It was a neat idea: giving Australian consumers up-to-date information about their medicines as a highly usable printout at the point of sale, when they picked up their prescriptions. The decision to do so was the result of one of those rare historical moments when industry and consumers stood shoulder to shoulder in agreement on the best course of action. But it hasn’t worked. Despite much effort, pharmacists, according to the most recent research, still continue after 15 years to deny consumers their rights to information about the medicines they are taking.

In a recent review and case history we at CRI went over this sad record (see CMI and the Pharmacists, and Shorter CMIs: The sad failure of a design project. At a recent conference, where I presented the results of this review and case history, I suggested that pack inserts were the best alternative practical option for both industry and consumers. Some delegates were alarmed; so let me elaborate.

In 1994 we wrote the first edition of Writing about Medicines for People. It is now in its third edition and remains a useful guide to anyone concerned with writing and testing CMI. The layout and typography in the design was predicated on the assumption that CMI would be printed at pharmacies using the then crude pharmacy software, and delivered by pharmacists at the point of dispensing. This meant that, while the CMI were usable, they failed to meet any of the other criteria for good document design. As a consequence, many CMI, even if available to consumers, were unlikely to be read. Nonetheless, we believed that the software for producing CMI would quickly improve and make them more acceptable to consumers. In anticipation of this, we built the design in such a way as to make the transition to more flexible technologies, such as pdf and xml, straightforward. But it was not to be, and the same crude printing used in 1994 is still being used on the few occasions when pharmacists deign to grant consumers their rights to the information.

At every step, pharmacists—through the Pharmacy Guild—have blocked attempts to improve the quality of CMI for consumers. Despite the fact that pharmacists are actually paid out of taxpayer funds for delivering CMI as part of their counselling, have been given taxpayer funds to buy duplex laser printers for printing CMI because they complained about the number of pages in a CMI, and have been repeatedly exhorted to give consumers CMI by their professional bodies, CMI are not available to consumers as a matter of routine. Moreover, I have yet to see evidence that the money was actually used to buy the dedicated duplex CMI printers pharmacists asked for, rather than double hopper laser printers—a cheaper alternative that can be used for multiple purposes, not just printing CMI. There are, in my view, sufficient grounds for an investigation into the potential misuse of taxpayer funds.

Meanwhile the road to quality information for consumers at the point of dispensing remains blocked. And recent research commissioned by the Pharmacy Guild to develop ‘effective CMI’ does not inspire confidence, though it would be nice to be wrong about this.

As a consequence of all these events, I have come to the view that there is little point in pursuing the goal of providing CMI at the point of dispensing. The pharmacists have had their chance to be relevant in consumer counselling, and blown it. Government should seriously consider withdrawing its funding for counselling and CMI delivery, and industry should consider going back to pack inserts as the preferred way of delivering CMI. Our private research and design for a number of pharmaceutical companies strongly suggests that pack insert CMI can be delivered to a much higher standard than the pharmacy-produced CMI, and much more specifically suited to consumer needs for information about specific medicines and to the branding opportunities for industry (as long as they avoid the EU template). The only drawback, apart from the cost to industry of new designs, would be the lack of timeliness in updates. But there is not much point in having timely information that is unavailable, and the branding opportunities should easily offset the additional costs to industry.

I know that I have till now been a champion of pharmacy-delivered CMI. But after 15 years of disappointing progress, and nothing better in sight, I have changed my mind. I still think it’s the best option in the long term, but in the short term the joint goals of industry and consumers can be best met by well designed pack inserts.

At long last we publish the ‘headline’ results for this study. I want to use this blog to thank, once again, our volunteer investigators who conducted the study.

• Alexander Tyers, Australia
• Carola Zurob, Chile
• Claudine Jaenichen, USA
• Consuelo Amenabar, Chile
• Frances Gordon, South Africa
• Judith Moldenhauer, USA
• Karel van derWaarde, Belgium
• Martin Gallo, Argentina
• Sandra Fisher-Martins, Portugal
• Thomas Bohm, UK
• Veronika Egger, Austria

The success of this project is due to their collective efforts.

Read the results here

click here

We are preparing to release some of the data for our international study of credit card statements. I was asked by Libby Fordham, our publicist, what were the main consequences of our findings for consumers. I Thought you might find my reply interesting.

The consequences for consumers are frightening. It means that when you buy your plasma screen, with the intention of paying it off over time, it’s going to be hard for you to find how much to pay, when you have to pay by each month, how long it’s going to take you to pay it off, how much extra it’s going to cost you in interest payments, and what happens if you miss a payment.

These were the tasks we set people to perform in the study. Using many of the statements, these tasks are either difficult or impossible to perform.

We are in the middle of conducting an international study of credit card statement usability as part of our Communication Benchmarks program.

The preliminary data, from places as far away as South America, India, Europe and Australia is very challenging and will be of interest to banks, consumers, and regulators everywhere.

I will be giving a paper about our findings at the forthcoming OECD/IIID conference in Paris on June 18 to 20 2009

If you would like to keep in touch with the results from this study, and others we are conducting, become a subscriber to our web site.

Last year we undertook a major research and development project for one of Australia’s leading investment product providers. There were many objectives for this project, but a central objective was to create a design for an investment report that would make it possible for every consumer and investment advisor in our testing to find over 90% of what they were looking for, and effectively use over 90% of the information they found. These are fairly common usability performance targets that we set in many projects.

Bear in mind that this work was taking place against a background of demanding disclosure regulations, difficult business requirements, limited technology, and a collapsing value in almost all investments.

While we cannot disclose the details of this specific project, we can share with you our major findings.

1. It is possible for any literate consumer, regardless of background and ‘financial literacy’, to find, correctly interpret, and act on information that they seek in an investment report, providing it is designed using professional information design methods.

2. While the current regulations in Australia do not necessarily encourage good design of financial statements, they do not make it impossible. This would not be true of many jurisdictions, particularly in the USA.

3. Even with major business constraints and limited production technology, investment statements that satisfy business and consumer needs are possible.

The salient conclusion from this is that there is no excuse for the financial industry to produce investment statements that are difficult for consumers to use.

The last word should go to one of the company’s customers who emailed the company as follows:

Hi, I just received my quarterly investment report from ***** and wanted to congratulate you on the new set out – for one of the first times I actually bothered to look at an investment report as it was so clearly set out and written in language that is understandable to the average dork like me. Thanks!

I’m escaping the Melbourne winter and will be working in Europe from the 17th of June to 17th of August.

If you would like me to do any work for you or give a lecture/presentation, please get in touch with Libby Fordham our Institute’s publicist.

The current banking debacle would be funny if it wasn’t hurting so many people. There is something slightly whacky about putting compulsive and highly competitive gamblers in charge of the money. Not surprisingly, the money has gone.

It’s tempting to demonise particular individuals or institutions, but that misses the point, the systemic reasons why we are all in the current mess. After all, you can’t blame the scum for rising to the top of the liquid.

Now, I used to think of banks as institutions that looked after my money, as a matter of sacred trust. How old fashioned! Modern banks, with the blessing of government, use my money as an ante into a global poker game. But the writing has been on the wall, quite literally, for some time ⎯banks’ logos on their walls look like logos for casinos. Dropping all pretence at prudential probity, one of our Australian banks recently changed its name and logo to nab (see this blog). We live in absurd times.

In the midst of all of this craziness, our regulators are scrambling to control these gambling houses, making them accountable for their actions, getting the gamblers to start looking after our money wisely and prudently, getting the gamblers to lend our money only to people who can afford to pay it back, and stopping the gamblers from putting our money into the global one-arm bandits.

Needless to say, the gamblers have no interest in complying with the regulators, and will only do so because they might otherwise end up in prison. Even that will not deter the inveterate and incorrigable gamblers amongst them. The only thing that would bring about real change would be to change the liquid, as it were, so that the scum becomes sludge, sinks to the bottom where it can be pumped out.

If banks were forced to become institutions that looked after money instead of gambling with it, and rewarded those who were the best custodians, then we would not need strong regulation. But in the absence of such radical systemic change, strong regulation is the only thing that will protect us.

Which brings me, in a roundabout way, to talk about regulating financial information for bank customers. Just as the gamblers have no interest in changing their behaviour to meet government requests unless they are forced to do so through prudential regulation, they have even less interest in providing customers, their mug punters, with information. When forced, they will only do so to the extent that it is in their interest, and to avoid penalties that will close down their casinos. This means that the regulation of bank customer information has to be particularly strong and effective, and compliance needs to be tested against the most stringent standards.

Regulators have a number of options which fall into two broad types: regulations of content, or regulation of performance.

Regulating content

In this, the most commonly used by regulators, the regulators specify the exact content that consumer documents should contain. In some cases, regulators go as far as specifying the layout and typography of such information.

To those of us with a background in document design, such regulations, written as they are by lawyers far removed from banking customers, are embarrassingly inept, even illiterate. They do not result in documents that are accessible or usable by customers.

This, ironically, serves the gamblers’ interests. They can produce documents that fully comply with the regulations, knowing full well that their customers cannot understand them, let alone query them. It also serves the interests of lazy regulators who can give these compliant documents a tick of approval, claiming that by doing so they have discharged their public duty. A complicity of silence protects the gamblers and their lazy regulators from further public scrutiny, leaving the customers to muddle through as best they can.

To be fair, some regulators are conscious of this inadequacy and try to encourage the recalcitrant gamblers by requiring that documents should be ‘clear concise and effective’ (see this blog) or that they should be written in plain English. This, too, encourages a tokenistic form of compliance that can be even more misleading to customers.

Faced with a document written in a plain English style—active constructions, using ‘you’ and ‘we’, short words and sentences, etc—customers, as the research shows,(see this review) are lulled into a false sense of security, believing that the documents are easily usable because of these surface stylistic features. Which one of us would be brave enough to say we cannot understand a document written in plain English? This emasculation and disempowering of the reader can achieve even greater effectiveness when such documents receive the imprimature of organisations like the Plain English Campaign and are awarded a Crystal Mark. Below, is an example of the genre from a UK bank. Who would dare complain now without feeling incredibly stupid?

The fact that the content is almost illegible at its normal size and colour, with only the Crystal Mark being legible, is a masterstroke of black irony.

Regulators need to guard against such tokenism.

Regulating performance

In contrast to the above is the more effective regulation of performance. This is in many ways an extension of the kind of regulations and standards setting used in technical areas where the performance of materials, chemicals or machines is specified, but the design and exact form is left to the manufacturer or designer.

In this type of regulation, the regulator specifies the tasks that customers should be able to perform with the documents and the level at which they should be performed, and leave the manufacturer to demonstrate by tests and data that the document complies, in that consumers can indeed use the documents appropriately in their own interest.

This has been highly successful in the regulation of medicine information in Australia (see this case history), and has been widely (though less successfully because inadequately conceived) applied overseas.

Of course, like any form of regulation it is open to abuse. The gamblers could lie about their tests and data, But hey! these are the guys who lie about their balance sheets. Flouting consumer regulations is, in their world, a minor risk. It seems that, after all, we do need to change the liquid in the bottle in which they float, so that the cream rather than the scum can rise to the top.

A DESIGN-LED BUBBLE

Before about 1912, you were more likely to die than get better if you went to see a doctor. Around that time doctors started routinely washing their hands between patients, and the odds changed. Accumulated evidence had gradually led to the general acceptance of germ theory over miasma theory as the cause of infection: miasma doesn’t stick to the hands, but germs do.

The accumulated know-how of the medical craft has led to other innovations in the last 100 years, demonstrating clearly the advantages of a cumulative tradition based on craft wisdom, research, and evidence of successful and unsuccessful practice. All three elements are essential.

Around the same time as doctors started washing their hands, some designers decided to throw out the water, the baby, and the sink as well. Getting your hands dirty was in.  The old crafts were discarded in the call for radical transformation radically transforming the lives of ordinary people using everyday objects. The result? High rise slums, mass-produced death. And some beautiful but unusable chairs.

I’m not suggesting a return to some mythical good-old-days, but suggesting that there is benefit to a practice that values its accumulated know-how secured by the three elements above. This valuing of accumulated know-how seems to me to be absent in contemporary discussion about innovation and transformation.

As a researcher, I have a habit: whenever I want to explore a new area, I review the research and practice that preceded me. I then use that review to consider whether it’s all been done before, whether it can be built on, or whether it’s time to rethink and start anew. All pretty ordinary stuff.

When I started working in design and design education, I noticed an emphasis on making, getting one’s hands dirty with innovation and creativity, often to the exclusion of any but the most superficial review of what had been done before. This emphasis is a strength of the design education and practice tradition. But it is also the weakness.

It doesn’t really matter when design is primarily concerned with styling, fashion, and the ephemera of life. But when design takes an interest in designing for people, our experiences, and the social, environmental and biological structures we create, then it does matter. Dirty hands can lead to death, or even extinction.

I’m appalled by the various design gurus, academics and journalists who go on about design, innovation, and transformation; who talk endlessly about the value of design yet offer not a shred of evidence in support of their claims. They speak like investment bankers in a boom market.

When you scratch below the surface, they are in the main talking to one audience only: desperate business. Innovation, they say, is all about making more money, more profits, competitive advantage. What an extraordinary narrow and boring view of innovation! A banker’s view.

But my concern runs deeper. In the Obama age, designers are sticking their hands up saying “Yes we can!” What hubris. With many websites created by professional designers being partly or wholly unusable, many designed objects contributing to the death of the planet, and many attempts at social design resulting in an accumulation of human misery, what could such help mean? In most areas of design, accumulated craft know-how, research and evidence are absent. Case histories are few, and those that are published generally lack any convincing before or after evidence. And we believe we can help? Designers are irresponsible to make such claims.

One might think of this in a way not dissimilar to the marketplace. In the marketplace of ideas, we are experiencing a DESIGN-LED BUBBLE. I suspect this bubble is about to burst and with it will go the grand vision of design being able to help solve the world’s problems. The bubble began when business discovered that people (ordinary shoppers and consumers) had money in their wallets and that being nice to people was one very successful way of getting the money out of their wallets and into the pockets of business. All went along swimmingly, and an industry of ‘user centred’ designers emerged to help business extract money from wallets. But here we are suddenly in an era when ordinary people either have no money in their wallets or don’t want to spend it. No amount of user-friendly design will squeeze more out of wallets. Business will stop pretending that customers are their friends.

All this is sad, if you believe in progress and things getting better. But if you really believe in design as a practice that can help in a small way to lessen the odds of death and misery, like doctors washing their hands, then it’s time to look very carefully at what works and what doesn’t and build on that practice.

I wash my hands of any design practice that is not evidence-based.

In some societies, if you want to make something difficult happen, a witchdoctor performs a ceremony. Take rainmaking. The rainmaker makes complicated preparations, chants special words and performs a special dance, and generally puts on a good show. And sometimes, it rains.

The latest round of government advertising on climate change is little more than a modern-day rainmaking ceremony: it consumes lots of resources, puts on a good show with mumbo jumbo, and shows that someone cares—so that they can claim that at least they tried and did their best—but like so many rainmaking ceremonies, it won’t have the desired result⎯in this case, to make people change their behaviour (and to bring on the rain, of course!).

Today we generally understand enough about science to know that such ceremonies are just symbolic rituals. But we may not be aware that the scientific evidence on the effectiveness of government information campaigns repeatedly shows that they are about as effective in bringing about desired social change as rainmaking ceremonies are in bringing on the rain.
Of course, every now and then it will rain immediately after a ceremony. Every once in a while, desired change happens immediately following a campaign. And that single event vindicates all past ceremonies. The rites continue, millions of dollars are wasted, and another opportunity to do something useful goes by.

It need not be so. Research clearly shows that communication between organisations and the public can work effectively to a high standards by applying know-how involving strict methods, appropriate skills and evidence.

The problem is that the know-how is not present in most organisations, and especially not in government. As in many fields, there is a long lag between what has been discovered through research and what is available as standard practice within organisations. It takes up to 30 years for researchers to make useful discoveries, articulate the findings, publish the results, write the textbooks, teach the next generation of practitioners, and get the next generations into positions of power where they can implement what they have learnt. But we don’t have 30 years in which to learn how to communicate effectively about climate change. We need to do it now.

Government needs to forget about the rituals; time enough for rituals once the temperature drops and the rains return (if they ever do).

In the meantime there are practical things that government can do using evidence-based approaches to designing information for the public to use. It sounds obvious to suggest that information should be designed using evidence, but this is simply not done. If you doubt this, visit almost any government web site and you will get lost, confused, and most importantly, not find what you are looking for.

As an example, I visited the government’s climate change website, as the advertising told me to. It was not entirely clear to me what to do next, but I noticed an instruction which said ‘Select a topic’. I selected the first topic on the list ‘Carbon Pollution Reduction Scheme’ because it made no sense to me and read:

The Australian Government is establishing a Carbon Pollution Reduction Scheme as part of an effective framework for meeting the climate change challenge.

After which I still don’t know what a CPRS is and I’m even less sure what an ‘effective framework’ is, though I suspect I wouldn’t like to bump into one on a dark night. As for ‘meeting the climate change challenge’, I love the alliteration but it sounds more like a golf tournament than anything that I can make sense of. The evidence shows that most people would give up at this point and look no further. That is the intelligent thing to do. After two unrewarding experiences, first on the home page, and then on the CPRS page (plus a history of similar experiences on other web sites), why would you look further? Life is short. Just to be diligent, I went down to the next level and was greeted with more abstractions. Life got shorter.

Sadly, this is the norm, the public experience of government communication. Sadly, this is not a symptom of individual failure, nor is it simply an example of bad writing. The problem is systemic and derives from outmoded standard practices for generating information.

With a modicum of training and support it would be possible for much of the communication by large organizations to the public to be made easily accessible and usable by the public to whom it is directed. There is good evidence to support this claim and practical experience in regulation and practice demonstrating this.

It is perhaps ironic that there is government regulation requiring some businesses to apply these standards. It’s a pity that governments fail to apply such regulation to their own activity.

But as the government advertising suggests, change is difficult. And as in previous times, it’s much easier to perform a rain making dance than it is to make it rain.

keep looking »

© CRI 2008 David Sless’s soap box