Research findings
4.1.1 User insight drift
The research showed that some services turn out very differently than the service concepts. I found that one issue that might influence the human-centricity of an implemented service is what I call user insight drift (see Publication 1 for the introduction of this concept). The term draws on the notion of design drift, a term used in software development research (Robillard, Lavallée, & Gendreau, 2014).
Design drift has been described as changes in the design concept that occur throughout the development process, especially in the transition from concept to implemented design (Robillard et al., 2014). User insight drift describes the issue of design concepts that drift away from the initially identified user needs.
In my research, I found that user insight drift inevitably occurs in any service development process in which users are involved and that drift itself is not necessarily something negative (cf. Robillard et al., 2014).
Yet from the perspective of user involvement and co-design, I argue that user insight drift can be challenging in cases where a service concept has drifted too far from the identified user needs. Then there is a risk that user insight drift can result in tokenism (Arnstein, 1969), rather than human-centered services, in cases when the essential user insights can no longer be traced in the final service.
Below are examples of user insight drift from my
participant observation in the Increased dignity and openness at the acute psychiatric ward project. The examples relate to the two topics: needs that cannot be met and decision-making in the later phases. Most of the material in these two examples has not been presented in any previous publications.
Needs that cannot be met
Sometimes during a development process, it is decided that certain features of the service concept need to be changed, even though the same features have been identified as important by end-users and other participants. During my observations of 13 service development processes, I noticed that this is not an unusual occurrence. It can be seen, for example, in the Increased dignity and openness at the acute psychiatric ward project.
The three groups who were considered users of the ward were patients, next of kin, and employees. In the text below, I refer to these three groups as users. In addition, I refer to a user representative, a former patient, who had an essential role in the development team of professionally representing the patient group at every step of the process. Other involved participants in the project are referred to as stakeholders.
The development team uncovered that what employees and former patients cared most about improving at the ward, in addition to renovating the interior in general, was the
hospital beds (see Figure 4.1). For patients spending many hours in their rooms, the bed can be a constant, visible reminder of their condition. The employees and former patients expressed that they wanted to avoid seeing the bed, and some wanted ordinary beds instead of hospital beds. This insight influenced the early sketches of the new interior, in which it was suggested that the bed could be an ordinary bed, hidden in the wall when not in use (see Photo 2 in Figure 4.1). Later in the process, it turned out that it was necessary to move away from the idea of ordinary beds because of hygiene and medical requirements. The bed, for example, has to be hard enough to withstand the weight needed for a CPR procedure.20
While the beds in the refurbished ward did not align with the needs articulated in the earlier phases of the project, the remaining aspects of the concept led to grand changes of the interior, reducing the importance of hiding or changing the beds. This understanding is supported by the evaluation reports (Ness, Ibabao, & Karlsson, 2017), which describe that those involved perceived both the process and final results as a success, in what is described as “real” user involvement (Ness et al., 2017).
Decision-making in the later phases
Another aspect of user insight drift is drift caused by
decisions made in the later phases. Two intertwined variables that might influence decision-making are new stakeholders getting involved in the process and contradictory aims and expectations among the stakeholders. Both variables were apparent in the Increased dignity and openness at the acute psychiatric ward project.
In this project, the management and another part of the organization had not been involved in the earlier phases, but got deeply involved later in the process. The new stakeholders had limited insights into the earlier phases of the process and hence, had slightly different agendas than that of the
20 CPR, or cardiopulmonary resuscitation, is a lifesaving procedure performed in emergency situations when the heart stops beating.
Service design in the later phases
78 Research findings 79
development team. The project leader described how there was a shift in focus in the process from the point when the new stakeholders became involved:
“Our management got involved . . . and then there was suddenly a completely different [set of] expectations coming in. Then the entire maintenance department at the Oslo University Hospital got involved. . . . And then [our project] was suddenly seen as [just another]
renovation project. . . . I have been to almost all of the meetings, and I have had to fight to keep the focus of the project up against, in a way, what they think. But I think they have listened, I do.” (Project leader)21
According to the project leader, the maintenance department had a different view on user involvement than the shared understanding that had emerged among the original
development team members. The project leader described how the differing perspective on users manifested in the language used by the new stakeholders:
“Just take their choice of words [when discussing different solutions at our meetings, such as the word] vandal proof.
You can imagine our patient representative jumping up from her chair, saying, ‘you can’t use that word!’ . . . Now, [the department] has changed a little, but it has taken time.” (Project leader)
Figure 4.1
Photos from before and after the changes were implemented at the acute psychiatric ward. Photo 1 shows one of the rooms before the interior was changed (photo by Sandra Aslaksen). Photo 2 shows an interior sketch by team members from Brandl Architects. Photo 3 shows the final interior in one of the rooms.
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21 To visually differentiate between quotations from other scholars and quotations from my interviewees, I have chosen to put all interview quotations in quotation marks.
When the maintenance department got involved, many decisions regarding details had to be made. The project leader gave an example of how the aims of the original development team members and the new stakeholders sometimes contrasted:
“There were a number of technical people, people who [focused on lighting], who came up with some comprehensive [solutions. For example, a solution in which] you can change the lighting based on the light outside, and many other tech gadgets. . . . And our project did not have that focus. But some stakeholders made huge efforts to get that through. Without me having realized or understood why.” (Project leader) In one of the meetings I attended, the intention was to decide on a number of details and to discuss costs, since a tight budget limited what could be implemented. My fieldnotes from the meeting further illustrates the tensions between the original development team and the new stakeholders in the decision-making process:
There were a lot of issues on the agenda for the meeting.
The person responsible for reducing and controlling project costs got frustrated, since the employees and the patient representative started discussing the details of each issue—in terms of how the different choices would impact the overall user experience.
One of the employees brought up the question of having an additional meeting with patients and user representatives in order to get feedback on some of the choices that they needed to make. The person responsible for costs insisted that, “you can’t bring in new things now . . .”
At the end of the meeting, a number of solutions based on previously identified user needs had been set aside due to costs. At the same time, new technical suggestions had been brought up by the new stakeholders, suggestions that had no apparent link to previously identified user needs. As the user
representative expressed, “It seems to me as if the project is drifting away from our starting point—instead of focusing on user needs, we are mostly discussing technical solutions and if we can afford them.”
(Excerpt from my fieldnotes, Fall 2016)
As noted in the introduction to this section, user insight drift is a phenomenon that will occur in any service development process where users are involved. The examples above
illustrate some of the parameters that might increase the user insight drift, for better or for worse. Sometimes, the identified user needs cannot be met since other issues are considered more important. Decision-making in the later phases will have an impact on the form of user insight drift. As seen in the example above, decision-making can be influenced by the involvement of new stakeholders, since these are likely to have a new perspective or a different understanding than the rest of the team. This contrast in aims, expectations, and perspectives can be fruitful, but it can also result in solutions that no longer answer to user needs.