by LIBBY KAUFER and MARIA VIDART-DELGADO, Ad Hoc LLC
Ethnographic methods that center systems-thinking, how knowledge is constructed, and how knowledge is shared among communities are the best approach for developing collective digital products like APIs.
Application Programming Interfaces, commonly known as APIs, connect the front-end interfaces we see when we navigate the internet (like websites and apps) to the back-end systems, or databases, that store information. APIs enable people to carry out transactions online, like purchasing goods, booking flights, or applying for government benefits. While they are invisible to end-users, APIs are crucially important to developers and to the way many websites, programs, and applications function.
Like codebases and databases, APIs are objects consumed collectively and collaboratively by teams of developers who work together to integrate front-end to back-end systems, run tests, and monitor and troubleshoot integration issues. In the context of APIs, typical UX research methods...
University of Cambridge & SympTech Ltd
This case study explores the scaling experience of an early-stage healthtech startup company called myICUvoice. During the Covid-19 pandemic, myICUvoice rapidly scaled from a single intensive care environment to being widely used nationally (UK) as well as globally. We explore why and how so many volunteers were motivated to donate their time and expertise to help scale this early stage startup. Specifically, we examine the roles that empathy played throughout the scaling process. There are three distinct types of empathy that we have identified in our story: em-pathos, empathetic understanding, and mass-empathy. These each had a distinct role in driving the startup forward. Importantly, we note that human-centered design (which often focuses almost exclusively on achieving empathetic understanding) will immensely benefit from considering the multiple types, and multi-faceted...
The case study presented is an in-depth view on the project “Casa nel Parco” (translated as “the House in the Park”), a three-year, European-funded project (ERDF Funds 2014-2020) in the Italian region of Piedmont that involves 4 hospitals, 2 large companies, 14 small-medium enterprises, 2 universities, and 2 private research centers. The goal is to research and innovate hospital-homecare services for elderly and ALS patients, as well as their caregivers, through the implementation of e-health solutions. The uniqueness of our case study lays on the fact that our ethnographic work was pivotal in shifting the narrative of closed hospital ecosystems (Goffman 1961); where those outside of the hospital environment are not viewed as credible or essential sources for improving the care system. In this...
Mount Sinai Kravis Children's Hospital
MASS Design Group
In April 2020, a study of The Mount Sinai Hospital in New York City was conducted to better understand the challenge of adapting idealized infection control design guides to site-specific conditions during a pandemic. The study aimed to capture quick interventions that are working, offer a new hypothesis and framework to guide future design interventions, and share lessons to assist other medical facilities as they pursue their own necessary spatial adaptations moving forward. Three units repurposed for COVID-19 were studied. Using action cameras and cloud-based videoconferencing, clinicians helped designers remotely peer in real time to active COVID-19 units, create “heatmap” annotations of perceived risk by frontline clinicians, and conduct interviews with decision makers.
The COVID-19 pandemic has challenged health care systems around the world to provide safe and effective care. Leveraging spatial design, architecture, and design...
ADAHEID L. MESTAD
During recovery and transition to the ‘new normal’, the loss of agency for patients and families of patients who go through a major health disruptor such as transplant, cancer, or cardio-vascular disease can be profound. Considering this, how can acute care hospitals help solve for caregivers’ loss of agency? And what does the physicality of such effort in the confines of a hospital building look like? The goal of this case study is to (1) demonstrate how ethnographic thinking and design research can help a medical center understand the needs, values, rituals, and agency of a patients and their families; (2) show socio-spatial solutions that can support the transition to the patient’s and family’s new normal.
The ethnographic study showed that the patients and families who go through a major health disruptor struggle with the loss of agency in various ways. While loss of agency can be obtuse, four themes emerged as contributing factors to the overall sense of loss: (1) loss...
MICHAEL C. LIN
Cast Study—In 2014, Kaiser Permanente began implementing a next-generation medical office model that reimagines the outpatient care experience, combining new architecture, workflow, and technology to create a more convenient experience for patients and a connected, efficient experience for staff and care teams. As the first next-gen facilities were being built, challenges emerged as teams across a variety of disciplines attempted to translate the model's vision into reality. Teams were making design and operational decisions in parallel, without the ability to see how their decisions impacted the overall user experience.
To resolve these challenges, our innovation team at Kaiser Permanente used a hybrid make-and-observe method of prototyping and ethnography. Employing a co-creation mindset (Bødker and Grønbaek 1991), we engaged staff and patients to help us bring the future state of these next-gen clinics to life in a minimally viable way....
A Piece of Pie
A Piece of Pie
MARIA FERNANDA ESTUPIÑAN
A Piece of Pie
A Piece of Pie
Case Study—In this case study we describe how we collaborated with a Colombian healthcare provider company and enabled its decision makers to understand the power of stories and other types of qualitative evidence in healthcare contexts. The stories became a tool for recognizing singularities in a complex, massive system, where individuals were constantly reduced to social security numbers. We describe the qualitative methods implemented, such as in-depth interviews, projective techniques, shadowings and observations, explain the difficulty in explaining the value of our qualitative evidence and mention some of the lessons learned throughout the project. We also discuss the project’s outcomes, such as understanding the difference between user perception and user experience, the impotance of healthcare providers to go beyond healthcare and using stories as input for measuring quality of the service....
LARRY S. MCGRATH
Design Science Consulting, Inc.
Using eye tracking in ethnographic research poses numerous theoretical and practical challenges. How might devices originally intended to record individuals' vision of two-dimensional planes be useful in interpersonal contexts with dynamic visual interfaces? What would the technology reveal about collegial environments in which different levels of knowledge and expertise come together and inform decision-making processes? Why would pupil movement show us anything that conventional ethnographic methods could not? In this paper, I argue that these challenges are not intractable. When tailored to specific questions about perception, action, and collaboration, eye trackers can reveal behaviors that elude ethnographers' gaze. In so doing, the devices enrich the observational and interview-based methods already employed in ethnographic studies of workplace dynamics.
Hospitals are a fruitful context in which to test the value of eye-tracking evidence. Healthcare professionals look, interpret,...
Founder, CEO, Acesio Inc.
Head of Behavioral and Organizational Research, Acesio Inc.
The focus of this paper is to investigate deep learning algorithm development in an early stage start-up in which edges of knowledge formation and organizational formation were unsettled and contested. We use a debate by anthropologists Clifford Geertz and Claude Levi-Strauss to examine these contested computational forms of knowledge through a contemporary lens. We set out to explore these epistemological edges as they shift over time and as they have real practical implications in how expertise and people are valued as useful or non-useful, integrated or rejected by the practice of deep learning algorithm R&D. We discuss the nuances of epistemic silences and acknowledgments of domain knowledge and universalizing machine learning knowledge in an organization that was rapidly attempting to develop algorithms for diagnostic insights. We conclude with reflections on how an AI-Inflected Ethnography perspective...
Seattle Children's Hospital
Seattle Children's Hospital
Case Study—Declining clinician engagement, increasing rates of burnout, and stagnant patient and family experience scores have led hospital leadership at Seattle Children's Hospital to submit requests to a data scientist and an anthropologist to identify key themes of survey comments and provide recommendations to improve experience and satisfaction. This study explored ways of understanding satisfaction as well as analytic approaches to textual data, and found that various modes of evidence, while seemingly ideal to leaders, are hard pressed to meet their expectations. Examining satisfaction survey comments via text mining, content analysis, and ethnographic investigation uncovered several specific challenges to stakeholder requests for actionable insights. Despite its hype, text mining struggled to identify actionable themes, accurate sentiment, or group distinctions that are readily identified by both content analysis and end users, while more...
MADELEINE CLARE ELISH
Data & Society Research Institute
The wide-spread deployment of machine learning tools within healthcare is on the horizon. However, the hype around “AI” tends to divert attention toward the spectacular, and away from the more mundane and ground-level aspects of new technologies that shape technological adoption and integration. This paper examines the development of a machine learning-driven sepsis risk detection tool in a hospital Emergency Department in order to interrogate the contingent and deeply contextual ways in which AI technologies are likely be adopted in healthcare. In particular, the paper bring into focus the epistemological implications of introducing a machine learning-driven tool into a clinical setting by analyzing shifting categories of trust, evidence, and authority. The paper further explores the conditions of certainty in the disciplinary contexts of data science and ethnography, and offers a potential reframing of the work of doing data science and machine learning as “computational...
CHRISTOPHER A. GOLIAS, PHD
This PechaKucha explores the ethics of interpreting data by employing an extended metaphor of data as the lifeblood of the connected world. It begins by exploring two distinct viewpoints on medical pulse diagnosis, starting from the perspective of the acupuncturist diagnosing a patient’s pulse and continuing through differences between Eastern pulse diagnosis and biomedical pulse diagnosis. I explore data as lifeblood, and imagine more visceral ways to read data (e.g., auguring data) and the ethical implications of such a reading. I envision data as a flowing river filling a lake, in which diagnostic specialists observe society’s reflection. In the process, I contrast utopian visions of a data driven world with dystopian ones before resolving tension by returning to the central comparison of data scientist and medical doctor. The presentation concludes by recalling medicine’s Hippocratic Oath, an ethical charter binding practitioners to a code of conduct, and implying...
Ad Hoc, LLC
Ad Hoc, LLC
“I got verbals, but verbals don’t hold up in court….I need it in black and white.”
After Sheila submits hospital quality data to the Center for Medicaid and Medicare Services (CMS), reports indicate that her data hasn’t been received. She makes countless calls to the CMS Help Desk to get answers. They reassure her numerous times that they have her data, yet Sheila is insistent that she needs to see the change explicitly stated in the report. Sheila makes it her personal crusade to obtain material evidence because only written testimony will prove that her data has been submitted successfully and protect her facility from CMS penalties.
At a time when we are becoming increasingly reliant on data and technology as the ultimate bearers of truth, Sheila exemplifies how people become stewards of evidence in service to these technical systems. As she moves her facilities’ data through CMS’ error-ridden reporting system, the burden of proof is on her to provide...
by CAMILLO DE VIVANCO and GAYATRI SHETTY, ReD Associates
Through years of research and work for the healthcare industry, we’ve come to experience the power of the auxiliary actors. The industry often overemphasizes the classic dyad of patient and primary health care provider, missing actors on the periphery who have frequent touch points with patients and frequently play a larger role in delivering care to patients than the actual healthcare professionals.
Take, for example, Benjamin, a health technician we observed for a full day in Paris. Benjamin spends his days driving from home to home, delivering in-home medical equipment to patients, as well as checking in on those who have notified his company of problems with the equipment they have been given. On average, Benjamin visits anywhere between 5 and 15 patients in a day, depending on the tasks he is assigned.
Benjamin, like many technicians we observed in our ethnographic fieldwork, consistently moves beyond his remit – spending significant amounts of time training...