Opbevaring af bedre-bevarede faner

Rapid Ethnography
– The Study of Behavior, Communication, and Context in Cosmetic
Surgery Consultations and the Design of a New Medical Device
Psychologists and Human Factors Specialists,
MSc Betina Rangstrup and MA Thomas Koester
FORCE Technology, Department of Applied Psychology
Design Engineer Malene Nibe, Danish Technological Institute
BSc (Psych) Tille Vedel Schøler, Aalborg University
Adjusting expectations
• This presentation is not about patient safety, human error, failure
or risk
• But it is about a consumer health care technology in a setting
where adjustment of expectations and patient satisfaction is of
extreme importance
•
•
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Work in progress – testing a prototype
Drawing the whole picture – not going into detail
Presenting examples from our work process
A case study in application of rapid ethnography
The context
Pre-surgery consultation for cosmetic
breast augmentation
The problem
From the perspective of the patient: Many choices to make
What hospital or clinic?
What surgeon (confidence and trust)?
What implant material (silicone or saline)?
What shape (round or anatomical)?
What projection/profile?
What size?
How will I look after surgery?
Illustrations: www.eurosilicone.com
The solution
3D Surgery is a decision support tool based on 3D computer visualization technology
Illustrating how the result may look
Based on realistic surgery results from database rather than morphing (competing technologies)
3D
Surgery
The SEPTIGON model applied as framework for understanding pre-surgery consultations for
cosmetic breast augmentation
Gender, age, personality, social background, etc.
Emotional state and behaviour. Pre-consultation
decision process and motivation. Opinions,
knowledge, expectations and wishes for
consultation, surgery and surgical outcome
Surgical preferences, competence and
values. Previous experiences and plan for
consultation process and own role in
decision process (Surgeon). Emotional
states and behaviour. Opinions,
knowledge, expectations and wishes for
consultation, surgery and surgical
outcome
Patient
Artifacts within the
consultation room
Surgeon
Friends, relatives,
spouse
Measuring instruments, computer, implants, mirror,
3D Surgery, etc.
Consultation room
Society and culture
Trends, body image, norms, media, aesthetic
surgery culture
Space, spacing, light, noise, temperature, electricity
provided, also used for, ownership, etc.
Time, structure, law and regulations, purpose and
content
Consultation process
Hospital
Profile, branding, prices, values, goals, finance,
organisational culture, employees, management,
etc.
Ref.: Koester, T. (2007). Terminology Work in Maritime Human Factors. Situations and Socio-Technical Systems. Copenhagen: Frydenlund Publishers.
Our job
Understand 3D Surgery Prototype in the context of use
Understand how 3D Surgery Prototype is perceived by users (patient and surgeon)
Give inputs to the design process (both software and hardware)
Give inputs to the future use of 3D Surgery (and to instructions for use)
Outline of our work process
Data analysis, SEPTIGON model
Design
recommendations
Field study, video stimulated recall interview
User tests, participatory observation, verbal selfreporting protocol and heuristic evaluation
Data analysis, theater reference frame and
decision making theory
Design
recommendations
Design
recommendations
Ongoing prototype development
Field observations, rapid ethnography
Methodological approach: Data and results are used both in fine
tuning of our instrument and in the design process
Our instrument
Method
Method
Our data and results
Rapid ethnography
Composite methods
Insights
Data analysis
framework
Psychological
theory
Theater reference frame
Design
observations,
comments and
recommendations
Decision making theory
Not rolling out a fixed or standardized method – but continuously adjusting choice and application of
method according to the insights we get through the process
Rapid Ethnography
1.
Rapid ethnography
2.
3.
Composite methods
Theater reference frame
Decision making theory
Two observes, discussion of
observations
Use of key informants
Hours or days rather than weeks or
months
First insights: The rapid ethnography data analysis
1. General understanding of the user context and how it could be investigated further using composite
methods
2. Finding that the consultation consisted of an elaborate interactional process between surgeon and
patient and with the use of several artifacts
3. Finding that the interactional content of the consultation could mainly be understood as a decision
making process (into which the 3D Surgery equipment was to play an important part)
First design observations, comments and recommendations
Kommen Dato
tar No.
1 jun-12
Setup relevans Baggrund
Design(Grymer, OUH, Observation (O) område
alle)
Udsagn læge eller
læge testperson (L
eller LT)
Udsagn patient (P)
Teori (T)
Bruger
Beskrivelse
(Læge = L
Patient = P)
Grymer
PL
O, L, P
Software
2 jun-12
Grymer
O
Software
PL
3 jun-12
Alle
O
Software
PL
4 jun-12
5 jun-12
Grymer
Alle
O
O
Hardware
P
Anvendelse og P
instruktion
Designanbefaling
Kameraet fremstiller kun 3D foto af torsoen, men Det kan eventuelt undersøges, hvorvidt det er muligt at inkludere en
patientens vurdering af brystets størrelse i forhold del af hoften, når der fotograferes. Der er dog stor sandsynlighed for,
til kroppen er baseret på en helhedsvurdering.
at dette vil blive for besværligt, særligt ift. Shape Modellen.
Alternative løsninger, hvor billedet af patienten kombineres med
billederne i databasen til en samlet fremstilling kan undersøges. Se
også kommentar no. 43
Det er usikkert, hvordan og hvor præcist
Er der eventuelt brug for optegning ved lav kontrast mellem
kameraet registrerer brystvorten.
brystvorte og hudfarve?
Det ses ved brystløft og brystformindskende
operationer, at der ofte sker en reducering af
brystvortens størrelse, hvilket har en stor
betydning for det visuelle resultat.
Der er mulighed for at patienten indtager to helt
forskellige kropsholdninger ved fotografering før
og efter operationen – og at dette har
konsekvenser for 3D billede og databaseindhold.
Patienten oplever at modtage en stor mængde
information under konsultationen, og der er
derfor risiko for ”information overload”.
Det kunne være væsentligt at teknologien er gearet til at
forventningsafstemme omkring størrelsen på brystvorten, fx kunne
man forestille sig mulighed for at justere størrelsen på det
genererede billede i Shape Modellen.
Betydningen af kropsholdning for billede og volumen skal
kortlægges. En mulighed, man kunne overveje, er at lave 3D foto
med patienten stående udstrakt op ad en væg i lighed med når man
skal måle legemshøjde. Se også kommentar no. 44.
Det skal være muligt at give en simpel og letforståelig forklaring til
patienten af hvad formålet med 3D-foto er.
Prioritet
Høj = umiddelbart
væsentligt for
funktionalitet
Trivision kommentar
Mellem = væsentligt
(dato + tekst)
når teknologi
funktionel
Lav = skal overvejes
ift. endeligt produkt
Lav
Mellem
Man kan formentlig sætte en hofte på - på samme måde som vi laver en
kunstig ryg
Systemet giver et bud på brystvortens omkreds men operatøren har
ansvaret for at optegningen går godt.
Lav
OK - burde være muligt.
Høj
OK - dette har ikke betydning for softwaren. Men det er oplagt at lægen
indfører de rutiner der går mod et bedre resultat.
Høj
Hvordan?
Har I et bud?
Composite methods: The field study
1.
Rapid ethnography
2.
Composite methods
3.
4.
Theater reference frame
Decision making theory
Combined observation and video
stimulated recall interview
Ecological validity (“almost real”
patient and real surgeon)
Continuous evaluation of realism by
surgeon and patient
Regular usability tests with
participatory observation, verbal
self-reporting protocol and heuristic
evaluation
Second insights: The field study data analysis
1. Further understanding of the user context
2. Confirmation of relevance for applying a theater reference frame for further analysis in relation to the
interactional process
3. Confirmation of relevance for applying psychological decision making theories for further analysis in
relation to the decision making process
Second design observations, comments and recommendations
26 8.2.13
Alle
(Grymer)
LT
Software
L
Program 1: LT forstår ikke helt rækkefølgen, da Navngivningen i programmet skal være enslydende
anvisningen ikke har samme navn som skærmen
- reflektorer/mærker (se billede)
Høj
27 8.2.13
Alle
(Grymer)
LT
28 8.2.13
Grymer
(Grymer)
LT
29 8.2.13
Grymer
(Grymer)
LT, O
30 8.2.13
Alle
(Grymer)
LT, O
Software
Software
Software
Software
L
L
PL
L
Program 1: LT kunne godt ønske sig en knap der Selvom der er to programmer, bør det gøres til en oplevelse af ét
hed ”vis målinger” der gik over i program 2
program for brugeren
fremfor at det skal åbnes separat
Program 1: Begge brugere undrer sig over
Hvordan er man kommet frem til det nødvendige antal prikker i
antallet af prikker i siden, og synes det er mange. siden? Kan der blive færre?
Hvor mange prikker nødvendige i siden (se
billede), jo flere markeringer der skal foretages,
jo længere tid tager det.
Program 2: Påfyldning af volumen: det ser ud
Vi regner med dette er en præmatur funktion og ikke bud på den
som om brystet kun vokser ud ad – ikke til siden endelige fremstilling
og i midten
Hjælpeteksten er rettet fra reflektor til mærker (skal muligvis ændres fra
mærker til noget helt tredje?).
Mellem
Der er indført en knap der "hopper" til 3D doctor og indlæser aktuelle
patient og model.
Mellem
Vi arbejder på at indføre en autodetektion af konturen. Dermed burde
det ikke gøre noget at antallet af konturpunkter er højt (med mindre
auto detektionen fejler ofte). Vi vil dog også reducere antallet af punkter
nu.
Lav
Korrekt
Høj
På OUH anvendes et program der "låser" musen til en desktop, så den
ikke kan komme ud på projektorene. Dette program installeres på
Grymer-maskinen.
Se dog også punkt 18.
Program 2: Musen kan forsvinde ud af skærmen, Musen bør ikke kunne forsvinde ud af skærmen.
så den ikke er til at finde. Dette er tidskrævende
og et irritationsmoment
Theater reference frame
•
Rapid ethnography
•
Composite methods
•
•
Theater reference frame
Decision making theory
Idea derived from the rapid
ethnography analysis
Idea further refined in the
composite method analysis
Theoretical background inspired by
Goffman
Chosen for its explanatory power
Theater reference frame
•
•
•
•
•
•
•
•
•
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Scene
Props and scenography
Actors and spectators
Roles and shift of roles
Lines
Manuscript
Improvisation
Dramaturgy
Choreography
Frontstage, backstage
Theater Reference Frame Insights: Dramaturgy
1. Introduction "Setting the scene"
a. From waiting room to consultation room
b. Patient’s background for wanting surgery
c. Patient health status questionaire
2. Surgical information "Presenting the product"
a. The implants - type and
material
b. Surgical techniques and
implant choices
c. Surgical results (before-after
pictures)
d. Before, during and after the
operation
3. Collecting data "Measuring the patient’s body"
a. 3D Surgery picture and measurements
b. Cardio rhythm and blood pressure
4. Shared decision making "Making the right choice"
a. Trying out implants in front of mirror
b. Viewing 3D Surgery Shape Models
5. Outroduction"Contracting"
a. Taking implants and 3D pictures home
b. Booking operation
e. Complications
Theater reference frame results
Waiting time at picture processing:
• Traditional usability pathway: Reduce
waiting time through optimization of
manual picture processing
• Theater approach: Adjust dramaturgy
and choreography, use time slot to
introduce a welcome break for trying
implants in sports bra
• Adjust focus in SW development: From
usability of interface to development of
other features
Theater reference frame results
Props:
• Use of simple props e.g. implants, bra and mirror
for visual appearance with clothes on
• Use of high fidelity props (3D Surgery) for visual
appearance without clothes
• Adjust focus in SW development: No need to put
effort into a “with clothes feature”
• Statement from CM about visual appearance
with/without clothes
Decision making theory
•
Inspired by the distributed cognition paradigm
(Hutchins), shared decision making and
distributed decision making (Chapman et al.)
•
Inspired by the naturalistic decision making
paradigm (Klein): Decision under time
pressure
• Multiple participants
• High-stake consequences
• Unclear goals
• Incomplete information (to be solved by
3D Surgery)
• Uncertainty
• Time pressure
Rapid ethnography
Composite methods
Theater reference frame
Decision making theory
Decision making theory results
Example of outcome from decision making approach
Design recommendation:
Create option for patient to bring selected pictures home on USB memory stick
Effect:
Increasing likelihood of long-term patient satisfaction with surgical choice
Background:
• Important decision / time pressure (consultations often shorter than 1 hour, time to make decision
10-20 minutes)
• Avoiding use of short-cuts and biases in decision making
• Possibility to include spouse, friend etc.
• Facilitating emotional bond with product choice (consumer perspective)
Validation of insights and results
Rapid ethnography
Composite methods
•
•
Theater reference frame
Decision making theory
Follow-up interview with patient
and surgeon
Retrieving comments from
development team
Summary
Our instrument
Method
Method
Our data and results
Rapid ethnography
Composite methods
Insights
Data analysis
framework
Psychological
theory
Theater reference frame
Decision making theory
Design
observations,
comments and
recommendations
Conclusions and lessons learned
1. We find that rapid ethnography with limited time and resources can generate valuable in-depth
contextual enquiries
2. Results are used not only for input to the design process as observations, comments and
recommendations, but also as input to the continuous fine tuning of our repertoire and application
of methods, frameworks and theories in our analysis (method and data triangulation)
3. When employed as part of the design process, a rapid ethnography approach can save otherwise
wasted time and resources for development of superfluous system features
4. Thus, applying a rapid ethnographic approach ensures that even with limited time and resources,
the medical device is designed to create not only a perfect fit for the user, but also for the context
of use.
Contact information
Betina
[email protected]
Thomas
[email protected]
FORCE Technology
Department of Applied Psychology
Copenhagen, Denmark
www.forcetechnology.com