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By Designdialogues, on May 2nd, 2010
Dr. Brenda Dervin presented a lecture and workshop at University of Toronto’s KMDI, kicking off the Making Sense Of series led by professor Peter Pennefather, KMDI outreach director. Peter and I hosted Brenda as befitting this first session in a series of workshops on “how we make sense” in several different domains. What’s new is the focus on new forms of media for aiding sensemaking.
Brenda is Professor of Communications at OSU and one of the founding thinkers of sense-making, along with Karl Weick. Their 1980′s work developed theory and cases for how people individually (Dervin) and organizationally (Weick) make explanatory sense of situations in everyday life and breakdowns. Newer contributors to the sensemaking literature Gary Klein, Dave Snowden, and the PARC (now Google) team of Russell, Stefik, Car, Pirolli have contributed versions that extend their prior work in cognitive science.
In Dervin’s lecture she explicated each contributor to the canon from the perspective of her recent publication in the Encyclopedia of Library and Information Sciences.
While there are other authors contributing to the discourse, Dervin finds these are the researchers committed to the development of a continuing field of research, and have had the most impact by citation. While their differences may appear reconcilable to most interdisciplinary scholars, there are significant differences based on ontological underpinnings and methodology. Dervin finds her sense-making meta-theory closest to Snowden’s view. Philosophically perhaps, but I find Klein’s a closer match because his work draws from naturalistic decision making and Snowden’s models are more abstract and not grounded in empirical field research, as Dervin and Klein’s are. Dervin’s SMM interviewing process and micro-moment analysis can be understood as a method for understanding streams of subjective experience, and bears methodical similarity to Klein’s Cognitive Task Analysis, even if their purposes and outcomes differ.
Pennefather and I are intrigued by the development of sensemaking theories in clinical informatics and new media. Sensemaking provides guidance beyond the limits of mere “decision making,” an overly constraining view of information activity. I see a hybrid interdiscipline forming between a lifeworld view of the person (how people make sense of concerns) and the media and information tools (media appropriated to aid sensemaking). This convergence is the basis of two papers:
Why do Senior Clinicians Ignore CDSS? (Slideshare) presented at AHIC 2010,
And a paper currently in review.
How Can we Design Dialogues to Enact People’s Capacity to Think?
Dervin asked this question rhetorically. I mean to act on this question in the Design with Dialogue practice community.
Dervin credits the sensemaking dialogic approach to her mentor Richard Carter’s dialogic theory. Carter viewed dialogic communication as expressed within and among individuals (through me to you, within me to you, through me to me, etc. +1 +2 +n).
Buber’s dialogues of within-person, between I-You, between I-Thou, and Man to God may have originated this configuration of perspectives. However, while Buber’s interests were spiritual-ethical, Dervin’s may be seen as social-educational-epistemological. She wants us to learn to think by observing communications as the source of understanding and the making of sense.
Dervin also enforces methodology and I see this as necessary to keep from getting fixated on method. Method is instrumental, and when pursued for its own sake, is merely about “getting things done.” Method keeps us from thinking about purposes, our stake in the research, and ethical stances. Methodology (and meta-theory) are not academic exercises. They are how and why we are doing research in the first place. This is a critical point for the design professions to acknowledge
Dervin describes her position as post-critical. The methodology invokes Gramsci, Foucault, Freire, and presents a method for understanding power relations in a dialogic “surround.” The surround can be seen as a triangulation of multiple perspectives on a concern, increasing the requisite variety of dialogue to express the different views discovered in the interaction of concern.
Borrowing from critical theory, the SMM pierces conventional notions of human experience by invoking and identifying sense-making and un-making functions, including:
- The person as contingent in and moving through time and space
- The person defined and understood as a creature of verbs, not the properties of noun objects
- The person as a dynamic, multi-perspectival, learning and evolving being
- The person as autonomous, self-oriented, and inherently superior to structures
- The person as subject to and interacting with power and controls in structures
- The person as enmeshed in struggles, muddles, resource appropriation, and seeking helps
These elements contribute to a basis for understanding the experience and evolution of experience.
By Designdialogues, on April 15th, 2010
Sense-making in Collaborative Practice: Can Media Design Support Sensemaking in
Professional Practice Collaboration and Decision Making?
This conversational workshop is designed as a “dialogue” between a panel of 5 question-askers
and Dr. Brenda Dervin.
The framing for the conversation has been developed by the panelists. Through a series of
questions and answers, Dr. Dervin will attempt to build a bridge between her approach to
Sense?Making Methodology and the different approaches to sense-making/sensemaking that
ground the panelists’ questions. We envision a two-hour workshop-conversation inviting
researchers and practitioners working in problems information seeking, interprofessional
practice development, and other joint decision making challenges.
Why has sense?making/sensemaking recently emerged as a lens through which we describe
human experience with information, decision making, and complexity? Haven’t people always
tried to “make sense?” If so, what have we learned from our attempts to describe the
phenomenon of sensemaking in research and practice?
Multiple disciplines have recognized a need to describe the human experience of coping,
struggling with, working around, and making decisions in situations where complexity reigns.
The lessons learned from such experiences are not simple or easy to describe. But, the degree
to which they achieve satisfactory resolutions in real experiences is often described as making
sense of the situation. This phenomenon of sensemaking occurs in the lived experience of
people. Yet research into this experience and into procedures and technologies that support it
often seeks to abstract and generalize that process.
The intent of the workshop is to briefly explore how the framing of professional work (like that
of healthcare professionals) as sensemaking might enable better design of innovative media to
inform a multi-perspectival orientation to that work and practice. We invite participants in this
workshop to share studies, observations, and experience related to these ideas as well as to
engage in a formative dialogue with Dr. Dervin on the applications of Dervin Sense?Making to
problems of collaborative practice and design of what we might call sense?making media. We
envision a two?hour workshop?conversation inviting researchers and practitioners working in
problems information seeking, inter?professional practice development, and other joint decision
making challenges.
Panel Organizer: Peter Pennefather, Leslie Dan Faculty of Pharmacy
Suggested Panel Questions
- How does sensemaking, both as research approach and as theory of human cognition and action, help researchers study, understand and explain problems of complex collective action?
- Can consideration of the information seeking and communicative tasks expressed as sensemaking better inform how media technology can be adapted to better serve collaborative professional service delivery?
- A significant stream of research finds sensemaking adopted to explain observations in collaborative work situations, where individuals seek information and resources to help resolve shared concerns and uncertainties with regards to disease treatment or health research issues. What do these attempts have in common?
- In healthcare research two major, divergent perspectives both aimed at improving practice outcomes compete for practitioner adoption: evidence?based medicine and patient?centered practice. The former seeks to establish the certainty with which a claim about the outcome of a practice can be trusted, yet the evaluation of whether that claim is applicable within the context of a particular intervention with a particular person can be best described as sensemaking process. The patient?centered school embraces dialogic and hermeneutic modes of evidence about human responses to service individual concerns, yet sensemaking studies are rarely employed in that domain of inquiry. In information technology, these perspectives appear as systems vs. user-centered design, and overall these are framed as positivist and interpretive. Can the concept of sensemaking serve as a bridge between these two horizons of knowledge?
- We find more sensemaking research in information seeking and online media practices, where the methods are perhaps best understood. But the problems of collaborative healthcare practice are only partially described by their relationship to information and media. How can current models of sensemaking support a robust model of making sense in collaborative problem/concern resolution or identification.
- While some new media services self?describe as sensemaking resources, their relationship to actual theories of sensemaking are tenuous at best. How can knowledge media designers and researchers into practices and technologies in that field use sensemaking as a theoretical framework for guiding their work?
- One of the most significant directions in sensemaking research has been the full adoption and integration of the naturalistic view of expert decision making into cognitive theories of skilled practice. Sensemaking has changed decision theory, but has sensemaking theory been changed in turn by integrating new formulations that enhance understandings in decision sciences? as a manifestation of pattern recognition that can only be viewed as “making sense of a situation.”
- Sensemaking has also recently influenced design thinking and theories of design oriented problem solving. Recent publications have associated sensemaking with abductive reasoning in design thinking, and have characterized the process of unpacking complex situations for the purposes of making effective design decisions as explicitly a sensemaking method. Designers speak of “visual sensemaking” as a new method for clarifying issues identified in so?called wicked problems. These design practices are contributing new media forms that may be repurposed to help facilitate the social engagement necessary to make sense of those problems.
Please join us April 22 at U of Toronto’s Bissell 205, for the lecture and for the workshop.
By Designdialogues, on March 31st, 2010
Simple shifts in user interface technology and interaction style can make a huge difference in long term for IT, web applications, and software design. The GUI has been in constant use in consumer software since the 1980′s Mac, with early 90′s Windows 3.0 mainstreaming the GUI. While numerous interaction designers have foretold the death of the GUI, they really haven’t had much to replace it with.
A decade ago it was voice, which I never bothered to even respond to. Voice will always have limitations, as it places too heavy a cognitive burden of vocal precision and thinking on the human speaker. We would have to transform our literate, objectified culture to an interpretive, oral culture to use voice UIs effectively.
The GUI as we know it took a decade to research, another to establish, and another to mainstream. The gestural touch UIs will probably last as long.
Why is this important for healthcare interaction design? First, we might recognize that design technology does not drive adoption. If we innovate a better device or interface than the status quo, usability and universal adoption do not necessarily follow. Consider this from an activity systems view. People have jobs to do with IT, with their motivated outcome (work product) as a critical goal of any collection of interactions. They must buy, install, learn, and integrate hardware and software to fulfill these outcomes. Changes cost, time and cognitive burden.
Every interaction involves trade-offs between platform, access, bandwidth response, application complexity, data entry and data (content) interaction, and the expected output. If any of these fail, the whole system fails. All of these functions are enabled by sub-cognitive operations that are committed to repertoire. Learning new interaction modes requires the inter-actor to rethink how work is done. Sub-cognitive operations are now tedious actions, followed step by step. Multitasking becomes impossible while learning or using the new techniques. The (clinical) activity itself may be affected by the change.
Clinicians are thought to be conservative IT adopters (on the whole) because they don’t pick up every new device, and there is this mistaken notion that they are savvy IT users, because they are smart professionals who work in high-tech locations. My research with specialists and residents shows that more senior docs actually use smartphones less than ever, not more than ever, at least for clinical IT. Yes, there’s interest and better apps will make a difference. But on the whole, doctors use the phones to talk, and the hospital computers to look things up. Residents love smartphones when they are learning things, but once they have learned their procedures and are doing the work, there is less time to search, and less need to use the smartphone for lookups. I mean, you try scanning an EMR record on an iPhone!
So that brings us to the iPad. 
A recent contributor from iMedicalApps in KevinMD (recommended) explains Why healthcare may not embrace the iPad. After reading the piece you may come to the conclusion that the early survey research is sketchy and it is too early to make the case either way. The study they base this on is:
According to the Software Advice survey, the medical community wants a tablet, with a third of respondents saying that they are likely to purchase a tablet. For over half of respondents, the primary factor that would guide their purchasing decision would be ease of use, with a fifth identifying software as their guiding factor. Why do they want it? Over 75% of respondents identified diagnostics management (ordering/tracking tests), medical reference, clinical decision support, prescribing, imaging, and notes as tasks they would like to perform on their tablet. As you read this, an obvious question arises – these are all things the iPad could probably do well, so where does the survey go wrong for the iPad?
The survey also explores the must-have features for a tablet, with over 50% identifying Wi-Fi, durability, lightweight, availability of medical software, and fingerprint access as essential features. Fewer respondents also identified dictation capabilities, RFID reader, camera, and barcode scanning as must-have features. While the iPad clearly does fares well with regards to some of these criteria (weight, Wi-Fi, usability), it lacks most of these identified must-have features. And these are certainly features that many, including us at iMedicalApps, have discussed as notable deficits when it comes to the iPad in healthcare.
They note this was a small survey (175) with only half clinicians. What’s missing here is context. “Apps” are not enough. The tablet must fit the style of practice. must be fully compatible with the institutional network (not just “wifi”), and must support, or at least not conflict, with mission critical IT such as EMR, order entry, test and imaging. It must fit in the white lab coat or smock pocket. It must seamlessly synch (not iTunes). It must take calls and show voicemails.
Eventually there will be a tablet that will integrate with the institutional infrastructure, But by then, there may be an open-architecture tablet that follows the iPad, is designed as a clean-surface device, with voice and remote gestures. The ubiquitous touch device presents problems in an environment where users where latex gloves or must be careful about persistent touches on a mobile device that transports between hospital locations. There may be real clinical reasons the Apple iPad is not adopted in healthcare, and the issues raised in the survey don’t yet touch on these. What do you think?
Join the Design for Care community and share your thoughts with nearly 300 designers and clinicians.
By Designdialogues, on March 26th, 2010
Appearing on the DiabetesMine community site, I’ve been asked to participate as a juror on their diabetes innovation contest. Here’s why:
Peter Jones may have a common name, but he’s a rare animal. He’s one of the few academic design experts focusing specifically on the user experience in healthcare. And we are delighted to welcome him this year as one of our expert judges for the 2010 DiabetesMine Design Challenge!
FYI, Peter has a PhD in Design and Innovation Management, and publishes research in organizational behavior, strategic innovation, and human information interaction as a visiting scholar at the Laboratory for Collaborative Diagnostics at The University of Toronto. He also runs his own consultancy, Redesign Research, and is currently writing a book.
Today, his perspectives on how improved design can help change healthcare for the better:
DBMine) Peter, you run an online community called Design for Care and are writing a book about “enhancing the human experience of health” through design. Why is all this necessary? What would you say has been missing that we’re looking for?
PJ) Design for Care is a response to the confusing array of design approaches being used in healthcare, ranging from basic user experience from web design to human factors engineering for critical medical devices. Healthcare is such a massively distributed enterprise, and much of the real innovation work is invisible.
For example, Clayton Christensen’s book, the Innovator’s Prescription, is all about policy and systemic change. Most of the big healthcare design conferences are architectural, and promote environmental and interior design approaches. The Health 2.0 movement is pushed by web services used by consumers. The current move to eHealth Records systems will lock institutions into massive IT infrastructures for the next decade or more. Systems and services are all talking about healthcare, but are missing the point of care.
The human experience of health is something every system or design intervention should care about. It’s a value that replaces “user centered,” for me anyway, since I cannot find any “users” when I explore healthcare situations. I find people — professionals and people seeking their help — making sense of changes in their personal health experience.
Find the rest of the interview at DiabetesMine:
By Designdialogues, on March 3rd, 2010
We previewed this opportunity a month ago, but now its live. Design for Care community member and DiabetesMine founder Amy Tenderich founded and leads this contest. I am a judge on the review panel for entries, and I promise to be impartial if your proposal comes our way.
There are 3 prizes of $7000 each, an extraordinary award. Winners will also get help from IDEO (and others) to design and produce their concept.
You have two months to conceive and prepare an audacious, health-changing service or device for people with diabetes or clinicians. The details are in the linked press release 2010 Contest press release – FINAL.
DiabetesMine™, a leading informational and community web site for people with diabetes, today announced kickoff of the 2010 DiabetesMine Design Challenge, a competition designed to foster innovation in diabetes design and encourage creative new tools that will improve life with diabetes.
This annual web-based competition is hosted at diabetesmine.com/designcontest, and is underwritten by the California HealthCare Foundation (CHCF), an independent philanthropy committed to improving the way health care is delivered and financed in California and beyond. It is also endorsed by Medgadget.com, the Internet journal of emerging medical technologies, and supported by the global design and innovation firm IDEO, with headquarters in Palo Alto, CA.
You have till April 30. Help design a better life for people with diabetes.
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A Peter Jones Publication Blogs have evolved into several popular forms - mine is an old-school online publication of written works in progress. While the topics range widely, they reveal my interest in understanding the emerging social meaning of technology in use, finding better ways of designing for knowledge and organizational practices, and progressive interpretations of systemic innovation.
The title is meaningful - I see design processes as dialogic. Not just iterative, but design as languaging, both verbal & visual. We co-create & co-interpret in shared languages. A dialogic orientation requires we discover and appreciate the perspectives of all participants in a socio-technical system. Dialogue is performative designing - it requires both discipline and improvisation, to enable emergence of new meaning in human systems.
We hold these dialogues every 2nd Wednesday in Toronto:
Realize that dialogue has occurred when speaking leads to a new state of mutual understanding, and right action arises. This is also the purpose of designing.
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