Health Technology Development and Use: From Practice‐bound Imagination to Evolving Impacts

Citation

Mozaffar, H. (2011), "Health Technology Development and Use: From Practice‐bound Imagination to Evolving Impacts", Information Technology & People, Vol. 24 No. 2, pp. 199-202. https://doi.org/10.1108/09593841111137377

Health Technology Development and Use is about the formation and diffusion of healthcare technologies and their social implications. This volume examines three types of technological innovations: innovation initiated by earlier experiences of designers, user‐led innovation (transformed to evolutionary co‐design) and radical innovation of a technology. The central theme that runs throughout the entire volume evolves around the “biographies” of technology and user‐developer interaction and their implications on the design of the product by placing activity and practice at the centre of analysis.

Sampsa Hyysalo in this book accepts the existence of a link between users and developers in shaping of technology and argues that the intensity of user‐producer relationship and dimensions of innovation from incremental to radical vary from one case to another. To study these diversities, the book is divided into three parts. The first part describes the theories and methodologies supporting the book. It is comprised of two chapters that expound major settings for the studies to be followed.

The second part of the book presents empirical findings of the longstanding empirical work of the author. Vivago‐Wristcare (a Telecare system) is examined at different levels of analysis from the early stages of its foundation through its use. The study traces the complex trajectory of the product across decades back to the 1970s. The author presents a number of longitudinal studies starting with an analytical birds‐eye view of years of Vivago‐Wristcare formation followed by studies of second generations of Vivago‐Wristcare with a closer look at the interactions for “designing usage”. The author develops the concept of Practice‐bound imagination (PBI) by stressing on the fact that invention of Vivago‐Wristcare demanded multiple creative insights and knowledge to advance the technology which could not be obtained simply by using earlier concepts, such as Bijker's Social Construction of Technology concept of technological frame and sameness of meanings for social groups. The author also examined Vivago‐Wristcare at a micro‐level, illustrating the evolution of ideas during the design process as well as the appearance point of design initiatives in the technology development process. To follow up this comprehensive examination of Vivago‐Wristcare, the author studied it as used by its users who often do not share the enthusiasm, skills and values of designers through the concept of “project”, adapted from McLaughlin et al. (1999). In doing so, the author demonstrates how technology features in the lives of its adopters and how its use is gradually constructed by end users. This part in particular throws light on the influence of users in the shaping of technology, in spite of the lack of their direct interest in design and use of the new system.

This comprehensive part of the book shows that the need for Vivago‐Wristcare is historically constructed by the change of social lifestyles as well as economic and political factors. It demonstrates that the practice of shaping technology is done through action and interaction. From the learning perspective, effects of using different methods on representation of use can be extracted from the analysis of Vivago‐Wristcare in these chapters. The author shows that during the design sessions users learnt by the trial of future technologies, first in a formal way, followed by a more informal interactions which were then turned into new design or use procedures and consequently influenced the technology. Healthcare technologies discussed here, just like many other technologies such as ERP systems, show a trend of formal interaction (during the early stages of design) becoming informal but more intensive (during the development) and turning back to formal (after the product launch) again. This excellent part of the book suggests that a strong link exits between using, learning and innovating which will in turn influence the development of artefacts. This indicates that knowledge and practice are inseparable and should act collectively. However these chapters have focussed on a specific type of innovation. Therefore the author has taken his studies further in part three of the book to give theoretically and empirically grounded insight into some other factors surrounding other types of innovation.

The third part of the book compares biographies of technology and designer‐user relations of two other types of technology in the healthcare industry. It introduces some issues that are of higher significance in their innovation context – such as transfer of power and regulatory issues. Overall, different contexts of innovation used in this part empirically points to the existence of different innovation drivers based on the types and sources of innovation. It shows that innovation emerges in various ways ranging from the sense of need for change to engagement of human and artefacts.

The study is rich in details and reveals the influence of actors on the technology. The PBI concept used in these cases goes beyond a single frame of analysis. By this the author brings to light that innovation is an interactive process requiring action and insight from designers, users and regulators which to be analysed fully must be viewed from multiple frames. This paints a clear picture of the need for broadening the study of artefacts from a single locale and time to multiple locales and at different timeframes. This is not the only shift in methods that is made. Sampsa Hyysalo also painstakingly made a powerful demonstration of the use of several different methods of conducting research on the same artefact.

This book provides a description of user‐led innovation by presenting numerous cases where users of technology have drawn implications of the system which had never occurred to designers. This work chimes well with Fleck's (1988) concept of innofusion indicating that the innovation of an artefact goes beyond research and development lab and continues as products are implemented and used (Fleck, 1988) and also Williams et al.'s (2005) research suggesting that analysis of design is located in multiple cycles of technology: design, implementation and use. However the author shows that not all user innovations are transformed into usable products, in contrast they follow one of the two different routes. They are either filed, for possible future use, or incorporated into next versions of the product. In both cases it is a matter of the designers and producers' decision on what would happen to the new invention by the user. This is an indication of the social shaping of technology. However it also indicates that not all social inputs and user‐led inventions are included in the final product which in turn reveals the impact of supplier power over technology shaping. This leads to a set of questions yet to be explored, for instance how are these inventions filed and organized? What happens to the filed inventions? Do they ever get reviewed to be considered as future technologies? On what basis are they reviewed?

Furthermore the author broadens his research from a single perspective of use, e.g. by home help staff, to cover many different possible uses and users of the technology. In this manner, he touches on the fact that different uses of the same technology could lead to diverse extents of enthusiasm and ability to influence the product. This gives rise to another perspective on the user‐led innovation literature, showing that variation of the use of the same technology, changes the degree of user‐led innovation.

Health Technology Development and Use is a theoretically and empirically valuable academic work. The author follows the biographies of artefacts, in particular the Vivago Wristcare, through time and space which resonates with the work of Pollock and William (2008) in that investigation of an artefact should be followed in multiple locales and historical timeframes. The comprehensive use of different approaches, ethnography, survey, interviews, historical enquiry, etc. in long time‐frames in this book shows the appropriateness of each method in a different locale in time and also provides an opportunity to compare the results obtained from each approach in a single project. Moreover unlike many other studies where technology development is either looked at in a very fine‐grained way or from a coarse‐grained angle, by using these range of approaches this study uses a wide lens to capture different moments of time and sites as well as a narrow lens to address the details of the interactions. This is coherent with the “biographies of technology and practice indicated in the second chapter: Intertwining multiple time frames and focal points of analysis” (p. 40).

The book brings to light that more complex research design is necessary in exploring artefacts and shows how many of the current studies that do not utilize such an approach give a partial understanding of the technology. Likewise, in an attempt to achieve this, the book presents techniques of using different methods collectively. However careful consideration is required on how to engage such an approach in short‐term research and consider the implications of the maturity of artefacts as well as their application in different spaces in a shorter timeframe.

Finally the book is a fruitful theoretical and empirical attempt to open the “black box” of technology by analytically evaluating the interplay and feedback cycles between users and developers. Furthermore, it sheds light on the varying degree of openness and closeness of innovation in different contexts and aids increasing the understanding of the processes involved in designing innovative artefacts for those who are interested in social shaping of technology and designers and developers of healthcare technology.