healthcare

Getting from Vision to Reality: How Ethnography and Prototyping Can Solve Late-Stage Design Challenges

BRADY SIH Kaiser Permanente HILLARY CAREY Winnow Research MICHAEL C. LIN Kaiser Permanente 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....

The Transformative Power of Singular Stories: Making the Case for Qualitative Evidence in Healthcare Contexts in Colombia

JULIANA CARDONA A Piece of Pie JULIANA SALDARRIAGA A Piece of Pie MARIA FERNANDA ESTUPIÑAN A Piece of Pie PAULA GAMBOA 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....

Eye Tracking in Medical Ethnography: Evaluating Evidence for Perception, Action, and Collaboration in Healthcare Professions

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,...

Who and What Drives Algorithm Development: Ethnographic Study of AI Start-up Organizational Formation

RODNEY SAPPINGTON Founder, CEO, Acesio Inc. LAIMA SERKSNYTE 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...

ReHumanizing Hospital Satisfaction Data: Text Analysis, the Lifeworld, and Contesting Stakeholders’ Beliefs in Evidence

JULIA WIGNALL Seattle Children's Hospital DWIGHT BARRY 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...

The Stakes of Uncertainty: Developing and Integrating Machine Learning in Clinical Care

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...

Diagnosing the World Pulse

CHRISTOPHER A. GOLIAS, PHD PechaKucha Presentation 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...

Can I Get a Witness? The Limits of Evidence in Healthcare Quality Evaluation Systems in American Hospitals

LINDSAY FERRIS Ad Hoc, LLC DR. NICHOLE CARELOCK 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 the...

The Power of the Fringe: Why Ecology Research Should Include Auxiliary Actors for Truly Powerful Results

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...

The Inhuman Condition: How Research Unlocked New Perspectives on Psoriasis and Began to Change how it’s Understood and Treated

SARAH KELLEHER Truth Consulting Case Study—This case study highlights the value of exploring the reality of having and treating psoriasis. Its aim is uncovering why it is that, despite treatments being available that offer transformative results, people with psoriasis can continue to live in isolation and with feelings of shame. If clear skin alone isn't enough, what is it that can help create a sense of well-being? Even undertaking a piece of work like this represented a significant step forward for the pharmaceutical industry where, historically, investing in this kind of deep patient insight work hasn't been common and where getting buy-in to the outputs is far from certain. How can sight lines be created and developed, particularly from physicians to patients? Explored in this case study are not only the ethnographic and other methodologies used, but also: some of the challenges in bringing together this encompassing piece of work; the strategies and efforts made to ensure that core audiences engaged with the research;...

Taking Sides in E-cigarette Research

RACHELLE ANNECHINO Critical Public Health Research Group, Prevention Research Center TAMAR ANTIN Critical Public Health Research Group, Prevention Research Center In the last ten years, an eclectic mix of electronic nicotine delivery products (‘e-cigarettes’) and practices have proliferated in the US with little restriction, producing a vast array of vaping mechanisms, flavors, and styles. At the same time, anti-tobacco movements have targeted e-cigarettes as a threat to public health and advocated for restricting e-cigarettes in much the same way as conventional cigarettes. While anti-vaping proponents associated with public health movements have typically regarded e-cigarettes as primarily harmful products that should be suppressed, vaping advocates regard e-cigarettes as harm reduction products that should be readily accessible to smokers. Distrust between these two warring “sides” animates the controversy over e-cigarettes. In our role as researchers conducting a qualitative study on e-cigarette use, we encountered...

Ethnography Is the Path-Maker to Better Care: Paving the Way to a Patient-centric Healthcare Model

CIARA GREEN Experientia LAURA POLAZZI Experientia ERIN O’LOUGHLIN Experientia VITTORIA TRAVERSO Experientia This paper presents a clear and flexible model for understanding the concept of patient-centricity. This model emerged from our own ethnographic work in healthcare contexts, and was tested and strengthened with a literature review and interviews with experts and thought leaders in the healthcare industry. Our model posits that patient-centric care should be Personalized, Hassle-free, Active, Collective and Transparent (PHACT). Hospitals, payers, clinicians, Pharma and MedTech divisions (among others) can use these pillars as a guide to drive their transition to patient-centricity. The underpinning principle for the PHACT model is that ethnographic inquiry is the necessary path-maker for each stakeholder to understand the best ways to implement and maintain these five pillars of patient-centric care in their particular healthcare context....

Finding a Voice in Opiate Addiction: Identifying the Role of Caregivers in the Recovery Process for VIVITROL

GAVIN JOHNSTON InTouch Solutions Case Study—Opiate addiction is a significant public health crisis. In the past year, it has become a hot topic at all levels, including the political realm ahead of the presidential election. Triggers, treatment options and restrictions, the criminal justice system, and costs to society are all part of the discussion but the cultural milieu in which addiction occurs is poorly understood. This was a significant problem for our client, the maker of a monthly injectable that inhibits the ability of an addict to get high. Our client, basing their marketing strategy entirely on quantitative data, realized that they needed to get a deeper understanding of addiction and the roles caregivers, friends, and family play in the treatment and recovery cycle. Our team convinced our client, who was inherently nervous about executing qualitative work, that in order to create a meaningful marketing plan, they needed to understand the complexities at a deeper level than data could provide. Working with the client...

Strategy as an Unfolding Network of Associations

TOM HOY Stripe Partners TOM ROWLEY Stripe Partners Cast Study—This case explores a business strategy development project run by Stripe Partners for a London-based online healthcare company, Dr Ed. The first part lays out the details of the process: an intense four-day ethnographic research programme called the ‘Studio’ involving the Dr Ed senior management team. The second half reflects on the outcomes of the process one year on through a series of management interviews, and evaluates the contribution the Studio made in relation to the new business strategy. The evidence from the case suggests that the concept of strategy can be reappraised. From strategy as a static set of choices made at a specific point in time to strategy as an unfolding network of people, shared experiences and artefacts that is constantly being remade. The primary benefit of the Studio approach is its capacity to initiate, align and catalyse a ‘strategy network’. Studios are effective because they combine ethnographic encounters with collective problem...