The 2am Test: Is Your Clinical Product Designed for Real Life?
What tired staff, a deteriorating patient and a slow computer can teach you about product design.
This is Clinical Product Thinking 🧠, a weekly newsletter featuring practical tips, frameworks and strategies from the frontlines of clinical product.
Welcome, friends, this is issue No. 044 of Clinical Product Thinking. This week, we’re talking about the workflow we think we're designing for and the work that clinicians actually do.
Many clinical products are designed around the happy path: the patient follows the expected journey, the clinician has the information they need, the technology behaves as intended, and each step leads nicely to the next. It all looks perfectly represented on your Miro process map.
This is because most product discovery starts in the same way. We interview users, run workshops, map workflows and document requirements. These activities are useful and necessary. They help us understand how a service is supposed to operate.
The difficulty is that healthcare rarely behaves exactly as it is described.
Patients do not always follow the expected journey. Clinicians are interrupted, multi-tasking, overworked or all three. Information is missing. The computer is too slow to load.
By the time a workflow reaches a whiteboard, many of those details have disappeared.
Healthcare products are often designed around the happy path because the happy path is easier to see. It is neat, predictable and easy to describe.
Clinical work rarely is.
Work as imagined vs work as done
One of the most useful concepts from safety science is the distinction between work as imagined and work as done.
Work as imagined is how we think a process happens.
Work as done is what people actually do in order to get the job done.
The difference between those two things is often where the most valuable product insights are hiding.
A workflow diagram might show a clinician reviewing information in a single system before making a decision. In practice, they may be checking multiple systems, referring to notes written earlier in the day, asking a colleague for context and mentally prioritising several competing tasks at the same time.
The process on paper is not necessarily wrong. It is simply an incomplete picture.
The 2am test
During a recent panel discussion, Benedikt von Thüngen, CEO of Sanome, spoke about the importance of getting all of his staff to shadow clinicians on a night shift. Not just product managers, engineers as well.
Some parts of clinical work can only be understood by seeing them first-hand.
That image stayed with me because it provides a useful test for any clinical product.
How would this work at 2am?
How would it work when the clinician is tired, the computer is slow, the patient is deteriorating, and the next safe action still needs to be clear?
Pay attention to adaptations
Product teams sometimes describe these behaviours as workarounds, but I think it is more useful to think of them as adaptations.
Healthcare workers adapt systems constantly. They create routines, shortcuts and informal processes that allow them to continue delivering care in environments that are often busy and unpredictable.
The adaptation itself is not usually the interesting part. The reason it emerged is.
If somebody leaves the product to find information elsewhere, that tells you something about the product. If staff maintain a spreadsheet alongside the official system, that tells you something about the workflow. If people repeatedly ask colleagues for information that should be easy to access, that tells you something about how knowledge is organised.
The goal is not to eliminate every adaptation. Many exist for good reasons.
The goal is to understand what those adaptations are trying to achieve.
Closing thought
Clinical products are often evaluated against the happy path. Clinical work is delivered in the real world.
The gap between those two things is where many usability issues, workflow problems and safety risks emerge.
Understanding that gap is one of the core responsibilities of clinical product teams because products that fit naturally into real clinical work are far more likely to be adopted, trusted and used safely.
Hiring spotlight 🚀
🇬🇧 Manual are hiring a Medical Director. I caught up with Earim, CMO, on the role and this an incredible opportunity for a visionary clinician. 👉 Apply here.
🇬🇧 Alertive are hiring a Clinical Product Director. I chatted with Kevin about this position and they are looking for a product leader to help turn its hospital communications and alerting infrastructure into safe, specialist clinical workflows as customer demand grows. 👉 Apply here.
🇺🇸 Hinge Health are hiring a Clinical Product Consultant to help them transform MSK care. 👉 Apply here.
Join the next clinical product panel 🎤
📆 14th July, 7pm, online
The next clinical product panel is on 14th July and we’ll be covering the “clinical product gap” or why healthtech needs a new kind of product leader. 👉 Sign up here.
That’s all for this week. See you next time! 👋
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Written by Dr Louise Rix, Head of Clinical Product, doctor and ex-VC. Passionate about all things healthcare, healthtech and clinical product (…obviously). Based in London. You can find me on LinkedIn.
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