Where are the desire paths in healthcare?

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We have all seen them. Unofficial paths, and grassless trails cutting across almost every park or urban green space, marking the routes that people wanted to go but which planners had not anticipated. They go by the rather delightful name “desire paths” and they tell us something important about how the world around us is designed.

Flickr: Daniel Neville[/]

Desire paths are a very physical example of the gap between how people actually use things and what designers intended people to do. As such they are often used as an illustration of why user centred design approaches can help design places that work better for users: laying the tarmac where people actually want to walk, not where we think they do (or should).

What do muddy tracks in the park have to do with healthcare? Well, desire lines don’t only exist in physical spaces, but also in every service and product. Users find ways of working around, adapting, hacking and remaking things in ways in which the designer never intended. Finding these through observation, and learning how people use things in the real world can help us design and plan better services.

Where then are the desire lines in healthcare? Some might be obvious – glaring examples where people or patients are breaking the rules of the system en masse. How people access urgent and emergency care in preference to waiting for less convenient appointments might be one example. More subtle desire lines might be found by :

– using quantitative data to describe how, and why, patients access particular healthcare services

– using qualitative methods (interviews, focus groups) to explore people’s beliefs and preferences about healthcare services

– observing how people manage their own health

Finding desire lines (and, in a virtual sense, laying formal pathways over them) could help us design healthcare services that are more responsive , efficient and provide the things that patients actually want. More radically, we could design services that deliberately encourage people to reshape them through their choices and actions. Citizen hackers, patient pathfinders: healthcare needs you to show the experts the way.

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