Mapping Actors in the Health Care Narrative

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Experience in Design Research Movitations, Hypotheses, and Testing in Experience Mapping actors in the health care narrative Jessica Newell M.Des in Design Innovation and Service Design 17099625 Tutor: Brian Dixon

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Contents.

Motivation.

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Throughout the first semester of the M.Des Design Innovation and Service Design course, I have been exposed to a wide variety of methods that are intended to facilitate the design process – Public Knowledge and Stakeholder Maps being a good example of this. I have become increasingly interested in how designers can use different mapping techniques in Service Innovation practice where “network environments remain one of the most significant, yet ‘invisible’ infrastructures” (Carroll et al., 2010).

Motivation Introduction to Actor-Network Theory Subject (exploration) Net-Map by Eva Schiffer Service Ecology Map by Livework Reflection Hypothesis formulation Test overview Interviews Evaluation and limitations Reflection Bibliography

One of the approaches that I have explored is Actor Maps, which is underpinned by the ActorNetwork Theory (ANT). I have previously utilised a form of Actor Mapping at the beginning of a project to identify people working in different in fields, and at different levels of influence, that can inform my thinking around a given topic. Whilst this practice usually takes place on an individual basis, I believe that there is a much more valuable opportunity to employ this method in my practice as a co-design technique. My motivation in this project is to explore how practitioners use Actor Mapping as an envisioning activity to increase insight efficacy. I believe examining this technique in greater depth will allow me to explore the relationships and hierarchies of different stakeholders in an established network in the hope of moving away from using the tool as just a listing exercise - towards using it as an ‘envisioning’ one. To accomplish this, I conducted a series of open-ended experiments to give me some clarity of understanding for my future projects.

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Actor-Network Theory. Actor-Network Theory has it’s orginiations in Science and Technology Studies, but was pioneered by academics Bruno Latour, Michel Callon, and John Law. It is a “material-semiotic... method of analysis” (Law, J., 2007) which “describes the world as a network of hybrid (social and technological) actants” (Elgali, Z). These webs can be considered ‘heterogeneous’ in nature, as the method gives both living and non-living beings an equality of status, arguing that “both human and non-human actors be understood within a network wherein their identity is defined through their interaction with other actors” (Cressman, D., 2009). As Innovation practitioners are required to consider all the components of an ecology when providing systemic solutions to complex issues, I decided to use my Designer in Place project to explore two different methods of Actor Mapping. I hope that this will give me a richer understanding of how the actants work together, in order to understand the scope of a project, and appreciate how a complex narrative can be visualised to a designer’s advantage.

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Exploration. In my first phase of experimentation I wanted to explore which method of Actor Mapping would give myself and the participant the greatest clarity of insight. I decided to investigate this in the context of self-management support in the health care system, with the user as the chosen subject. Self-management is a “term used to include all the actions taken by people to recognise, treat and manage their own health and support� (England.nhs.uk, 2018). My method was an open-ended experiment to test two different, existing methods of mapping actors; record my own thoughts and reflections on the process and gather feedback from the participant through an open-ended interview. My icebreaker questions to the particpant were as follows: - - -

Is this an accurate representation of all the actors in your self-management network? Is it easy to understand the relationships between the actors? Using the map, is it easy to reconfigure the actors to make new relationships that better support your self-management?

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01 Process/Reflection-in-action Net-Map by Eva Schiffer My first experiment was testing the Net-Map method developed by Eva Shiffer. After explaining the process and discussing the theme of self-management with the participant, I asked a variety of questions to assist her with the generation of the map. First, she was asked to record who was involved in the self-management of her health care and then arrange the actors she’d identified into different categories. This was a relatively quick and fluid process – there was no struggle to group the information she’d written down. The participant was also able to move and reclassify information quickly and easily when she needed to. Next, she was instructed to draw lines of interaction between the different actors and assign them a hierarchy to visualise the relationships and see where there was more importance given. Finally, she was asked to note down to what extent she felt that their goals matched her own – The participant found this confusing as one of the actors she’d identified was a big organisation that had multiple objectives, so it was difficult to summarise their goals and relate them back to her own narrative – This raised questions about what constituted as an ‘actor’ as things that she believed were important – such as medication or self-therapy treatments are not an organisation or a person but were still perceived as a self-management tool and indispensable to her when mapping an accurate self-management network.

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01 Reflection-on-action Net-Map by Eva Schiffer I found the Net-Mapping exercise very straightforward as the process was adaptable to the reformulation of the participants thoughts. I didn’t feel that I was influencing the process or that the participant was trying to ‘shoehorn’ information into a specific pre-imposed category, as she was grouping and making links between the different actors of her own accord. I felt that this facilitated a more elastic and smooth process for both the participant and myself, as the structure of the map wasn’t set in stone. However, the participant voiced that she believed she was focusing in on the medical aspect of self-management and neglected to see the broader picture, which prompted me to believe that it wasn’t representational of her self-management support system. However, it was easy to instigate a discussion around the new relationships which could be formed that could further support the self-management of her own health. I felt that this map provided an informative understanding of the self-management landscape and was a very valuable tool to gain insight which would further inform my project.

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02 Process/Reflection-in-action Service Ecology Map by Livework My second experiment was testing the Service Ecology Map developed by Livework Studio. The map is made up of three concentric circles representing the levels of application, and then divided into the six W’s investigation categories. For the experiment, the participant filled in the grid section-by-section using each of the W’s as a question prompt. Shortly after the process had commenced, to both myself and the participant’s surprise, the seemingly straightforward categories ‘What’ and ‘How’ needed more consideration and debate, as the regimentation was more confusing. I didn’t feel that the structured approach was successful as the participant needed continued reassurance that she was ‘mapping correctly’ as opposed to allowing the process to evolve naturally. A large proportion of the time was spent discussing the format, rather than the information that was being mapped. I notice that there was a ‘tipping point’ midway through the exercise where the information became too general and the relevance of exercise got lost. At this point, when the interviewee was asked to discuss new opportunities, the conversation came to a standstill, as the participant felt that it was too general to see how the different categories communicate with each other.

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02 Reflection-on-action Service Ecology Map by Livework I believe this method allowed the interviewee to think more generally about the topic, however, as the network that was established was so vast, it was difficult to make any connections between the disparate pieces of information that had been generated. Although the amount of information produced was substantial, it became apparent that there was a point where it was hard to engage the interviewee in a meaningful conversation about the material as it had lost its relevance to her personal narrative. It was hard to establish existing links and work out how they could be reconfigured, as when the map became saturated with information, the Six W’s gave a regimented outlook which gave no flexibility to create unique links. The process required a lot of clarification between myself and the participant which I believe made the experience more frustrating for both of us. Overall, it was too broad to see any relationships and the amount of information produced was overwhelming, which didn’t help to situate the individual at task within the system.

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Reflection. Following both mapping sessions, I conducted an interview with the participant to understand her experience of doing both tools. For the Service Ecology Map, her main takeaway was that “it needed explanation to understand it - Half the battle was working out which things to put into each category” which suggests that the rigidity of the map and/or specificness of the ‘why’ and ‘what’ categories made the process stilted and confusing. The participant also observed that “it’s not very organic - you can’t have things straddling categories” further indicating that she felt that the way in which she was being asked to categorise information is not representative of real-world contexts. In regards to the Net-Map, the participant found that it “demonstrated more complex links” and was able to give extensive feedback on the how the connections could be reconfigured to create new relationships that would better support her, indicating that the visualisation of the relationships between stakeholder parties was a springboard for her to generate new ideas.

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Following my exploration, I began to ask if designers imagine they would gain a greater clarity of insight from the information gathered in the Net-Map, as opposed to the Ecology Map. Based on my exploration, I believed that designers would have a better reaction to the Net-Map.

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Hypothesis testing. To test my hypothesis, I conducted four interviews with different Innovation Designers about their impressions of the mapping techniques, based on their imagined use. With each interviewee, I described the process I had undertook and presented photos of the final outcome of each activity. I asked each designer to suggest a rationale as to which map they would, hypothetically, find the most useful in their own practice. Following this, I compared and contrasted the feedback from each of the interviewees to determine to what extent their feedback was in alignment with my own hypotheses. .

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Interview Participant 03. Interview Participant 01.

“It would depend on where I was in the process. I feel that the Net-Map would be useful for getting a lay of the land and seeing how the actors relate. However, I can imagine it getting confusing really quickly if it’s a larger system. Whereas the Ecology Map is more helpful further on in the process once you’ve specified a specific context.”

“In the Net-Map you can clearly see where there’s more importance given. I feel that with the Ecology Map, I would need to dig a little deeper to draw out the meaning - You can’t see the level of importance that’s placed on something. Although it’s an overall view, it’s more simplified.

“There’s already a visual hierarchy to the Ecology Map because it’s centred around categories. I feel that there is much more room to organise the hierarchy of the NetMap as it’s developing, rather than trying to organise said information into a structure. It might be more useful if it was less broad.”

Participant 02. “I feel that the first one (the Net-Map) has more potential to prompt, but it doesn’t tell you what other things are involved besides the people. The second one (Ecology Map) doesn’t help you understand the level of control that a person feels. Neither really give you the complete picture but I think they might work well in conjunction.”

Participant 04. “There is a lack of visual structure to the Net-Map - the Ecology Map is very visually structured. However, sometimes the context isn’t actually as neat and structured as you would like. I believe the Net-Map is much more depictive of reality because of the way in which it conveys information.”

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Evaluation. The interviewees impressions did not match up to my hypothesis in the way that I had anticipated. Naively, I had assumed that the information would be of the same value at different stages of the design process. The interviews concluded that the different insight gathered might be valuable at different times e.g. Ecology Map might be more useful at the beginning of a project where there is a need to establish who are stakeholders in the process, whereas the Net-Map could be used later down the line, to explore specific context. In addition to this, it was suggested by a participant that that the maps might work better in conjunction. I was able to adjust my experiment with the final two interviewees to deduce whether they imagined, like the first interviewee, that the maps might work well in conjunction. Although the final two interviewees had a clear preference for the Net-Map, they were also in agreed that the maps would work well together, which gave me a basis to alter my hypothesis to “would designers imagine that they would be able to gain a greater clarity of insight if the maps were used in conjunction with each other?� and evaluate the efficacy of the process – ultimately providing a blueprint for my future approach. One of the limitations of the experiment was that the interviewees did not have the opportunity to use the tools in practice due to the constraints of the project. Each interviewee was given the information regarding the mapping techniques and had to envision the use using their own knowledge and experience of the design process. If I were to conduct this experiment again, I would undertake a workshop with more objective measures that provided an opportunity for people to interact and engage with the tools in practice. I would choose an issue to tackle which each participant was a stakeholder in and therefore had the ability to influence, as I believe it was my own participation in the process which re-informed my understanding of the tools.

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Reflection. Overall, The Experience in Design Research course has given me a greater understanding of the value of experience-based testing. In the first phase of my experimentation, immersing myself in the experience and reflecting-in-action gave me a heightened awareness of my role as a facilitator, and the clarification that was required to do the project. My direct engagement with the tools also allowed me to challenge my original assumptions and preconceived ideas – enabling me to evolve my hypothesis as further data was gathered. Initially, I had assumed that one technique would work better than the other and that the insight gathered would be of equal value, rather than each map being important in their own way depending on when they are used in the design process. Each map facilitates a particular research ‘need’ and therefore, although it may not have seemed immediately obvious at the beginning of the project, I understand that they allow the designer to understand the actors in the design narrative more comprehensively. I found that reflecting on the process helped me to reframe my initial evaluation of both tools. In the second phase, even though the interviewees analysis was only based on imagined use, their feedback gave me a new understanding of the mapping process that I hadn’t considered before. It became clear that variation of the map’s value can depend on the application, and the timing, of the Actor Map in the design context. My findings through this experiment have been especially useful when considering the actors involved in a health-care narrative, and I believe will allow me to understand an individuals journey when working on future projects.

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Bibliography. - Carroll, N., Whelan, E., & Richardson, I. (2010). Applying Social Network Analysis to Discover Service Innovation within Agile Service Networks. Journal of Service Science, 2(4), 225–244. - Elgali, Z., Kalman, Y. Using Actor-Network Theory to Analyze the Construction of the Failure Concept in a K-12 ICT Integration Program. Available at: https://www.openu.ac.il/personal_ sites/download/yoram-kalman/using-actor-network-theory.pdf. (Downloaded on 22nd April, 2018). - Law, J. (2007). Actor Network Theory and Material Semiotics,’ version of 25th April 2007. Available at: http://www. heterogeneities. net/publications/ Law2007ANTandMaterialSemiotics.pdf. (downloaded on 22nd April, 2018). - Cressman, D. (2009). A Brief Overview of Actor-Network Theory: Punctualization, Heterogeneous Engineering & Translation. Available at: http:// faculty.georgetown.edu/irvinem/ theory/Cressman-ABriefOverviewofANT.pdf. (Downloaded on 22nd April, 2018). - England.nhs.uk., (2018). Available at: https://www.england.nhs.uk/ourwork/patientparticipation/self-care/

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