The National Institute for Occupational Safety and Health’s (NIOSH) “Prevention through Design” (PtD) initiative encourages the exploration of different methods to foster dialogue between engineers and healthcare workers. Although engineers are encouraged to follow a user-centered design (UCD) process to identify user needs (ANSI/AAMI, 2009; IEC, 2007), NORA (2009) warns that engineers may “fail to get the full range of healthcare worker input on the usability of a device”. The primary goal of this research was to present storytelling as an elicitation method that addressed the PtD call for methods that improve usability within healthcare.

This work provides three contributions to the PtD initiative. First, a conceptual model for the role of storytelling in design, which represents a synthesis of narrative and design research, is presented. The conceptual model explicitly states how the elicitation and analysis of stories results in the identification of a design opportunity that addresses user needs. Second, the Design + Storytelling framework, which guides designers’ use of storytelling, is presented. An instantiation of the framework specific to the identification of a design opportunity within an emergency room (ER) is investigated to determine the framework’s impact on design. Findings resulted in the study’s third contribution: design guidance comprised of storytelling guidelines, decision support tools for storytelling method selection, and traceability support for design evaluation.

The investigation of the framework focused on two primary stages: (1) story elicitation and (2) story analysis. Storytelling sessions, which varied in context, collected 573 stories (i.e., 441 habitual, 132 hypothetical) from 28 ER nurses. Qualitative analysts used the framework’s instructions to identify and specify 383 user needs within the narratives. Empirical comparisons of the compiled needs across groups informed decision rules for elicitation method selection. The impact of the framework’s analysis instructions during design practice was investigated. Student design teams analyzed nurses’ safety stories to create a conceptual design for an identified design opportunity. Findings indicated a trend for stakeholder experts to rank conceptual designs created by teams with the instructions as more usable than teams without the framework’s instructions. The theoretical and practical exploration indicated a positive impact on design.