Critical Care Futures: Final Reflections
By Catherine Montgomery, Lizzie Abernethy, Santini Basra, Freyja Harris, Corrienne McCulloch and Annemarie Docherty
This is the sixth post in our Critical Care Futures series. If you need to catch up, head back to the first post where we give a little context on this project, the second post where we talk about what the process of co-designing the cultural probes looked like, the third post where we talk about what happened when the cultural probes were sent out to the project participants, the fourth post where we discuss how we generated insights from the probes, or the fifth post where we describe the process of distilling our research into public facing outputs.
This blog covers our team’s reflections on the year-long project that was Critical Care Futures: what worked, what didn’t work, and what we would do differently next time.
Just over a year ago, we published the first blog post in this series. In it, we outlined our aspiration of using cultural probes to engage different stakeholders around the question of what ICU as a place of care and research should look like in the future. Our team consisted of an academic consultant and a nurse researcher in critical care, three designers and a sociologist; what would happen when we used methods from critical speculative design to catalyse conversations with patients, carers, ethics committee members, clinicians and researchers? Would we be able to work together? Would other people want to get involved? Would anyone be interested in what we had to say? One year on, here are our reflections.
Interdisciplinary Chemistry
To receive funding for our eclectic group of individuals from across the medical sciences, the social sciences, and the arts to use potentially subversive methods to conduct a public engagement project filled us with real optimism for the future. The benefits of interdisciplinarity are well documented but so too are the challenges, ranging from paradigmatic incompatibilities to institutional politics and entrenched power inequalities (Balmer, Calvert et al. 2015, Callard and Fitzgerald 2015). In Critical Care Futures, the disciplinary diversity of the team and the energy this generated was one of the highlights of the project for us. Founded on respect for the different expertise each team member brought, our working relationship was characterised by epistemic equality and a clear division of labour. This meant each team member worked to their strengths in pursuit of a common goal shaped by our collective experiences. The result was on the one hand, a project delivered to time and on budget, but more importantly, a project which was animated by interdisciplinary chemistry. As the project ended, we reflected that it would have been better still to create more opportunities to inhabit each other’s working spaces: for the designers to have a greater degree of immersion in the ICU context, and for those of us with social science and clinical backgrounds to get a better feel for the world of design.
Data management self-sabotage?
In spite of the success of our collaboration, one aspect which didn’t work well was the conscious severance of data management processes from the collective life of the project. At the outset, team members met with information governance experts from the University to understand how best to deliver on our obligations vis-à-vis data security. These discussions revolved around who should have access to participants’ personal information and research data. Our interpretation of this resulted in the cultural probes process being managed entirely by the design team: from seeking informed consent from participants, to sending out packs of cultural probes and looking after the returns, as well as fielding queries and providing support. In practice, this meant that the clinical team members, who had knowledge both of the ICU context and of those initially approached to participate, were not aware when the designers needed input to help support participants. It also meant that the experiences participants had of taking part in the project were not available first hand to the sociologist, whose interest was in observing and understanding the process. Our very cautious anticipatory self-regulation may ironically have led to less rich insights and a more limited understanding of how to use cultural probes for public engagement in health research.
Polyvocality
Much as some elements of the process remained opaque, clearly evident was the polyvocality — literally, multiple voices — that the cultural probes made space for. One of our key goals was to enable more perspectives to be heard in discussions about the future of research in critical care, and to catalyse conversations between different people who might not ordinarily sit around a table together. By co-designing the probes with representatives of the groups we wanted to engage — ethics committee members, ICU survivors, clinicians and researchers — we hardwired this potential into the tools themselves. Both the initial co-design workshop and the subsequent debrief workshop, during which we co-produced the principles for human-centred data use in critical care, were alive with the throng of many voices speaking to each other and to us about what matters in critical care research. This was not about reaching consensus; rather the very raison d’etre of the probes methodology was to avoid analytic closure and instead expand the possibilities for alternative futures. In this it was successful. It’s worth noting that in spite of our best efforts, not all of the groups we wished to engage were equally represented in the room. As we go forwards, a key challenge remains how to build routes for dialogue with ethics committee members, who play a central role in debates about the future of data and consent in the ICU.
The Future
Looking back over the past year of the project, we inevitably ask ourselves “What would we do differently next time?” Critical Care Futures was ambitious in bringing playful, design-led methods into the sphere of applied medical research and its publics. To more fully realise this ambition, in future we would spend more time developing the probes themselves and working in closer proximity to participants. This relational and affective dimension of working with cultural probes — part of subverting the traditional relationship between researchers and researched — needs time, resources and commitment. It sits beyond what is measurable and therefore can easily be overlooked when prioritising tasks as part of project management. It is this, however, which ultimately shapes the richness of the probe process and is likely to generate the most evocative, surprising and imaginative insights. Valuing imagination and eliciting the unexpected do not typically sit well within mainstream medical research. In order to produce insights which are not only aesthetically pleasing but also have a practical value, we ask ourselves whether this type of work is better situated within or outside the mainstream. How to do public engagement differently, but still find credibility within the institutions which mandate its relevance? We believe that Critical Care Futures walked this line successfully; whether future, more aspirational iterations of this can do the same is a challenge we look forward to rising to.
You can read and download a copy of the Critical Care Futures Insight Report here.
References
Balmer, A. S., J. Calvert, C. Marris, et al. (2015). “Taking Roles in Interdisciplinary Collaborations: Reflections on Working in Post-ELSI Spaces in the UK Synthetic Biology Community.” Science & Technology Studies 28(3): 3–25.
Callard, F. and D. Fitzgerald (2015). Rethinking Interdisciplinarity across the Social Sciences and Neurosciences. Basingstoke, Palgrave Macmillan.
