Experience Ecology & Machine Oriented Research
When September 2015 - June 2016
Where SOAS, University of London
Research Tools Participant Observation, Research Design
Experiences are not just about individuals. Experiences are created by a multiplicity of elements and has a collective component. How can we make sense of experience beyond the individual through research? Over the course of my PhD project, it became apparent that there was a lack of research tools for understanding the collective ecology and its contribution to experience. Drawing on anthropological techniques like participant observation, I designed my own research tool for investigating ecologies of experience.
Machine Oriented Research (MOR) is new approach to studying experience that combines psychology with anthropological research techniques. This document explains how MOR is applied to a London hospital, and shows the role that paper documents play in:
- Managing patient expectations
- Controlling the flow of physical bodies
This research suggests ways that service designers can make use of this knowledge in their practices.
"In this world, the most prminent casualty is the idea that, while an artefact is a mechanism, it is also a 'strategy' for the concrete and actual governing of the many forces that confront each other in a particular determined field." Renato Troncon
Experience is ecological.
Consider the importance of ambient temperature on every day experience. A few degrees too hot or too cold and an experience becomes unpleasant. Consider all the factors that can contribute to the temperature. To name a few:
- nearby bodies
- air conditioning
- flu virus
This brief list emphasises the range of interconnected factors that contribute to experience.
How can experience research take all of these into account?
Experience Ecology & Machine Oriented Research
Machine Oriented Research is an approach to exploring experience ecologies. By building a deeper understanding of complex situations and experiences, MOR can help Service and UX Designers to develop solutions grounded in local experience ecologies.
The key features of MOR include:
- Putting machines and machinic processes at the centre of experience.
- Using anthropological techniques, particularly participant observation.
- Revealing the collective, non-linear nature of experience.
MOR expands on the service design principles of co-creation and holism. MOR expands on these by insisting that machines are effectively stakeholders in service provision, and by opening up an avenue for them to participate in the design process.
In MOR, the things people interact with are called machines. Machines include devices like computers and software packages, as well objects like paper forms and signs. Because the term covers so many things, we can say that in MOR, everything is a machine.
The main goal of MOR is determining the nature of the experiences these machines are producing when they are working in concert. Unlike a map of a user's journey through an environment, MOR is focused on the ensemble of machines that are consistently found in a given environment. As a result, MOR is ecological rather than individualistic
MOR involves studying the experience ecology of an environment and developing an understanding of the role that machines play in producing the specific configurations of experience related to that environment. Knowledge gained through MOR can add depth to service blueprints and contribute to idea generation.
Case: Front Sheets
Front sheets are single-page documents that contain basic information about the patient: name, date of birth, their GP, and so on. It also includes information about the patient's ethnic group and their occupation. This information is presented in a two-column layout.
Front sheets are prepared from electronic records by the clinic's administrative staff. This usually occurs a few days before the patient is scheduled to arrive.
- Provide an interface between different parts of a patient's consultation and their medical records
- Manage time in the clinic
Front Sheets are perhaps the most powerful objects in terms of regulating the flow and behaviour of both patients and staff while they are in the clinic.
Movement & Information
Front sheets move through the clinic in a prescribed order. The front sheet always precedes the patient's physical journey. Wherever the front sheet goes is where the patient will go next. Patients are never supposed to touch their own front sheet.
When a patient arrives at the clinic, their front sheet is placed on the reception desk. If a patient accidentally picks up the front sheet, the patient will not see the doctor because the clinical staff will not have a visible record that the patient has arrived. In fact, because front sheets are piled on top of each other, potentially several patients will not see the doctor.
It is the responsibility of the nursing staff to collect them from reception. If the reception desk is not crowded, they should be able to notice that new documents are ready from their position at the nurses' station. In fact, when they are not busy, nurses tend to stand against a particular corner wall so that they are both available to patients and can watch for the presence of new documents.
When new front sheets appear, the nurses collect them and distribute them. Outside each clinician's door there is an area reserved for documents. It also has a printed list of all the patients the doctor is due to see on that day. The nurses place the front sheets in a stack in this area according to appointment time, and check the patient off the list.
The stack is not a vertical column, but staggered in such a way that the top quarter of all the documents are visible. In this way an approximate order for the patients can be assessed by looking at the pile and, in addition, it is possible to determine roughly how delayed the clinic is by comparing the current time with the scheduled appointment time at the top of the front most document.
One of the overriding concerns of patients – perhaps of even greater concern for some than their medical treatment – is the amount of time they will have to spend in the clinic. Controlled access to this information is only available with reference to the front sheets. This happens in one of three ways.
When a patient asks how long they are going to be waiting to see the doctor, the only information that they will receive is the number of patients ahead of them for that particular clinician. In order to figure this out the administrator will have to check the pile of front sheets outside that physician's consultation room. Then the patient can be told how many people are ahead. If the front sheet is missing, it is assumed that the consultant has taken the documents into their room for review and preparation before the patient is called, in which case the patient will be told, "It shouldn't be much longer now."
In the main waiting room there is a whiteboard with the estimated waiting time for each doctor. In order to update this board, nurses must compare the front-most patient's scheduled time with the current time in order to estimate the amount of time by which the clinic is delayed. Nursing staff are unwilling to give individual patients an estimation of their projected waiting time, and will only give numbers for the whole clinic. The reason for this is a sense that patients who have been told a specific time will be more likely to become aggravated when that time is proved to be inaccurate, and therefore more likely to file a complaint.
Front sheets also records the time at which the patient actually arrived for their appointment. Because many patients are elderly and arriving via patient transport (which is almost always late), the afternoon clinic is fairly lax about the time when people actually arrive for their appointments. However, recording an arrival time prevents late patients from jumping the queue, and also can be used as a kind of reference for staff to determine whether they are dealing with a particularly demanding or difficult patient if, for instance, a patient shows up late and begins complaining about their waiting time.
Because the front sheets are so important to the flow of patients, any problems with their creation and distribution will cause stress levels among the staff to ramp up very quickly.
Understanding Front Sheets
How can we think about front sheets in terms of experience?
Theory of Experience
Experiences are produced through movements across four different elements, which are designated FΦTU.
- F - (Stratified) Flows - codes, built environment
- T - (Existential) Territories - lived space, the body
- U - (Incorporeal) Universes - art, aesthetics, creative ideas
- Φ - (Abstract Machinic) Phyla - link experiences and the three other elements with each other
Machines - including front sheets - that are observed in practice are concrete machines, combining both Φ and F, but which build links across all four elements. We can describe this link-building in terms of functions.
When considering the front sheet's role in the clinic, we notice two things:
- Information about the patient is encoded on the front sheet.
- The patients physical movement is constrained by the front sheet.
The process of encoding a patient's details involves a move from the existential territory of the patient to a stratified flow. This is a caricaturing movement that reduces the richness of a patient's life to a few details. This is stratification because it stabilises the patient's existence at a particular moment. It fixes the patient's life into a few relevant data points which are used to manage patient's expectations.
The process of constraining a patients physical movement also involves a move from existential territory to a stratified flow. However where as the encoding process concerned information, this process concerns physical matter. A hospital clinic is a site where flows of biomatter – people and diseases – constantly enter, circulate, and leave again. In order for the hospital to function as it does, it must influence these flows and choreograph them. By constraining physical movement, front sheets produce the choreography of an outpatient clinic. They do so according to a logic which is not immediately apparent to the patient. This is stratification because it fixes physical movement to a few specific routes.
What we can see from this analysis is that front sheets are involved in processes which stratify existential territories. As shorthand, we can say that front sheets are disciplining machines. The way in which front sheets act as disciplining machines will be specific to the ecology in question. In the case of the clinic, we can see that the front sheet, as a disciplining machine, is used to control both patients' expectations and physical movements. As a result, we can say that a patient's experience of the ecology of the clinic is partly defined by this disciplining process.
Implications for Design
Thinking about the role that front sheets play as disciplining machines in the ecology of the clinic can help to frame design challenges differently. To be effective, any interventions must consider the need to both manage patient expectations and choreograph their physical movements. Designers should ask:
- Can anything else help manage patient expectations more effectively?
- How else can patient movements be choreographed?
- Can a different machine perform these functions with fewer errors?
- Might the functions of front sheets be combined with other disciplining machines already found in the clinic?
In other words, rather than designing solutions around the experience of individual patients, an ecological approach helps us to think of solutions created from shared elements.
Getting started with MOR
Front sheets are just one example of a single machine found in a specific ecology. A full account of the clinic's experience ecology would involve cataloguing all of the machines and analysing their functions. This can be performed systematically using qualitative research techniques.
Researching machines in an environment involves thinking of them them as participants. Some questions a machine oriented researcher might ask:
- Where is the machine located?
- Is it always in the same place or does it move?
- Is it hidden or accessible?
- How is it put to use?
- Is its usage restricted?
- Is its use associated with certain people or roles?
- How much power does it seem to have?
- Do people defer to the machine or question it?
- What happens when something goes wrong with the machine?
- Which of the elements does it draw on and combine?
- Does it draw on different elements depending on different uses?
- How does it link to other elements of other machines and other contexts?
- Can a more general function be abstracted from its activities?
- Do other machines in the environment have similar functions or roles?
- Can the overall ecology be described in terms of these functions?
MOR is largely based on the work of Félix Guattari, a theorist and practising psychotherapist. Unlike traditional Freudian psychotherapy which tends to be individualistic, Guattari promoted group therapy. Guattari was also influenced by biology, particularly the concept of Autopoiesis or self-production.
Bryant, L.R., 2014. Onto-Cartography: An Ontology of Machines and Media Edinburgh University Press.
Guattari, F., 1989. The three ecologies. New Formations, 8(Summer), pp.131–147.
Troncon, R., 2010. Service Design and Biophilia. In M. Stickdorn & J. Schneider, eds. This is Service Design Thinking. Bis Publishers.
Vilaseca, S.L., 2014. Félix Guattari and urban cultural studies. Journal of Urban Cultural Studies, 1(1), pp.137–144.