THERAPY-Magazin
Sometimes less is more – on the hunt for new features
Discover how user-centred design helps prevent overengineering in therapeutic devices. CTO Otto Höbel explains why intuitive, simple features lead to better outcomes in neurorehabilitation.
Redaktion
THERAPY Magazin
User-centred development of robotic and therapeutic devices for neurorehabilitation requires interdisciplinary cooperation.
The use of robotic and technology-assisted therapies in neurorehabilitation is booming. The development of new therapy equipment must be preceded by a thorough examination of customer needs. In fact, manufacturers are prone to overengineering. They spend a lot of time on development projects and want to make their products as “perfect” as possible. No one knows better than the therapists who work with the equipment in practice what is important, explains Otto Höbel (CTO THERA-Trainer) in an interview. It’s important to interview them in a structured way and to focus on their needs.
Avoiding overengineering and focus on customer benefits
Promoting evidence-based robotic therapies as well as technology-based therapies in neurorehabilitation has triggered a veritable surge of innovation and transformation in recent years. This is an important step forward, because the use of new technologies helps therapists to expand their treatment spectrum and make complex therapies more efficient and safer. However, the spirit of innovation and the search for sophisticated solutions also has a dark side. Manufacturers sometimes forget that the focus should not be on the product, but on the requests and needs of the users. A therapy device that is perfect from the developer’s point of view does not necessarily have to be perfect for everyday use.
The constant search for more, better, trendier is increasingly leading to a phenomenon in medical technology that is referred to in specialist circles as overengineering. A therapy device is equipped with as many features and functions as possible. True to the motto: More is better. “In reality, it’s the second best choice”, says Otto Höbel, Managing Director for Technology and Development at THERA- Trainer.
Promoting evidence-based robotic therapies as well as technology-based therapies in neurorehabilitation has triggered a veritable surge of innovation and transformation in recent years. This is an important step forward, because the use of new technologies helps therapists to expand their treatment spectrum and make complex therapies more efficient and safer. However, the spirit of innovation and the search for sophisticated solutions also has a dark side. Manufacturers sometimes forget that the focus should not be on the product, but on the requests and needs of the users. A therapy device that is perfect from the developer’s point of view does not necessarily have to be perfect for everyday use.
The constant search for more, better, trendier is increasingly leading to a phenomenon in medical technology that is referred to in specialist circles as overengineering. A therapy device is equipped with as many features and functions as possible. True to the motto: More is better. “In reality, it’s the second best choice”, says Otto Höbel, Managing Director for Technology and Development at THERA- Trainer.
“Never fall in love with your product, always fall in love with your customers”
Editorial: Mr. Höbel, with the phenomenon described in mind: As the main person responsible for technology and development at THERA-Trainer, how do you face the problem of overengineering?
Otto Höbel:What I often hear are statements such as: “Our competitor has this or that new feature. We need that too. Only better!” (grins). That makes my ears prick up. On the one hand, of course it’s important to know what the competition is doing. But on the other hand, because in such cases my developers are quickly put to work on a subject that has never been questioned and analysed more closely. So if you ask me where I stand on this, I say: I’m increasingly critical!
Otto Höbel:What I often hear are statements such as: “Our competitor has this or that new feature. We need that too. Only better!” (grins). That makes my ears prick up. On the one hand, of course it’s important to know what the competition is doing. But on the other hand, because in such cases my developers are quickly put to work on a subject that has never been questioned and analysed more closely. So if you ask me where I stand on this, I say: I’m increasingly critical!
Editorial: Isn’t it the job of development to deal with problems around new features and functions?
Otto Höbel:No. What the engineers then end up doing is developing a desired feature on the basis of vague statements and missing specifications. The end of the story is usually a product that may be adorned with good-sounding advertising claims, but has essentially been developed completely past the customer’s needs. The question was missing at the beginning: “What benefit should the feature provide for which customers?” Only then does it make sense for the development team to address it. And then you also find good solutions.
Otto Höbel:No. What the engineers then end up doing is developing a desired feature on the basis of vague statements and missing specifications. The end of the story is usually a product that may be adorned with good-sounding advertising claims, but has essentially been developed completely past the customer’s needs. The question was missing at the beginning: “What benefit should the feature provide for which customers?” Only then does it make sense for the development team to address it. And then you also find good solutions.
Editorial: So would you say that it doesn’t necessarily have to be a lot of features and functions, but most importantly it’s the right ones that should end up in a product?
Otto Höbel: Yes, exactly. For example, if you get into a modern car with full equipment you’ll encounter features and functions that you never need. That only makes it harder to find important functions quickly and operate them intuitively. In therapy, these kinds of “usability issues” are serious. A therapy device intervenes in a sensitive area of application. It must support treatment on humans. The focus must not be on the operation of the device, but 100 percent on the patient. Just as you should always keep your eyes on the road when driving a car and not on any controls in the car.
Otto Höbel: Yes, exactly. For example, if you get into a modern car with full equipment you’ll encounter features and functions that you never need. That only makes it harder to find important functions quickly and operate them intuitively. In therapy, these kinds of “usability issues” are serious. A therapy device intervenes in a sensitive area of application. It must support treatment on humans. The focus must not be on the operation of the device, but 100 percent on the patient. Just as you should always keep your eyes on the road when driving a car and not on any controls in the car.
The use of a therapy device only pays off if it runs as uninterruptedly and error-free as possible in clinical operation and the users are happy to keep on using it.
Editorial: What negative influence does overengineering have on the development process?
Otto Höbel: Overengineering means that products are given properties that were not requested by customers and this means, in a narrower sense, they do not correspond to the company’s goals. So it’s a waste of resources. You have to remember that therapy devices are medical devices that must be developed in a strictly regulated process. That’s a good thing, because it ensures safety in clinical use. A lot of time is lost in planning, designing and testing unnecessary functions and features, which can cause delays in market introduction.
Otto Höbel: Overengineering means that products are given properties that were not requested by customers and this means, in a narrower sense, they do not correspond to the company’s goals. So it’s a waste of resources. You have to remember that therapy devices are medical devices that must be developed in a strictly regulated process. That’s a good thing, because it ensures safety in clinical use. A lot of time is lost in planning, designing and testing unnecessary functions and features, which can cause delays in market introduction.
Editorial: The fully equipped cars you mentioned are also usually quite expensive. To what extent do superfluous functions influence the price development of therapy equipment?
Otto Höbel:Therapy equipment is always expensive. People are often shocked by this, especially users. The high prices result from the quality and safety requirements placed on medical products.
However, in cases of overengineering, the more functions a new product has, the more costly the development, production and assembly becomes. As a result of unnecessarily high product complexity, the profit margin decreases and this naturally drives up the price.
Otto Höbel:Therapy equipment is always expensive. People are often shocked by this, especially users. The high prices result from the quality and safety requirements placed on medical products.
However, in cases of overengineering, the more functions a new product has, the more costly the development, production and assembly becomes. As a result of unnecessarily high product complexity, the profit margin decreases and this naturally drives up the price.
Editorial: Does this mean that an unnecessarily high range of functions is more likely to break the price-performance ratio than to bring demonstrable benefits?
Otto Höbel: Of course, you have to be balanced here. Not every new feature is bad per se. Quite the opposite. But if it doesn’t prove useful in practice later, then it is what it is. The development costs are not even the biggest evil. Product complexity also always leads to greater susceptibility to errors and therefore higher service costs. The use of a therapy device only pays off if it runs as uninterruptedly and error-free as possible in clinical operation and the users are happy to keep on using it. Here, overengineering can lead not only to frustration but also to financial “side effects”, since in addition to impairments in usability, sometimes considerably high follow-up costs can occur.
Otto Höbel: Of course, you have to be balanced here. Not every new feature is bad per se. Quite the opposite. But if it doesn’t prove useful in practice later, then it is what it is. The development costs are not even the biggest evil. Product complexity also always leads to greater susceptibility to errors and therefore higher service costs. The use of a therapy device only pays off if it runs as uninterruptedly and error-free as possible in clinical operation and the users are happy to keep on using it. Here, overengineering can lead not only to frustration but also to financial “side effects”, since in addition to impairments in usability, sometimes considerably high follow-up costs can occur.
Redaktion: Consequently, searching for what’s more, better, trendier alone does not lead to success. But to what extent is innovation slowed down by such strict pragmatics?
Otto Höbel: In colloquial language, the word innovation is often used in the sense of new ideas and inventions and their economic implementation. In the narrower sense, however, innovations only result from ideas when they are translated into new products, services or processes that are actually successfully applied and penetrate the market. In my opinion, there’s often an error of interpretation here.
Otto Höbel: In colloquial language, the word innovation is often used in the sense of new ideas and inventions and their economic implementation. In the narrower sense, however, innovations only result from ideas when they are translated into new products, services or processes that are actually successfully applied and penetrate the market. In my opinion, there’s often an error of interpretation here.
Editorial: How much do additional features and functions determine the degree of innovation of new products these days?
Otto Höbel: Many medical technology companies today determine the degree of innovation of their products by the presence of additional features that often don’t even have a proven additional therapeutic benefit. As a result, as already mentioned, there are high development costs. But to remain competitive market prices must remain at an attractive level. Then this quickly comes at the expense of quality. In practice, overengineered products usually prove to be unstable and prone to errors. This is actually good for the manufacturers. In this way, they can subsequently improve their margins through repairs and service orders. The ones who suffer in the end are the customers. That’s why at THERA-Trainer we don’t do that. Maybe we’re just too “Upper Swabian” for that. No, joking aside: As in medicine, we have imposed on ourselves the imperative of economic efficiency and expediency. And according to this principle, we do everything every day to develop the best therapy devices. That’s what sets us apart. And we’ve been doing it for 30 years now. And that by no means closes the doors to our innovative spirit. Quite the opposite.
Otto Höbel: Many medical technology companies today determine the degree of innovation of their products by the presence of additional features that often don’t even have a proven additional therapeutic benefit. As a result, as already mentioned, there are high development costs. But to remain competitive market prices must remain at an attractive level. Then this quickly comes at the expense of quality. In practice, overengineered products usually prove to be unstable and prone to errors. This is actually good for the manufacturers. In this way, they can subsequently improve their margins through repairs and service orders. The ones who suffer in the end are the customers. That’s why at THERA-Trainer we don’t do that. Maybe we’re just too “Upper Swabian” for that. No, joking aside: As in medicine, we have imposed on ourselves the imperative of economic efficiency and expediency. And according to this principle, we do everything every day to develop the best therapy devices. That’s what sets us apart. And we’ve been doing it for 30 years now. And that by no means closes the doors to our innovative spirit. Quite the opposite.
Editorial: How do you create cooperation within the company that makes “real innovation” possible in the area of tension between what sounds good and what actually makes sense?
Otto Höbel: It may sound boring now. But it’s through a user-oriented design process that is lived in interdisciplinary teams consisting of engineers and application specialists. A profession on its own can never succeed in developing a useful product. A software developer, for example, can write good source code, but how is he supposed to know how to maximise customer value by doing so? This requires close cooperation between development, product management and, last but not least, the users in practice. The exciting thing is that in medical technology, this development process is actually mandatory. But I find that it’s only really lived by a few. This was also a challenge for THERA-Trainer to establish the process. But we’ve done it and we’re getting better at it.
Otto Höbel: It may sound boring now. But it’s through a user-oriented design process that is lived in interdisciplinary teams consisting of engineers and application specialists. A profession on its own can never succeed in developing a useful product. A software developer, for example, can write good source code, but how is he supposed to know how to maximise customer value by doing so? This requires close cooperation between development, product management and, last but not least, the users in practice. The exciting thing is that in medical technology, this development process is actually mandatory. But I find that it’s only really lived by a few. This was also a challenge for THERA-Trainer to establish the process. But we’ve done it and we’re getting better at it.
Editorial: That means therapists are at the centre of the development process at THERA-Trainer?
Otto Höbel: You could say that. At the very least, together with the users, we consistently focus on the benefit that a medical device should provide and, based on this, look for ways to generate this benefit with consistent ease of use.
If a feature offers no added value in this context or makes only a minor contribution, it is put under the critical microscope. In the increasingly complex and specialised health sector, it’s often difficult to balance the diverse interests and requests of all stakeholders. Returning to the benefit for the customer and to the priority features is especially important then. Every feature must be consistently and repeatedly checked for usability and the degree to which it fulfils the user’s needs, even during its creation. This sometimes requires many iteration loops to get from the usage requirement through different ideas to a final solution. Sometimes it’s necessary to ask the customer several times. This is because you have to understand the customer’s processes in the context of the application and have the work steps, and the associated requirements, described in as much detail as possible. And in the end, the product should not offer more than a fulfilment of these requirements. We’ve been pursuing this concept very consistently and with proven success for several years now. But along the way, of course, we also paid our dues.
Otto Höbel: You could say that. At the very least, together with the users, we consistently focus on the benefit that a medical device should provide and, based on this, look for ways to generate this benefit with consistent ease of use.
If a feature offers no added value in this context or makes only a minor contribution, it is put under the critical microscope. In the increasingly complex and specialised health sector, it’s often difficult to balance the diverse interests and requests of all stakeholders. Returning to the benefit for the customer and to the priority features is especially important then. Every feature must be consistently and repeatedly checked for usability and the degree to which it fulfils the user’s needs, even during its creation. This sometimes requires many iteration loops to get from the usage requirement through different ideas to a final solution. Sometimes it’s necessary to ask the customer several times. This is because you have to understand the customer’s processes in the context of the application and have the work steps, and the associated requirements, described in as much detail as possible. And in the end, the product should not offer more than a fulfilment of these requirements. We’ve been pursuing this concept very consistently and with proven success for several years now. But along the way, of course, we also paid our dues.
Keep it simple! The products do not have to offer more solutions than required.
Editorial: What have you learned and what is the most important aspect to consider when developing new therapy devices?
Otto Höbel: Keep it simple! As already described: The products do not have to offer more solutions than required. That’s why we always reduce it to the essentials. But as I said, this does not rule out our innovative spirit. In order to remain fit for the future, we have been building modularly for many years, for example. This allows us to plan expansion options for a product exactly when we can assume that they will be needed in the future. That’s innovation. The same applies to the fact that we can usually even offer our customers these kinds of innovations for retrofitting existing therapy equipment. This is sustainable and allows us and our customers to keep up with the times and remain at the cutting edge of technology throughout the entire product life cycle.
Otto Höbel: Keep it simple! As already described: The products do not have to offer more solutions than required. That’s why we always reduce it to the essentials. But as I said, this does not rule out our innovative spirit. In order to remain fit for the future, we have been building modularly for many years, for example. This allows us to plan expansion options for a product exactly when we can assume that they will be needed in the future. That’s innovation. The same applies to the fact that we can usually even offer our customers these kinds of innovations for retrofitting existing therapy equipment. This is sustainable and allows us and our customers to keep up with the times and remain at the cutting edge of technology throughout the entire product life cycle.
Editorial: Did you just say: along the way, of course, we also paid our dues? What did you mean by that?
Otto Höbel: Of course, we have allowed ourselves slip-ups along the way. With our therapy software THERA-soft, for example, we introduced far too much complexity at the beginning. We thought we were doing everything right at the time because we wanted to give the therapists every opportunity to individualise exercises. Then we realised that no one was able to operate it in practice. It was far too complicated. So we started listening closely to users and gathering feedback. By doing this, in combination with findings from the scientific literature, clear patterns suddenly emerged and we developed very simple and intuitive treatment algorithms. This allowed the performance spectrum and functionality to be retained, but the complexity was significantly reduced. We took the same approach with our new bemo bed trainer.
The search for an optimal solution was long and tedious, but the result speaks for itself today. And our end-effector walking trainer lyra, which was developed at the ETH in Zurich, also impresses with its simplicity. For some, the device looks spartan at first glance. But in the end, therapists love our end-effector walking trainer because it’s easy to use and they don’t have to be afraid of the technology. It’s important to not forget that aspect too. Therapists did not choose their profession to mess around with complex technical systems, but to be able to concentrate on their service to people.
Otto Höbel: Of course, we have allowed ourselves slip-ups along the way. With our therapy software THERA-soft, for example, we introduced far too much complexity at the beginning. We thought we were doing everything right at the time because we wanted to give the therapists every opportunity to individualise exercises. Then we realised that no one was able to operate it in practice. It was far too complicated. So we started listening closely to users and gathering feedback. By doing this, in combination with findings from the scientific literature, clear patterns suddenly emerged and we developed very simple and intuitive treatment algorithms. This allowed the performance spectrum and functionality to be retained, but the complexity was significantly reduced. We took the same approach with our new bemo bed trainer.
The search for an optimal solution was long and tedious, but the result speaks for itself today. And our end-effector walking trainer lyra, which was developed at the ETH in Zurich, also impresses with its simplicity. For some, the device looks spartan at first glance. But in the end, therapists love our end-effector walking trainer because it’s easy to use and they don’t have to be afraid of the technology. It’s important to not forget that aspect too. Therapists did not choose their profession to mess around with complex technical systems, but to be able to concentrate on their service to people.
Editorial: How do you effectively avoid these kinds of “slip-ups”?
Otto Höbel:Thanks to modern development methods, the properties and behaviour of a therapy device can nowadays be simulated and tested at a very early stage. This makes it possible to continuously check whether we’ve taken the right path to fulfil the product requirements. Early feedback from customers and users also makes it possible to assess whether product development even makes sense or not, or where adjustments still need to be made.
Otto Höbel:Thanks to modern development methods, the properties and behaviour of a therapy device can nowadays be simulated and tested at a very early stage. This makes it possible to continuously check whether we’ve taken the right path to fulfil the product requirements. Early feedback from customers and users also makes it possible to assess whether product development even makes sense or not, or where adjustments still need to be made.
Editorial: So the conclusion is “less is sometimes more”?
Otto Höbel: Sometimes, exactly (laughs). When it comes to listening to customers, it’s more a case of “more is better” in order to understand their requests properly. When it comes to development, you’re right: Then less is usually more. Product development is an intelligent translation, a condensation of requests into structured, definable usage requirements. Development should never serve the goal of creating a particularly trendy product with as many functions as possible. It should be a reduction to the essentials. You can solve almost any complex hardware problem with lots of steel and thick screws and solve any software problem with many thousands of lines of source code and umpteen sliders. That’s no longer an art today. Rather, the art lies in creating efficient solutions. We will continue to focus on this in the future and inspire our customers with optimal solutions.
Editorial: I wish you every success in this and thank you for the interesting conversation.
Otto Höbel: Sometimes, exactly (laughs). When it comes to listening to customers, it’s more a case of “more is better” in order to understand their requests properly. When it comes to development, you’re right: Then less is usually more. Product development is an intelligent translation, a condensation of requests into structured, definable usage requirements. Development should never serve the goal of creating a particularly trendy product with as many functions as possible. It should be a reduction to the essentials. You can solve almost any complex hardware problem with lots of steel and thick screws and solve any software problem with many thousands of lines of source code and umpteen sliders. That’s no longer an art today. Rather, the art lies in creating efficient solutions. We will continue to focus on this in the future and inspire our customers with optimal solutions.
Editorial: I wish you every success in this and thank you for the interesting conversation.
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