Imagine worlds in which humans feel at home — Klaus Krippendorf, The Semantic Turn
In pursuit of crafting authentic and meaningful service experiences, artificiality is a useful tool for designers. In this essay I will discuss my role as rhetor as I pursue my thesis project creating a self-service design for women’s healthcare. Using Sudheer Gupta and Mirjana Vajic‘s framework for dimensions of service experiences (Gupta and Vajic 2000, 36), I will argue that the strategic manipulation of space, user participation, and social interaction can promote an ideal environment where a woman takes a leadership role in her own healthcare. By purposefully creating imaginary products and service mechanisms, my project will advocate for a shift in control of health care services from doctors and pharmacies to the patient herself.
Because service is an intangible experience, Christian Gronroos says that service providers will often “tangibilize” the interaction with “concrete, physical evidence” that helps shape the user’s perception, (Gronroos 2007, 29). An everyday example of service evidence in women’s health care might be the website of a health care clinic a patient uses to make an appointment. As a designer, I was first inspired to consider false evidence when I read about designer Ronen Kadushin‘s conceptual, open-source “Bearina” intra-uterine device (IUD). Made from a one-cent coin and shaped like the head of a teddy bear, this piece of “design fiction” was not created as a product ready to sell, but as a “political product” intended to “disrupt” the monopoly of large pharmaceutical companies on contraceptive technology, (Kadushin 2011). It was shared as an open-source model in order to invite collaboration from forward-thinking organizations who could further develop the low-cost prototype.
In Aristotle’s Rhetoric, it is “artificial proofs” that make one a master of rhetorical argument. In a discussion of trial argument styles in a legal case, Aristotle compares the method of presenting only the facts and relevant laws (forensic argument) with the work of the evaluating character and arousing emotion (deliberative oratory), (Aristotle and Freese 1926, 7). Aristotle states that the function of rhetoric is “not so much to persuade but to find out the existing means of persuasion” (13). The rhetor does not argue for what is false, but choses a communication strategy. She may seek to establish a strong moral character, to stir up emotions, or to present a strong line of reasoning (17). Aristotle recognizes that rhetoric “which is true and better is naturally always easier to prove and more likely to persuade.” As a designer and rhetor, I must identify the means of persuasion that will ring true with the potential consumers of my self-service design. By researching existing health care mechanisms and identifying their weaknesses in delivering service experience, I can also make a political statement through design fiction. While I do not intend for my thesis project to be fully operational at the end of the year, I do hope to present it to the public as a set of inspirational tools and ideas for the women’s health care community.
Gupta and Vajic’s framework identifies three dimensions of a service experience: the physical space, user participation, and the social environment, (Gupta and Vajic 2000, 36). First, let’s look at the current physical spaces for women’s healthcare. If a woman wants to obtain long-term contraception or has a common infection, she must coordinate three layers of service: a medical facility for consultation, a pharmacy for her dispensed supplies and an insurance policy for payment. In an ideal situation a woman has access to all three and she is able to obtain the required care. However in reality, the service environments of these organizations can be problematic. Clinics may have limited hours, may not have available appointments, or may have complicated websites or phone trees. Once inside the clinic, a woman is in the domain of her health care provider and is no longer calling the shots. She is usually undressed, undergoes a pelvic exam, and is interrogated for her medical and sexual history. At the pharmacy, she again may encounter inconvenient hours, long wait times, or difficulty with her insurance information. Her supply is limited to the insurance company’s regulation, so even though she may plan to use her form of contraception for a year, she can only get a monthly supply, forcing her to return again and again.
These environmental service constraints are significant because they place the woman at the bottom of the balance of power, and she knows it. Mary Jo Bitner links the “atmospherics” of the physical surroundings to the behavior of customers and employees in a service scape, (Bitner 1992, 57). With this knowledge, I hope to alter the architecture of the healthcare service scape to support my project’s strategic goals. I suggest the installation of a mechanism for dispensing self-diagnosis, self-treatment, and contraceptive female care products in women’s public restrooms. Through rigorous prototyping, I hope to explicitly visualize the scenario where a woman is able to attend to her own healthcare needs in her existing environment. An accessible and semi-private space such as the restroom feels more familiar to women than the specialized environment of a clinic or pharmacy, which is designed around the needs of employees rather than the patients. While self-service healthcare is not appropriate for complex or life-threatening situations, the technology exists for women to administer their own dipstick or urinalysis tests for everyday ailments and certainly for them to swallow a pill for treatment. In obtaining contraception or diagnosing a common infection, a clinical environment is not always necessary and can ironically be a barrier to obtaining care.
Next let’s explore the social environment for a self-service health care design. The means of persuasion for questioning the existing health care conventions lie in the unintended consequences of interactions between a woman and the “gate-keepers” of her health care needs: medical providers, pharmacists, and insurance companies. The current practice for obtaining long-term contraception entails a medical visit. She must deliver the “right answers” to her doctor in order to secure the method of her choice. At a recent gynecological exam, I was asked dozens of questions about my personal life, my family’s medical history, and my body while sitting naked in a cloth gown on an examination table as my provider typed my responses into a computer. I knew that if I gave any indication that I was not completely healthy or brought up any questionable behavior, I’d be unable to obtain my contraception of choice.
Bitner states that “experiences are distinguished from products and services by the degree to which they interact with other customers and the employees” (Bitner 1992, 39). My service experience relied heavily on an intense one-to-one interaction with my provider, who was judging my fitness to receive the product I desired. In the self-service experience I propose, the customer does not necessarily have to consult anyone before obtaining care. Her social interaction may be limited to conversations with other women in the bathroom or may be completely private. In an attempt to prevent the feeling of privacy from becoming the feeling of isolation, I may explore a dimension of anonymous but open information contributed and shared by customers in an online feedback forum. As women use and evaluate the products, their experiences could be collected and visualized with those of other users to inform and empower their decisions.
Last, let’s discuss the aspect of customer participation in models of female health care. In the current system, a patient participates in her care by tending to the administrative details of appointment-making, insurance paperwork chasing, form-completing, and making requests to employees for her needs. Her role in the bureaucracy is to ensure accuracy and delivery of her personal information, then put herself in the hands of the provider who will dictate the course of treatment. While the burden of securing care is up to the patient, the right to decide the course of care is not. It is when a woman can’t get an appointment, is denied contraception, or is forced to bear discomfort in waiting to receive treatment that the “moment of truth” about the conventional system is revealed to the customer. Gronroos explains a moment of truth as “the time and place when and where the service provider has the opportunity to demonstrate to the customer the quality of its services” (Gronroos 2007, 42).
Let’s consider a scenario where a patient has a moment of truth where she takes full control of her health care needs through self-service. A women is out and about in town. She feels unwell and goes to a nearby coffee shop to use the restroom. Once there, she notices a female problem. She walks up to a vending system on the wall and purchases a self-diagnosis kit, which she performs in the stall. A few minutes later, she has the results of her test. She has an infection and needs a treatment. Again, she finds the medication in the vending machine and purchases it, then administers treatment by taking pills. She leaves the coffee shop and continues on her way. By the next day, she notices she’s feeling better. She checks the website of the vending system and reads reviews from other users. She logs in anonymously and reports which symptoms she had, what test she took, her results and her treatment.
By shifting the responsibility for decision-making to the customer, self-service sends a message that a patient is powerful and knowledgeable enough to care for herself. By informing the patient through informational packaging and instruction design, the consumer believes that she knows her body well enough to identify her symptoms and determine a course of action. A humble vending machine becomes a self-service healthcare experience by engaging the physical space, making the social interaction anonymous, and increasing the level of customer participation. This simple concept is an illustration of Gronroos’ argument that “a machine, or almost any product, can be turned into a service to a customer if the seller makes efforts to tailor-make the solution to meet the most detailed demands of that customer,” (Gronroos 2007, 25).
I hope to make use of these fictional design stories and artifacts as the means of persuasion to argue for increased accessibility of women’s health care. Although my proposed self-service products and vending machines are not in the marketplace today, the components to build them certainly are, and the use of false evidence to suggest change and question current practice will be the core strategy of my thesis work.
Aristotle and John Henry Freese. 1926. “Book I” in Aristotle’s “Art” of Rhetoric, 3-39. Cambridge: Harvard University Press.
Bitner, Mary Jo. 1992.”Servicescapes: The impact of physical surroundings on customers and employees.” Journal of Marketing 56,2: 57-71.
Dezeen, 2011. “Bearina by Ronen Kadushin.” Last modified September 5, 2011. http://www.dezeen.com/2011/09/05/bearina-by-ronen-kadushin/.
Gronroos, Christian. 2007. “The Nature of Services and Service Quality” in Service Management and Marketing, 27-48. West Sussex: John Wiley and Sons.
Gupta, Sudheer and Mirjana Vajic, 2000. “The Contextual and Dialectical Nature of Experiences” in New Service Development: Creating Memorable Experiences, edited by James A. and Mona J. Fitzsimmons. 33-51. Thousand Oaks, CA: Sage Publications.
Kadushin, 2011. “Bearina IUD Concept.” Accessed October 1. http://www.ronen-kadushin.com/Open_Design.asp
Krippendorf, Klaus. 2006. “History and Aim” from The semantic turn: a new foundation for design, 1-15. Boca Raton: CRC Press.