Caught in a Web of Fuzzy Problems, by Ina Wagner
What’s a better chair: this one? Or this one?
What’s a better font: this one? Or this one?
How do you know? Are you so confident in your answer that you’d have no hesitation to impose your taste on other people?
Most of the time, the choices we face as designers aren’t simple selection problems, but are far more complex. They often aren't problems of taste but of practice -- how we perform activities.
In hospitals, surgeries are often scheduled in days or weeks in advance. But people who need surgery are sometimes too sick to have an operation. Urgent cases need to take priority. Operating theatres, and teams of doctors and nurses who will perform the operation, are often only scheduled the day before. Even then, things can change on the day. Ina Wagner wrote about this in her paper “Caught in a Web of Fuzzy Problems” which was published in the Proceedings of the 1992 Participatory Design Conference.
The Participatory Design Conference (PDC) is a biannual conference of academics and practitioners who have a common interest in participatory design. Another term for the same approach is co-design. Presentations at academic conferences, unlike practitioner conferences, are often accompanied by written papers. Those papers are often published in a book called the Proceedings.
At PDC ’92 Ina Wagner presented on how a clinic in a “large university hospital” scheduled operations:
“A research project was set up in which the clinic’s social practices of managing time were studied in depth, with the objective to help identify high-leverage factors for the design of supportive technology.”
The clinic uses a paper book to support their time management practices (remember this was 1992). A senior surgeon decides how to manage the daily detail of surgery bookings. This surgeon knows the capabilities of the other doctors and the nurses, but the decisions for assignments were not made collaboratively. The planning in the book is often abandoned or changed: “due to unrealistic time estimates, unforeseen complications, emergencies and organisational delays”. This is obviously disruptive.
Moving to a computerised system that all the different doctors and nurses could see would make it a little easier to keep up with last minute changes. It's important that people can keep up with these changes because the way the clinic assigns staff to operations isn't how you'd probably expect.
In the clinic, teams of people perform surgery, but it’s not group work. Each person plays their role, but the whole task of surgery flows through them.
After the patient has been brought into the operation theatre, first enters the anaesthesiologist, second the assistant surgeon, third the main surgeon (who finds the patient as an “open field” on who to perform his specialised task) and these persons leave in reverse order. This sequential work order also reflects a hierarchy of knowledge, with the surgeon’s expertise and time being considered more valuable as the knowledge and time of e.g surgical nurses.
Wagner calls this a “pool” arrangement. She says that the pool arrangement leads to a de-prioritisation of the skills of nurses and the anaesthesiologists. The pool positions those professionals as service providers to the surgeons. The pool structure means that patients don’t have consistent contact with one team of carers. Instead, patients move through the pool for different stages of their clinic experience.
Wagner says that there are lots of arguments in favour of a team arrangement rather than the pool system. Nurses would be able to offer more consistent care to patients. The surgeons, anaesthesiologists and nurses would cooperate rather than being directed by the senior surgeon. And then she flips that perspective on its head:
teamwork as a goal is hardly consensual. It is conflicting with many other goals that different groups of actors in a hospital think worthwhile adhering to; e.g. the interest of nurses to preserve distance from surgeons, surgeons’ interest in dividing their time more efficiently between surgery, research, administration and teaching. Teamwork might prove to be a solution to some problems while creating new ones.
A shared calendar system that supports the way the clinic works would not be — could not be — “neutral to these organisational decisions”. A system that supports a team arrangement wouldn’t be useful in a pool system. There is no one true design for supporting the scheduling of surgeries. Any scheduling system has to reflect particular ways of understanding and using time. It has to support certain points of view and eliminate others. Wagner says any scheduling system is unavoidably biased.
What it means in 2020
It’s important for us to realise that as designers we don’t have a neutral point of view. We have a particular expertise and what we value isn’t always what other people value. Designers learn to identify particular kinds of problems and solve them by working in particular ways. We build our values into what we design. Wagner cautions us:
an ethic of social responsibility faces the dilemma that decisions, even when they are rightful in some legalistic sense cannot be considered “good” as long as they are not consensual.
Being a designer comes with a kind of power. Our designs necessarily have a point of view. People do their work and live their lives in what we make. It’s so easy to assume that our taste and values are correct. The power we have as designers means it’s easy to impose our values, our taste, our style, on others. We need to avoid seeing our values as the standard. We need to do all we can to use our power with consent.
Book Recommendation
If you’d like to know more about participatory design and co-design, I strongly recommend Kelly Ann McKercher’s book Beyond Sticky Notes. It’s easy to read and rigorous in its approach. More importantly, it will challenge how you approach your work.
Serious things
Formal reference
Wagner, I. (1992, January). “Caught in a web of fuzzy problems: Confronting the ethical issues in systems design.” In Proceedings of the Participatory Design Conference (pp. 23-30).
Canonical URL
https://ojs.ruc.dk/index.php/pdc/article/view/74/66
Publicly available source
The same as above! We love open access!