Wednesday, 19 September 2012

Encountering information: serendipity or overload?

After my keynote at ISIC, one of the participants challenged me on my claim that information overload is a "bad thing" (not that I put it quite like that, but I certainly suggested it was something to be avoided). I framed it as a challenge when trying to design to support serendipity. We had an extended discussion about this later that day.

What Eva made me realise (thanks, Eva!) is that encountering exactly the same information can be regarded positively or negatively depending on the circumstances and the attitude of mind. If the attitude is one of exploring and of opportunity then the experience is typically positive. Eva consumes information enthusiastically on a wide variety of topics, and rarely if ever feels overloaded by the sheer volume of information available.

Whether or not information encountering is regarded as serendipitous is another question. A while ago, I gave a PechaKucha talk on the SerenA project; in the talk, I gave an example that I argue was serendipity: I encountered information that was unexpected, where I made a connection between my ambitions and an opportunity that was presenting itself, and from which the outcome was valuable. I also described the "sandpit" process that initiated SerenA – i.e., putting a bunch of academics together in a space that was conducive to ideas generation. Arguably, this experience was positive and creative, but not serendipitous, because it was designed to lead to positive outcomes. So although we could not have predicted the form of the outcome, we expected there to be an unanticipated outcome. So it wasn't serendipitous. Based on our empirical studies of serendipitous experiences, we have developed a process model of serendipity, namely that "a new connection is made that involves a mix of unexpectedness and insight and has the potential to lead to a valuable outcome. Projections are made on the potential value of the outcome and actions are taken to exploit the connection, leading to an (unanticipated) valuable outcome." From this, we also developed a classification framework
based on different mixes of unexpectedness, insight and value that define a “serendipity space” encompassing different “strengths” of serendipity.

So where does information overload fit? Well, as a busy academic, typical of many busy people, new information (however valuable) often represents new obligations:
  •  to assimilate the information,
  •  to assess its value, and
  •  to act on it. 
I recognise the potential value of opportunities, and feel frustrated by my lack of capacity to exploit them all. And because of limited capacity, every opportunity taken means other opportunities that have to be passed over. In addition, limited memory means that even assimilating all the information I "should" know represents a substantial obligation that I can't hope to fulfill. So I feel under constant threat of information overload. And that seriously inhibits my openness to serendipitous encounters.

As recounted in the PechaKucha talk: twenty-something years ago, when my children were 2 years and 3 months old respectively, I came across an advert for a PhD studentship. It was my "dream" studentship, on an exciting topic and in the perfect location for me. Doing a PhD was not in my plans at the time, but was too good an opportunity to miss. And the outcome has been fantastic. It was unquestionably a serendipitous encounter. Apart from the unintended consequence that I now feel constantly under threat of total information overload!

Wednesday, 12 September 2012

The Hillsborough report 23 years on

I'm listening right now to the news report on the review of the Hillsborough disaster from 23 years. ago. I have heard terms including "betrayed", "dreadful mistakes were made", "lies" and "shift blame" (all BBC News at Ten). There is talk of "cover up", and people not admitting to mistakes made.

Families of the victims seem to be saying that they were never looking for compensation but that they wanted to be heard, and they want to know the truth. Being heard seems to be so important; if we do not hear then we do not learn; if we do not learn then we cannot change practices for the better. Maybe for some compensation is important, but for many others all that matters is that the tragedy should not have been in vain.

Earlier today, in a different context, a colleague was arguing that we need people to be "accountable" for their actions and decisions, that people need to be punished for mistakes. But we all make mistakes, repeatedly and often amusingly; for example, this evening, I phoned one daughter thinking I was phoning the other one, and because I was so sure I knew who I was talking to, and because we have a lot of "common ground", it took us both a while to realise my error. We could both laugh about it. Errordiary documents lots of equally amusing mistakes. But occasionally, mistakes have unfortunate consequences. Hillsborough is a stark reminder of this. Does unfortunate consequences automatically mean that the people who made mistakes should be punished for them? Surely covering up mistakes is even more serious than making errors in the first place. How much could we have learned (and how much easier would it have been for families to have recovered) if those responsible had not covered up and avoided being accountable? Here, I want to use the term "accountable" in a much more positive sense, meaning that they were able to account for the decisions that they made, based on the information and goals that they had at the time.

Being accountable currently seems to be about assigning blame; maybe this is sometimes appropriate – particularly if the individual or organisation in question has not learned from previous analogous incidents. But maybe sometimes learning from mistakes is of more long term value than punishing people for them. That implies a different understanding of "accountable". We need to find a better balance between blame and learning. Unless I am much mistaken.

Friday, 7 September 2012

Patients' perceptions of infusion devices

Having recently had two friends-and-relations in hospitals on infusion pumps (and one on a syringe driver too), I have become even more aware of the need to take patients' experiences into account when thinking about the design of devices. To the best of my knowledge, there have been no situated studies of patients' perceptions of infusion devices. I should emphasise that this is not a formal study: just an account of two articulate people's experiences of having glucose, saline and insulin administered via infusion devices.

Alf (not his real name) felt imprisoned in his bed by the fact that the devices were plugged in to the wall. He hated being confined to bed, and would have been perfectly capable of making it to the bathroom if he hadn't felt attached to the wall. He didn't like to ask the staff whether the devices could run on battery for a while so that he could move around.

This contrasts with stories that others have told us: of patients being seen out with their infusion devices having a smoke outside the hospital, chatting up a fellow patient in the sunshine, and even going to Tesco's to do some shopping with drip stand in tow. I suspect this reflects people's amount of experience of receiving medication via infusion devices.

It also contrasts with some of our observations in situated studies, where we have found that devices are run on battery for extended periods of time because there are too few sockets available, or simply to allow the patient to move around more freely.

Manufacturers generally take the view that devices should remain on mains power except for very short periods, which is a position somewhere between Alf's sense of imprisonment and some other observations. As pumps get smaller and more portable, it should be possible for patients to feel less imprisoned by their devices, but this creates new challenges of improving battery life, adapting the physical form of stands to make them easier to move around with, and making sure that batteries get re-charged reliably (which depends on there being sufficient power sockets as well as good notifications of when charge is getting low).

Bert has a cannula in the crook of his elbow, and almost every time he moves his arm it sets off the occlusion alarm. He has learned to silence it, but it only stays silent for a short period and then alarms again (he hasn't worked out how to restart the pump). In a previous informal observation, we noted the same problem; because patients are not meant to touch their own device controls, nurses are understandably reluctant to tell patients how to restart them; in the previous observation, we found that knowledge of how to restart the pump was passed around the ward by the patients who had been in there for a while to the more recent arrivals. Some pumps will automatically detect that the occlusion has been cleared and restart themselves.

However, Bert hates having this happen while he's eating, and would really like to be able to suspend the infusion while he eats, then restart it again afterwards. In our observations, we have noted pump operation being suspended while the patient has a shower: nursing staff are able to achieve this effect, but the patient himself is not. Bert feels capable of taking responsibility for more of his own care than he is being permitted to, and finds that frustrating.

The one-size-fits-all approach to infusion device design, which removes both power and responsibility from the patient (who often has the time and the intelligence to take a more active role in their own care) may improve safety by reducing variability. However,  it may also reduce resilience and it definitely degrades the quality of the patient experience by concentrating
it all on busy, multi-tasking clinical staff.

Sunday, 2 September 2012

Situated interaction from the system perspective: oops!

I am in Tokyo, to give a talk at Information Seeking In Context. Blogger infers that because a post is being composed in Tokyo, the author must understand Kanji. Result:

I have just experimented by pressing random buttons to enlarge the screen shot above from its default illegible size. It is quite gratifying to discover that it is still possible to compose a post, add a link, add a graphic, and maybe even publish it as intended. But believe me: it's taking a lot of effort. I am interacting with what appear to me to be squiggles (though of course those squiggles have meaning for readers of Kanji), and I can only guess the meaning from the graphical layout and positioning of the squiggles.

This is an amusing illustration of the dangers of computing technology being inappropriately "situated". The system has responded to the "place" aspect of the context while not adequately accounting for the "user" aspect. I fully accept that the physical environment presents information to me in Kanji, and that I sometimes fail to interpret it correctly. I don't expect the digital environment to put the same hurdles in my way!