Susan Popham

popham_photo1Title: Assoc. Professor

University: University of Memphis


Twitter: @spopham

Description of Work:

Bad Design in Health Care Forms: An Analysis of EOBs in Genre and Activity Systems
This piece is drawn from my long-ago dissertation research, when I observed and
collected documents from three different billing/payment offices of three medical
practices. In this document, I plan to construct two different arguments: one about
the healthcare field, in which I want to argue that the poorly designed payment
forms show a rhetorical strategy of obfuscation and unnecessary complication on the
part of the insurance companies by which they attempt to maintain control and
timeliness of the payment processes; the second about the issue of document design,
in which I want to argue that generalities about meeting audience needs elide other
important and sometimes oppositional purposes which technical and workplace
communicators often face.

Symposium Submission:

Bad Design in Health Care Forms: An Analysis of EOBs in Genre and Activity Systems

This research is an exploration of part of the genre system of health care forms, (EOBs, medical charts, patient summary forms, surgical summaries, admission and discharge notes, etc.). Health care forms influence and impact treatment and payment decisions by health workers and payers of that health treatment. Previously I have argued that the design of these forms reflects societal changes in professions and disciplines, specifically those of business and medicine. I further argue, following on work by Schryer and Berkenkotter, that these genres create a “view” of the patient that elides the humanity of the health sufferer. This presentation examines several poorly designed health care forms—Explanation of Benefit Forms (EOB’s)—that were transmitted from health insurance companies to medical clinics. These forms contradict almost every guideline for effective visual document design. And, for the clinic staff whose job it is to work with these forms, the badly designed forms are incredibly difficult to manage.

Typical guidelines for designing effective documents advocate for clear transfer of information, with the emphasis on the ease of understanding for the audience; especially for novice users, Bruce Tognazinni (2007) calls this understanding a “no-brainer” path of movement through the text. Indeed, usability studies in document design work with the grounding assumption that the audience’s clear and quick understanding should be the ultimate goal that guides design decisions. More specific guidelines, usually found in technical communication textbooks, emphasize ease in finding key information, the elimination of chart junk, the use of high-contrast colors, the development of consistency in design choices, and cooperation between visual information displayed in charts, tables, and diagrams and the verbal information presented in prose form. When grouped together, these design guidelines indicate an audience-centric principle and pre-suppose an achievable “clear conduit” of information from designer to user; however, communication does not function like that. This audience-centered transmission principle needs re-examination, especially for texts within the genre system of health care forms, which move from clinic to billing staff to payer to billing staff, in other words, which move beyond the boundaries of a single workplace.

In regard these EOB forms, while the bad design is most immediately striking, subsequent analysis, that which takes into account theories of genre and activity systems (Bazerman, Fountain, Engestrom, Russell), reveals purposes and objectives that are often not elucidated nor understood. The design of these forms suggests a contradiction between the objectives of the health insurance companies and the objectives of the medical clinics. Despite the bad design of such documents, the forms were highly effective in purpose for building and maintaining profits for the health insurance company, but not for the main audience, the billing staff at medical clinics. Such an examination of these genres within the generic and activity system reveals that texts that move outside of organizations may not follow the audience-centered principle; rather such documents and their design might be better understood with a purpose-centered principle. I argue that while the audience-centered principle may suit a single workplace model, a new model that addresses complex cross-purposes may be more suited to a widening sense of workplace(s) in which our students will find careers. In my symposium presentation I will show that the health and medical forms have different purposes, values, and ideologies than what the readers of the forms may expect. In short, the objectives and place of origin of the forms determine the document design, not the needs of the audience.