Gaining Support for User Testing (1994)

Health insurance communication is notoriously difficult to read, especially the legal document (often referred to as a policy) that explains what the insurance company promises to pay if and when a person requires health-care services. This legal document is usually intimidating to users who often react by setting it aside without looking at it until they are confronted with an unexpected health crisis or financial liability for services they assumed were covered. The user unfriendliness of most policies does nothing to put distressed readers at ease. The fact is, readability of health insurance policies is easily improved by applying verbal and visual document design features such as plain English, information chunking, foregrounding, cross-references, indices, headings, subheadings, and font variation. However, ensuring that readers actually understand and can use the document is another matter. Confirming readability and usability requires the implementation of an ongoing user-testing program in all stages, but especially in the early stages, of product design. The following is an account of how support for user testing at one company, Blue Cross and Blue Shield of Iowa (BCBSI), evolved. SEEING THE NEED TO REVISE CUSTOMER POLICY BOOKLETS In 1991, in response to a movement to automate and consolidate the production of benefit documents, I started to rewrite, redesign, and consolidate the legal contract and customer policy into one document. My status as a novice in health insurance became an advantage. My lack of health insurance knowledge caused me to ask questions whose answers seemed obvious to those working in the company. Essentially, my lack of knowledge allowed me to approach the document from the users perspective. As the project progressed, I became one of the first members of a newly formed document writing and production team. As the team was being formed, another department within the company hired a consultant to survey customer perception of corporate image and communication. Survey results revealed that while customers had a positive image of the company, they desired improved written communication. The writing and production team used these survey results to reinforce their argument for the changes necessary to create user-friendly customer policy booklets. The changes were based on effective document design practices. Figures 1 and 2 illustrate changes that the document team made in presenting information about services not covered that appears in two different Blue Cross and Blue Shield of Iowa policies. Figure 1 is an excerpt from a policy and legal contract before the redesign project; Figure 2 presents the same information after redesign. The original policy makes no use of foregrounding, information chunking, headings or subheadings. In contrast, the redesigned consolidated policy uses section headings, foregrounding, font variation, cross references, and information chunking, all of which help the readers find the information they are looking for. In addition, the redesigned policy includes an index (not shown) that assists readers in locating specific information. TESTING A PROTOTYPE After several versions of the initial policy were drafted and reviewed by experts, a prototype was agreed upon and additional tests performed: the Fog Index readability formula and focus groups. The company was familiar with and comfortable executing such retrospective testing. Management preferred the tangible numbers provided by the Fog Index test, which indicated readability improved from the 24th grade level to the 8th. They seemed either unaware of or unconcerned with the limitations of readability formulas. Focus groups revealed that test participants unanimously preferred the policy prototype to the original documents. The legal department was optimistic that defending language would be easier now that the legal contract and customer policy were successfully combined into one document. …