sector which worldwide has over 1.5 billion consumers. Examples of the
main categories of impact are described below.
Economic Impact: Since 2007 the group's research expertise has
supported over 197 companies and organisations to deliver 141 products and
9 services [A]. These companies have been assisted in expanding into new
markets and successfully launching products, and have thereby also
increased employment. While the research has focussed on health and
assistive living products and services, the Group's expertise in obtaining
hard to collect information has been recognised more widely. For example,
the Group provided Human Factors consultancy to Unilever , [a], one of
the world's largest consumer goods companies. The research contributed to
the design of a global strategy for crisis prevention and response to
ensure the health and wellbeing of the Unilever business, customers and
employees. The `crisis toolkit' has been used internationally to guide
teams in situations as diverse as disaster recovery (e.g. the recent
flooding in Thailand) and in crisis management that could damage
Unilever's global reputation. Unilever has provided follow-on funding for
further research and consultancy.
The Group and staff at the HDTI have worked with entrepreneur Ian Jones
to develop a series of innovative walking aids and accessories. New
materials and manufacturing processes were used to create a comfortable
and stylish walking stick handle, crutch handle and a flexible ferrule.
The innovative walking aid, developed for Abianco Holdings Ltd has since
sold 1,000 units to the US and Germany. Abianco Holdings Ltd is now
planning production of 100,000 units which will deliver further economic
impact as a result of the job creation in the companies employed during
the prototype manufacturing phase [c].
Similarly the Group used its research techniques and models  to
user-test a new adaptable underwear range for Adaptawear. Feedback from
the usability trial found that the product gave the wearer a greater sense
of independence which had significant impact on the health and well-being
of arthritis sufferers and their carers. By July 2013 Adaptawear had sold
1,000 of its unique and adaptable brassieres in to this specialist market.
The success of this product contributed in turn to the trade sale of
Adaptawear to the Senior Clothing Company Ltd.
While most of the Group's work has resulted in the design, testing and
launch of products, the group has also achieved an economic impact by
providing evidence that a proposed concept will not work with the
intended user group. Nick Keight of TC Keight stated "they had used the
group to test a concept which did not work as expected [...] the company
saved £50,000 in manufacturing costs by stopping the intended production
of the product" [d].
Biomechanical ergonomics research has supported companies to evidence
their products' contributions to health and wellbeing [e]. The Group's
research is referenced in Vauxhall's international marketing campaign as
evidence of the advantages of the company's technology over standard car
doors: this is indicative of commercial impact. For example, Shippen
conducted testing on the FlexDoors, which looked at the effects of lifting
an object in and out of the rear seats. He found that, compared with
previous models, the FlexDoors reduced back muscle load by up to 58% and
leaning and twisting angles by up to 48%. Vauxhall has used this evidence
in its international marketing campaign.
The Meriva brochure (2013 Models Edition 2) states that one of the
benefits of the FlexDoors is that they are `easier on the back'
and `far kinder on your back' and cites the research done in the
Department of Industrial Design at Coventry to support these statements.
In addition, Vauxhall released a press release in 2010 about the
advantages of the FlexDoors based on Shippen's research. The car
is marketed on its appeal to families and the older generation. Martin
Lays, Head of Brands at Vauxhall, stated "... that more grandparents
rather than parents are buying this car, which ... could be a reflection
of the number of grandparents who are childminders" [e].
Health impacts: The Group's research was the first to explore
parental views on consent practices with respect to the expanded newborn
screening programme in the UK. The exploration of parental needs and
resulting re-design of health information contributed to a national pilot
expansion of service delivery in relation to newborn screening. The
guidelines produced were adopted by the national newborn screening service
[D], . There has been a higher than 99% uptake of the screening tests
at the six initial centres (Great Ormond Street Hospital, Guy's St
Thomas's, Birmingham Children's Hospital, Central Manchester Foundation
Trust, Sheffield Hospital and Leeds Hospital). This indicates that the
redesigned information for parents is effective and appropriate. Professor
Bonham, Clinical Director of Diagnostics, Pharmacy & Genetics, Newborn
Screening Project estimates that, by the end of the project, 750,000
new-born babies will have been screened [b]. Eight true positive results
for screened conditions have been detected so far during the roll-out.
This early detection of a condition has enabled treatment to be started on
the child immediately. The Group was subsequently contracted to explore
the impact of screening results on parents; follow-on funding of £250,000
has been secured from the National Screening Committee to continue the
project until March 2014.
The Group' s health design research supports over 15 NHS Trusts,
including Sheffield Teaching Hospitals NHS Foundation Trust, Heartlands
and University Hospitals Coventry and Warwickshire NHS, to research and
develop user-centred products, services and guidelines [A]. In 2008, the
University signed a collaboration agreement with NHS Innovations South
West to facilitate research transfer between the institutions these too.
The Group is a partner in the Department of Health-funded Devices for
Dignity Healthcare Technology Co-operative, focusing on the design,
development and evaluation of devices to address unmet clinical needs.
is a national resource capable of getting new technologies into practice
more quickly, thus improving healthcare quality and well-being for
patients. The project supports five core NHS Trusts. Since its inception
in 2008 the Group has been an academic partner (alongside the University
of Cambridge and the University
of Sheffield) offering user-centred design expertise. A further four
years' funding was awarded in 2013. The relationship has led to the awards
of two joint grants for multi-disciplinary design teams to develop
products for urinary incontinence. This work has since been taken up by a
leading manufacturer of continence products to support the Urology
industry and facilitate advising NHS Trusts about patient choice.
The Group also work on the "Warm Neighbourhood" programme which has
resulted in the "Warm Neighbourhoods®" (http://ifocus-dallas.com/pub/),
"AroundMe™" service and devices developed with the Advanced
Digital Institute. This has recently been adopted by a "national channel
partner" for distribution to 10,000 homes in the UK to remotely monitor
elderly residents in their home.
Impact on User Engagement in Policy Making: The Group's research
has addressed the Government's requirement for more user-engagement in
policy making by developing VoiceYourView and MyCare applications.
developed technology which allows people to express their perceptions of
safety in public spaces by capturing spontaneous comments from members of
the public. These comments can be used to improve the safety of public
space designs. VoiceYourView was mentioned in Parliament in the context of
discussing software and the digital economy. MyCare (http://tinyurl.com/nosvxrv)
is an innovative, usable and reliable patient record system which can be
used in both day to day medical consultations but also in emergency
situations. MyCare was cited in Parliament as an example of an approach
similar to the NHS Spine Service but which could be implemented with less
financial investment. (http://systems.hscic.gov.uk/spine).
The Group's unique research expertise has also been recognised by the
European Commission, DG SANCO who contracted the team to develop a
European Code of Practice for Telehealth Care. The draft Code has been
tested in six EU countries (Belgium, Bulgaria, Hungary, Italy, Slovenia
and the United Kingdom). The European Commission confirmed that the code
the Group developed will provide the framework to guide telehealth service
providers in all 27 member states of the European Union. The code can be
found at http://www.epractice.eu/en/library/5364841
Conclusion: The Group brings together interdisciplinary research
expertise, in combination with the specialist staff and facilities of the
HDTI, to tackle health design issues from a user-centred design
perspective. This has enabled companies to develop new products and
services which improve the health and wellbeing of the population with
long-term health conditions, which is growing in numbers. In addition, the
Group's research has delivered economic impact to companies and health
organisation by designing, creating and testing new products and services
which address this growing market. The Group's research expertise has
developed EU-wide guidelines which have a policy dimension.
Sources to corroborate the impact
a. Dr Jon Arthur, Group Resilience Director, Unilever, UK (information
collected by RAND Europe in an interview, see report PR-523-CU).
b. Professor J R Bonham, Clinical Director of Diagnostics, Pharmacy &
Genetics, Newborn screening project (information collected by RAND Europe
in interview, see report PR-523-CU).
c. Ian Jones, Director of Abianco, UK (information collected by RAND
Europe in an interview, see report PR-523-CU).
d. Nick Keight, Director of TC Keight, UK (information collected by RAND
Europe in an interview, see report PR-523-CU).
e. Martin Lays, Head of Brands, Vauxhall, UK (information collected by
RAND Europe in an interview, see report PR-523-CU.