Sometimes you just have to be there

17 Oct 2016 6min read

Team Discussion

Multiple authors

Of course, if it’s a moon landing there are some practical reasons why you can’t be there and, back in 1969, even watching it on a TV was a challenge. Nevertheless, there are some things that simply demand your presence, when you feel privileged to share, where your wonder is amplified by the wonder of those around you.

I have felt that same privilege and wonder spending time with people using medical devices: watching that daily, small victory of an injection; understanding why a mother’s non-adherence was a necessary consequence of the care of her baby; and how the debilitating effects of COPD was robbing a father of his role and his masculinity.

I have done this type of research with clients present and in situations of great intimacy and importance for the participant. We have sat through tears and anger, family dinners and blazing rows; memorably, I’ve even had to help out once during surgery.

I don’t know about you, but I design because I care. I believe – and, as time goes on, I think I have more evidence to back this up – anything that makes me care more, helps me to design better.

So, what’s a good way to care more? Can I really be talking about AAMI Technical Information Report 51? Well, yes indeed I am, and although the authors don’t couch it in this way, if you follow their “Guidance for contextual inquiry” you will care more (see the box at the bottom of the article). They talk about “a deeper understanding … providing insight … evidence”. Of course, all of those things are important.

These, and other great things, are the products of spending time with patients and device users, but you will also care more.

TIR51 makes it all sound so technical and complicated when, in essence, it is little more than what designers of my generation used to call “familiarisation” or “observation”: spending time with people doing the things, or using the products, of interest. Trying not to get in the way too much, shrugging off the embarrassment of asking ‘stupid’ questions, taking away as many quotes and photos as possible and the sense of what’s going on.

There is more to it than that, of course; you can’t just rock up at someone’s house or lurk around in clinics. It does have to be carefully arranged, and we have to pay attention to the necessary preparations and permissions, but none of that has to get in the way of simply ‘being there’. I have done this type of research with clients present and in situations of great intimacy and importance for the participant. We have sat through tears and anger, family dinners and blazing rows; memorably, I’ve even had to help out once during surgery.

What do you need to do this? TIR51 talks about notebooks, cameras, video recorders, etc – all the usual tools one might imagine. These are the practical steps – and there are others, of course, all well documented in TIR51 – but the key step, for you and for me, is to be humble.

We have to bring some humility and openness to this type of research. As professionals, we may have deep expertise in some aspect of the disease, drug or device, but the patients’ experience of their disease and how they cope with it is unique and potentially vast. You may see them for an hour, they spent nearly 9,000 hours last year coping with it. You have to acknowledge that whatever people do just is. Whether they do it “correctly” or “perversely”, it just is.

“We have to bring some humility and openness to this type of research”

No, they don’t always read the instructions; yes, they will pay undue attention to the neighbour with no medical qualifications; maybe they’ll breathe out first, maybe they won’t. One of the difficulties of contextual inquiry – a very personal challenge – is to stop yourself from intervening and correcting something you know to be wrong. There are good reasons not to, not least that I have no medical training, and there have to be exceptions for real harm, but part of the value of this work is the gritty reality, the quirks and mistaken beliefs. (Having said all that, I often find myself reminding people that their doctor is always there for advice on technique.)

The key aim of this type of research is to draw out their hard-won experience and expertise.

There is massive value in seeing the reality, unearthing the problems and taking them seriously in design. The empathy – the caring that arises – inspires as well as informs; it brings teams together with a shared goal. And I have to admit to a certain mischievous pleasure: when you’ve taken a client to see just how their product is used in truth, and you’ve faced them with the sheer improbability of that truth, you’ll never go back to the pedestrian ways of doing design.

AAMI TIR51:2014 “Human Factors Engineering – Guidance for contextual inquiry”

Contextual inquiry has its origins in the growth of usability or human computer interaction methods during the 1980s and 90s. It sits in the phenomenological school of qualitative design and it seeks to explain how people experience things and events. It is similar to ethnography in that it deals with the lived experiences of people, but it has a much narrower focus, specifically on the user, product or task of interest.

It has very little theoretical underpinning so people new to the technique can rapidly gain valuable insights and data, which can vary in scope from observed problems and work-arounds, through to new ways of conceptualising tasks or desired outcomes.Basically, people are watched within the actual context of a product’s use – in the precise location, at the same times, with the usual resources, demands and management oversight. The session is normally recorded and key moments or artefacts are photographed. With each session, the researcher will refine their area of interest, keeping a broad view but also focusing attention on key tasks and asking questions about specific areas of doubt. In this way the research becomes a collaborative endeavour in which the user prompts the questions as well as providing the answers.

The analysis is usually discursive, simple story-telling; researchers (often with the subjects present) will share what they have seen, important observations will be noted and patterns or themes will be identified.

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