Sensemaking and Human-Centred Design: a Practice Perspective
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SENSEMAKING AND HUMAN-CENTRED DESIGN: A PRACTICE PERSPECTIVE Isaac Thomas Michael Holeman King’s College Judge Business School University of Cambridge October 2017 This dissertation is submitted for the degree of Doctor of Philosophy ACKNOWLEDGEMENTS Five years ago I began a new life in a timeless place in search of, as the Cambridge motto puts it, enlightenment and sacred draughts. This turn in my journey followed an exhilarating, life changing and exhausting few years on the road, without fixed address, in Malawi and Kenya. I needed time for reflection and I found it here. I never shed my practitioner concerns and partnership with the good people of Medic Mobile, so it may have been inevitable that I would see only a part of Cambridge, as through a window, brightly. This was more than enough. With time for reading, writing and a fair few remarkable human beings, my imagination caught fire again. I won't always have the time for reflection that this place has afforded but I hope, like waking from a dream that fades yet leaves a residue, to take the sense of timelessness with me. Many people have made my life here remarkable, have made it possible, have been patient when I was too deep in my books to keep up with anything else—thank you. This work owes countless debts to my family, an inspiring bunch of free thinking folk poets and farmers, inventors, war heroes and dissident intellectuals, fishers, athletes, teachers, tree cutters, mechanics, entrepreneurs and public servants whose story spans six generations in the rural reaches of the pacific northwest. Word, sentence and paragraph, the voice in my writing is a song I sing for my family. The pages that follow also show more or less clearly that my writing and my design practice are one and the same adventure, head, hand and heart. I am grateful to the many partners at Medic Mobile who have made my small part in the movement for global health equity so fruitful. Dianna, Jacqueline, Josh, Katanu, Marc, Regina, countless community health workers and the good people of St. Gabriel’s Hospital deserve special appreciation. I continue to believe that we are all health workers. Claudia and the University of Edinburgh’s Global Health Academy afforded my first major teaching experiences, inviting me to bridge my work experiences and scholarly interests in a way that has shaped my writing greatly. Thank you. King’s College, the Gates Scholar community and Cambridge: your libraries, chapel choir, formal hall and thousand charmed traditions have made for a remarkable intellectual and spiritual community. Michael for opening the door to my studies in digital innovation, Mark for being a fox in a hedgehog’s world, Jen for teaching me to get back in the saddle—you’ve nurtured me more than I can say. To my fellow students Andrea, Andrew, Ben, Brianne, Halliki, Jorge, Katie, Kevin, Nick, Roderick, Tara, Toby, Victor—thank you for living the Cambridge motto in full form; you have been the lights and sacred draughts of my time here. Finally, Tim, thank you for loving books long before I did; you’re the reason I learned to read. Carlos, trying to understand your story sent me on this whole humanitarian journey. Above all Tara, for drinking from the same cup, for your sociomaterial partnership, I dedicate this work to you. ii Hinc lucem et pocula sacra ~ We are all health workers iii DECLARATION This dissertation is the result of my own work and includes nothing which is the outcome of work done in collaboration, except where specifically indicated in the text. For Chapters one, two and six I am the sole author. In Chapter Three I worked with one co-author (Michael Barrett) and performed approximately 75% of the work. In Chapter Four I worked with two co-authors (Mark de Rond, Jennifer Howard- Grenville) and performed approximately 50% of the work to produce the version in this dissertation. In Chapter Five my one co-author (Dianna Kane) is responsible for approximately 25% of the work and the remaining 75% is of my creation. Collectively, chapters two-five are 75% of my own creation and 25% the creation of co-authors, in keeping with expectations set forth in the Judge Business School PhD handbook. This work has not been previously submitted, in part or whole, to any university or institution for any degree, diploma, or other qualification. As I note in the text, Chapter Three draws on data which I used to write a dissertation for the degree of Master of Philosophy, while studying in the University of Cambridge sociology department. More than two thirds of the data used in Chapter Three were gathered after my MPhil degree was conferred, the present text has been entirely re-written and the theories we engage and the analysis we develop are altogether different. For this reason no part of Chapter Three is substantially the same as work submitted for other degrees. This dissertation is 75,796 words in length excluding bibliography but including tables, footnotes and appendices. This is in accordance with the Judge Business School Degree Committee Policy that PhD theses should not exceed 80,000 words. Signed:______________________________________________________________ Date: October 8th, 2017 Isaac Thomas Michael Holeman, MPhil iv SENSEMAKING AND HUMAN-CENTRED DESIGN: A PRACTICE PERSPECTIVE Isaac Thomas Michael Holeman This dissertation explores how people address problems of real human concern in situations of complexity, ambiguity, uniqueness, conflicting values and rapid change. Such circumstances stretch formal and idealistic rules and procedures to the breaking point. And yet, people in a variety of fields work through such difficulties in a pragmatic manner, at times finding ways to assert their humanity. Sensemaking and human- centred design are related activities through which many people approach such work. Through cases in digital innovation, global health care delivery and an unlikely voyage of the Amazon River, this portfolio shows that they are relevant to a wide range of settings. Rather than isolating the components or key variables of such work and taking their measure, this research advances a more holistic view of sensemaking and designing as sociomaterial practices. My research is grounded in performing the phenomenon of study, offering insights from complex practice rather than a spectator’s study of it. This ethnographic approach has yielded theoretical contributions related to designing for the emergence of practices, embodied sensemaking, a more substantive notion of what it means to be ‘human’ centred and more pragmatic ways of investigating sociomaterial practices. By discussing sensemaking and human-centred design as antidotes to failures of imagination in global health and development, this dissertation suggests a distinctive perspective on why these topics matter for the health of poor and marginalized people around the world. Keywords: digital health, digital innovation, global health, human-centred design, ICT4D, imbrication, information systems, materiality, mHealth, organizational ethnography, practice theory, sensemaking, sociomaterial practices. v CONTENTS 1 INTRODUCTION ........................................................................... 1! 1.1 DISCOVERING DIGITAL HEALTH ............................................................................ 1! 1.2 AN ONGOING APPRENTICESHIP IN HUMAN-CENTRED DESIGN ............................. 3! 1.3 SENSEMAKING AND HUMAN-CENTRED DESIGN .................................................... 9! 1.3.1 Sensemaking in the Design Literature ......................................................................... 10! 1.3.2 Sensemaking and the Process of Organizing ................................................................ 12! 1.4 THE STRUCTURE AND AIMS OF THE PORTFOLIO FORMAT DISSERTATION ........ 14! 1.5 PLAN FOR THE THESIS AND CHAPTER OUTLINES ................................................ 18! 1.5.1 Room for Silence: Pluralism and the Pragmatic Study of Sociomaterial Practices ............ 21! 1.5.2 Designing for the Emergence of Sociomaterial Practices ................................................ 22! 1.5.3 Sensemaking In The Flesh ........................................................................................ 24! 1.5.4 Human-Centred Design for Global Health Equity ...................................................... 25! 1.5.5 Appendices II, III and IV ........................................................................................ 28! 1.6 BRINGING IT ALL TOGETHER: A THREE FOLD PRACTICE DISSERTATION .......... 30! 1.7 REFERENCES ......................................................................................................... 32! 2 ROOM FOR SILENCE: PLURALISM AND THE PRAGMATIC STUDY OF SOCIOMATERIAL PRACTICES ......................................................... 37! 2.1 INTRODUCTION .................................................................................................... 38! 2.2 DESIGN AND REFLECTIVE PRACTICE .................................................................... 41! 2.3 PLURALISM IN SOCIAL THEORY’S PRACTICE TURN ............................................. 44! 2.3.1 Ethnomethodology and Pragmatism as Test Cases for Theoretical Pluralism .................. 46! 2.4 SOCIOMATERIAL PRACTICES ................................................................................ 50! 2.5 DOES SOCIOMATERIAL INVOKE AN ONTOLOGY OR ONTOLOGIES? .................... 57! 2.6 ETHNOMETHODOLOGY AND ROOM FOR SILENCE .............................................. 60! 2.7