How

Ethnography

Informs

Design

by Dennis Nordstrøm

IT Product Design, Masters ProgrammeMads Clausen Institute

Syddansk Universitet, Sønderborg

_______ ___________________ (Date) (Signature)

Supervisor:Jacob Buur

16-05.06

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Acknowledgements I would like to thank Professor Jacob Buur and Professor Margot Brereton for letting me use their Moggill community-ethnography. I would also like to thank Pernille Ingildsen and the company Invisense, for supporting and helping me through the development of the user-ethnography. Thank you very much for the field-notes, they helped a lot. Thanks to the pharmacies, that let me join their work-practice for a couple of days. I appeciate the help and guidance I got from Løve apoteket and Jernbane apoteket. A huge thanks also goes to the people that were so kind to participate in the pharmacy-ethnography. I would also like to thank the staff at the Mads Clausen Institute for their never-ending patience through out the writing process.

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Table of contents

ABSTRACT ...................................................................................................................................................5

INTRODUCTION.........................................................................................................................................6

USER-ETHNOGRAPHY: GOING TO THE SACRED PHARMACY...............................................8

A pharmacy?..........................................................................................................................................8 WAITING IN THE CHURCH-AISLE .............................................................................................................9

Two services, one waiting room ...........................................................................................................9 “Leave me alone!!”.............................................................................................................................11 A pharmacist is not just a pharmacist................................................................................................11

THE PREACHING PHARMACIST...............................................................................................................12 “This stays between you and me!!” ...................................................................................................13 A show for the pharmacy ....................................................................................................................14 Pharmacists: The motherly type.........................................................................................................14

PHARMACIST: THE MODERN TIMES’ ALCHEMIST ................................................................................15 “Give me the highest amount of drug, I can take!!” ........................................................................15 Learning pharmacists .........................................................................................................................16

PHARMACISTS AS SALES-PEOPLE...........................................................................................................16 The monopoly of pharmacies..............................................................................................................17 “I have what you need!!” ...................................................................................................................17 Pharmacies as in-betweens ................................................................................................................18

DIFFERENT VIEWS ON ETHNOGRAPHY........................................................................................19

CHARACTERISING USER-ETHNOGRAPHY..................................................................................................19 DIFFERENT PRACTICES WITHIN ETHNOGRAPHY.......................................................................................20 THE IMPRESSIONS OF ETHNOGRAPHY.......................................................................................................20 THE EXTRA LEVEL OF USER-ETHNOGRAPHY ............................................................................................22

USER-ETHNOGRAPHY AS INTERPRETATIVE RESEARCH .....................................................24

USER-ETHNOGRAPHY’S CONTRIBUTION TO DESIGN ................................................................................25 USER-ETHNOGRAPHY AS A DISCOURSE FOR DESIGN ...............................................................................28

PHARMACY-ETHNOGRAPHY AND MOGGILL COMMUNITY-ETHNOGRAPHY..............30

BRISBANE DESIGN DIALOGUE ...................................................................................................................30 PHARMACY-ETHNOGRAPHY .....................................................................................................................31 THE DEVELOPMENT OF THE USER-ETHNOGRAPHY ..................................................................................32 THE QUALITIES INCLUDED IN THE USER-ETHNOGRAPHY.........................................................................32 THE INSTRUMENTS USED IN THE USER-ETHNOGRAPHY ...........................................................................35

BRISBANE DESIGN DIALOGUE ..........................................................................................................38

MOGGILL COMMUNITY-ETHNOGRAPHY DESIGN-OUTCOME....................................................................38 THE BRAINSTORMING SESSION .................................................................................................................38 INFORMED BY THE USER-ETHNOGRAPHY.................................................................................................40 REFLECTION SESSION ON THE USER-ETHNOGRAPHY ...............................................................................42

PHARMACY-WORKSHOP.....................................................................................................................43

THE WORKSHOP.........................................................................................................................................43 THE DESIGN-OUTCOMES ...........................................................................................................................44 HOW THE USER-ETHNOGRAPHY INFORMED THE DESIGN.........................................................................46 THE INSTRUMENTS OF THE USER-ETHNOGRAPHY....................................................................................47 USER-ETHNOGRAPHY AS PROVOCATION..................................................................................................48 USER-ETHNOGRAPHY AS COMMUNICATION.............................................................................................49 USER-ETHNOGRAPHY AS A FRAME OF DISCOURSE ..................................................................................50 UNDERSTANDING-BROADENING...............................................................................................................51

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COMPARISON WITH THE BRISBANE DESIGN DIALOGUE...........................................................................52

CONCLUSION............................................................................................................................................54

REFERENCES ..........................................................................ERROR! BOOKMARK NOT DEFINED.

APPENDIX 1: MOGGILL COMMUNITY-ETHNOGRAPHYERROR! BOOKMARK NOT DEFINED.

APPENDIX 2:USER STUDIES ON PHARMACIES - LØVE APOTEKETERROR! BOOKMARK NOT

DEFINED.

APPENDIX 3: USER STUDIES ON PHARMACIES - TØLLØSE APOTEKSUDSALG..ERROR!

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APPENDIX 4: USER STUDIES ON PHARMACIES - JERNBANE APOTEKETERROR! BOOKMARK

NOT DEFINED.

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Abstract

Ethnography as a means for observing a culture has been used since the 1970s (Forsythe 1999) within design in order to inform the design-outcomes. Thus ethnography has been fitted within many different design-contexts and has through that adaptation been misconceptualised (Anderson 1994). This thesis will investigate the misconceptions and try to develop a user-ethnography closer to the traditional ethnographies, and further away from the adapted misconceptualised ethnographies. The thesis will then through the user-ethnography investigate how the user-ethnography informs design. By doing this, the thesis tries to reinstates the relevance of user-ethnography within design. The theoretical framework poses some ideas about the strengths the user-ethnography will have. These are the theorisation of the observed culture, which initially will lead to a reframing of the designers’ “problem to a solution frame” (Anderson 1994). Since there is this theorisation, arguments of treating user-ethnography as a theory will be provided. A theory in itself has some qualities that can be used within a design team. When treating user-ethnography as a theory, the strengths of theory would thus be transferred to the user-ethnography. These strengths are: theory providing a “Lingua Franca”, and theory providing a common ground for discussion (Erickson 2006). By testing the theoretical framework on the user-ethnography written about pharmacies, and on a Moggill community-ethnography, some characteristics will emerge. These characteristics will then validate the theoretical framework posed by Anderson (1994) and (Erickson 2006). The workshops ran on ethnographies show that the designers did get a broadened understanding of the culture investigated in. The workshops showed that the user-ethnography and the theorisation within it did inspire the participants in the workshops. The participants would discuss the theories presented, and hence to define it by their own means, or to challenge it into something that would suit the participants. Furthermore the user-ethnography would not only question the participants’ preconceived perception of the culture by posing a theory on the culture. It would also make them reflect in order to broaden their understanding of that culture. By reflecting the participants received a broader understanding of the culture and thus tried to enrich the culture, instead of focusing on issues to fix. In that way the user-ethnography did open up the designers’ problem-solution framework. The user-ethnography also provided the participants with a starting point for design dialogue, where the participants were presented to aspects that a discussion would revolve around. The user-ethnography thus worked as a provocation, as a means for communication and as a means of frame of discourse.

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Introduction

Most designers approve of the idea that designers design for people, and that the designers should have a base knowledge about the people they are designing for. Ethnographic studies are a way of approaching this matter. Ethnographic studies provide insight into the culture1 under investigation, and allow the ethnographer to communicate the observed culture. Thus ethnography is used as a method for observing a culture, and as a written account. Ethnographic studies are made in order to get an understanding of the culture under investigation. Ethnography has grown to be used within design since the 1970s (Forsythe 1999), and is used by many design teams today. It also seems that within the growing interest in the use of ethnography in design many misconceptions about the role of ethnography in design have emerged.

My contention is, simply, that the failure of designers to see the background on which it draws has led to some profound misconceptions about ethnography and its applicability in design.

(Anderson 1994, p. 154)

The aim of this thesis is to reinstate the relevance of user-ethnography within design. Investigating how ethnography informs design will help do this. An investigation on the impact of ethnography in design has not been done before (Matthews) and should hopefully thereby be able to shed light on user-ethnography and its role. This investigation will be done by first discussing the various views and usages of ethnography and then using this discussion to define user-ethnography. On the background of this definition of a written user-ethnography, a workshop will be conducted. An analysis of the workshop will answer the research question of how ethnography informs design. The analysis provided is based on a workshop conducted with ten design students who participated by designing on the background of a user-ethnography written about pharmacies2. Furthermore, an analysis of a design-workshop conducted by Jacob Buur and Margot Brereton, on the basis of their user-ethnography of Moggill community (Appendix1) is included. Since there are many misconceptions about ethnography (Anderson 1994), (Forsythe 1999), there will probably be many opinions of how an ethnography is supposed to be. The pharmacy-ethnography will therefore be presented in the beginning of this thesis, in order to reach a definition of the concept of user-ethnographies and the frames in which it is used in the thesis. A discussion will then follow on why the user-ethnography has taken the form it has, and on what ideas that were behind writing the user-ethnography as it was. By explaining the views there are about ethnographies, and arguing against these “misconceptions”, the user-ethnography of pharmacies is deviated from other

1 Culture in this thesis is being regarded as a collection of people within a certain site. This leads to sociality within work-practice, social relations, technology used, power-relations etc. 2 The user-ethnography was developed in collaboration with a company called Invisense. Invisense is

mainly focused on selling health applications for mobile phones. Because of the company’s interests and contacts, pharmacies were the obvious choice.

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“misconcepthualised” ethnographies. By deviating the user-ethnography an attempt to find the essence of user-ethnographies is made. After a discussion about the theoretical framework within which the user-ethnography was written, and an explanation of the thoughts that were behind the user-ethnography, an analysis of the two workshops on the two user-ethnographies: the Moggill community-ethnography and the pharmacy-ethnography, will be presented. This will be followed by a comparison of the two workshops in order to compare the findings done within these two workshops. By comparing the two workshops a pattern emerges, of how the user-ethnographies informed the design. Extracting the aspects in the user-ethnography that aided in informing the design, a picture of the strengths, if any, in the user-ethnography surfaces. When defining and characterising the strengths of user-ethnographies, this thesis will be able to provide designers and ethnographers with an understanding of the ways in which user-ethnographies can play an influence onto designers when designing. Indications to experienced as well as inexperienced ethnographers, of thow to write an informing a user-ethnography for design is made. So when Forsythe (1999) states that ethnographies are being done more and more by non-ethnographers, and Anderson (1994) states there is a misconception about ethnography and its role in design, this thesis makes a step towards reinstating the relevance of user-ethnography written by designers and ethnographers for design. This is done through discussions on how user-ethnography informs the design, and about how the pharmacy-ethnography was written, and what sort of qualities were found important to include into the pharmacy-ethnography. This will give designers and ethnographers an idea of how to approach the subject of user-ethnography within design, and will aid in the reduction of misconceptions about ethnography within design.

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User-ethnography: Going to the sacred pharmacy

A pharmacy?

A pharmacy is in a way the last stop for customers before the doctor. The customers will get in and get advice on health issues, which differs pharmacies from classical stores. In this way the pharmacies are not doctor-offices, but also not just a common store. They are something in between, and this makes them very interesting for a user-ethnography. This special link between doctors, customers, and the mediators between them (Pharmacists) is what makes pharmacies very interesting. Pharmacists are in the middle of the customer and the doctor, and thus spokesperson for the two. In a pharmacy people can get the medication that has been prescribed to them by their doctor. The customers will then in go in and pay for the medication and then leave. But there is a lot more going on inside pharmacies besides just picking up prescriptions. If there is something wrong with the customers and it is just a minor thing, the customers will go to the pharmacy in the hope that the pharmacists can help and guide them to the medication that will help them. This shows that the pharmacists have a large area of responsibility within the pharmacies. The pharmacies observed, all have a couple of counters (depending on the size of the pharmacy, some will only have one), a waiting room, and some shelves with information and varying products such as skin products, diapers, cough drops, and at some pharmacies there is even wine on the shelves. An overview of Løve Apoteket in Sønderborg:

Overview of the entire pharmacy

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The counter is oriented towards a discrete place, and is placed so that the customers can benefit from the discretion. When first going into the pharmacy it reminded me a bit of a church, there was a silence, and people seemed to keep them to themselves.

Waiting in the church-aisle

The first thing a customer would see is waiting customers, and therefore one would only expect to wait as well, and so it is. There is a lot of waiting in a pharmacy. It is a place where people have to wait in order to get what they want, just as it is in a church. There is an implicit amount of time where people just have to stand around. They look like sheep, walking around not knowing what to do. In the time that I spent there, the majority of services were of customers that needed to pick up their medicine that had been prescribed to them. Some of the customers that went in there to buy something did not even know what they needed. They would just describe symptoms to the pharmacists, who then would try to help the customers in the best way they could. As the head pharmacists emphasised several times to me at one pharmacy: “we take any request or question seriously, since they are serious to our customers”. The waiting room at Jernbane Apoteket in Sønderborg

Two services, one waiting room

Most people that went in the pharmacy looked as if they expected the waiting and simply handed in their prescriptions, took a stand or a seat, and waited for their turn. In the observations made there did not seem to be much aggravation from the customers. The pharmacists had certain company-policies about waiting, they have a guideline for how long people should wait. This varied a bit depending on the pharmacy and the type of customer. The two different customer types are prescription customers, who pick up medication, and shopping customers, who do some shopping of products sold by the pharmacy. None of the prescription customers seemed to buy anything of the shelves, they only picked up their medication.

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The two different types of services in a pharmacy.

Prescription customers would usually require a bit more time because the pharmacy holds strongly on the effectiveness and safety of handing out medication. So even though the customers should not have to wait more than necessary they should also be able to trust the pharmacy for handing over the right medication, and since mistakes sometimes happen at the doctor’s office it is up to the pharmacists to check the prescriptions. During my study it occurred to me that in this way the pharmacy is the customers’ last line of defence in order to prevent any mistakes in the medication flow. Even though there are standards for how long the pharmacy wanted customers to wait before the medications were handed out, several pharmacists said that sometimes this does not hold because there are different customer types. The pharmacy use the terms red, yellow, and green customers. Green customers are the ones that go in and then they leave as soon as they have what they need, yellow customers might have a question or two about the product and red customers are typically the customers that do not know what they want, they just know that they are sick. In order to uphold the standards, the pharmacists cannot always spend a lot of time on a red customer when the pharmacy is completely full. During my studies it almost seemed as if pharmacists had to hold a quota of waiting customers to a minimum. Because even though customers know they have to wait, they do not want to wait longer than what is required. Therefore it is also a profound criterion for pharmacists to work fast. One might argue that a metaphor for this kind of work might be that the pharmacists’ function resembles the one of a pieceworker, that has to do as good as possible as fast as possible. While I was observing in the waiting room at the pharmacy, I met an older woman that did not want to wait. She sat next to me waiting and she had to wait a longer time than pharmacy standards. She finally got her medicine and is on her way out, when I catch her eye and smile at her. She simply shakes her head and says: “Then

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you can sit here and grow a beard”. To me this really seemed like she was sympathising with me. She had waited a long time, and she thought I had to wait even longer.

“Leave me alone!!”

Usually when customers collect their prescribed medication they go in and hand in their prescription to the pharmacists, or sometimes the prescription is sent by the doctors beforehand and then printed out at the pharmacy. The customers then wait; afterwards they get their medication and pay. At this point of payment they just want to leave the pharmacy. Most people would just answer in an annoyed way when the pharmacists asked them about the medication, which to me was a huge indication that they just wanted to get out. The customers do not in any way seem that frustrated and edgy when they are waiting. So they expect that they have to wait, but when the waiting is over they do not want to stay any longer. The pharmacists, according to Danish law, have to ask if the customer knows how to take their medication, but most people have had the medication before and are therefore a bit rude towards the pharmacists when being asked this question. To them it is an annoyance that they are asked about the medication they might have taken all of their lives. A pharmacist told me, after having serviced such a customer that: “We have to ask, it is a part of our jobs. Then we just have to deal with the customers’ utterances”.

A pharmacist is not just a pharmacist

There are different people working at a pharmacy. The boss is the head-chemist and sometimes the owner of the pharmacy. The others are either chemists or pharmacists. The chemists are the ones who check the medications and the prescriptions, which the pharmacists are not allowed to do. The medication is checked three times. When it is placed next to the prescription, when it is labelled, and again just before it is given to the customers. In this way the pharmacists usually deal mostly with customers since the chemists are running around in the back talking to doctors in case there is a problem with the prescription. The medication is checked in the back of the pharmacy, where the customers cannot see the pharmacists checking. After a certain amount of waiting by a customer, a pharmacist will appear behind the counter ready to take any requests they might have. She could be:

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Walløe: The Head-pharmacist of Løve Apoteket

The preaching pharmacist

Another part of the pharmacist-job is to listen to anything the customers had to say about their illnesses and still take them seriously and try to provide the best service possible. Customers would talk to the pharmacists about any disease or illness they might have. Even about things that might have been a bit shameful for the customers. Pharmacists are in this sense confidants that the customers can share intimate things with, without the intimacy and the confidence being breached. At Tølløse pharmacy, a woman came in, leaned over the counter and whispered: “I have a rash in my lower regions”. The pharmacist later on said in relation to this discretion by the customers: “We get that every day, it is like selling a litre of milk for us”. (Ingildsen 2006). The pharmacist in that relation reminds me of a priest, that the customers confess to and tell everything there is to know. The pharmacists could then “offer absolution” by helping the customers towards medication that would help them. The pharmacist would explain how, when, and where the medication was to be taken. In that sense the pharmacist might for some customers seem like a spiritual being that eases their illness. To me this interaction seemed almost religious, as if the pharmacists were giving the customers the Holy Communion. Customers hold their “darker sides” to themselves, and do not want the world to know what is wrong with them. Customers therefore only protect themselves from the undesired attention from others. In order to try and stick to the metaphor of the “sacred”, the counter in a pharmacy can be seen as the wall of the confession booth, where the people would talk through which people talk in a silent manner, and there as sinners they would talk about their illnesses as if these illnesses were sins.

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The counters where the people would “confess”

This sort of confidence between customer and pharmacist will best be described as the one going on in a confession booth, where nothing is left out.

“This stays between you and me!!”

One of the reasons for the people talking in the subtle way they did to the pharmacists is also one of the issues

that deviate from the confession metaphor. Namely the idea that there are a lot of other customers around that might hear what is going on between the pharmacist and the customer. It is on this account important to note that the more shame there is connected with the illness the more the customers require discretion. It could probably be compared to people going into a bank; there discretion is also desired because not many people like their finances to be spelled out to the world at large. When going into a pharmacy and stepping up to the counter, one of the pharmacists that a customer might meet, could be:

Mette from Løve Apoteket This idea of confidence is also a part of a dilemma that pharmacists have within their roles. People confide in pharmacists, who takes their integrity seriously. However according to the law, the pharmacists have to make sure that the customers know how to take their medication. Several incidents occurred where it seemed as if the customers felt as if an authority was checking on them, when asked if the customers

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knew how to take the medicatioby the pharmacist if they know how to take their medication. For example, a man was sitting in the waiting room, when the pharmacist brought him his medication, and started telling him how to take it, she had barely started before he bluntly told her: “I know”. In another case, which seemed to work a bit better, the pharmacist handed out the medicine, looked at the customer, and in a subtle way asked: “You have had this medicine before?” The customer had had, and the pharmacist replied “Ok, then I do not have to tell you how to take it?” This is a way of signalling the care that pharmacists show. Although the pharmacists have to make sure that the customers are sure about how to take the medication, they sound like a caring nurse or physician, perhaps even a motherly type when they talk to customers, and it is also in this way the priest metaphor works.

A show for the pharmacy

Several pharmacists told me that discretion is one of pharmacists’ high priorities, even though there were incidents where it did not seem like that at all. For instance, during my time in the pharmacy, there was a middle-aged woman that got in the pharmacy and needed to pick up some asthma medication, which she had just had been diagnosed with. The pharmacist then, just before giving her, her medication brought forward two testers. These testers are the inhalers just without the medication. It is on them that the pharmacists show the customers how to take the medicine. The pharmacy was full and the woman stood at one of the middle counters in the store. The pharmacist explained how to use the inhaler, and then said that first she would use inhaler and then afterwards it would be the customer’s turn to try out the other tester. The pharmacist furthermore said: “It will give a little sound, so that we are sure that it works, but the real inhaler does not do that”. So the pharmacist tried out the inhalator, and the inhaler gave out a loud squeaky sound, and everybody turned to look at the pharmacist and the customer. After this she again explained to the customer how the inhaler works, and made her try it. Once again it gave a loud noise and everybody looked. The pharmacist went on with the explanation, while the woman, quite red in her face, started packing her bag. Later on I confronted one of the pharmacists and asked how that complied with the idea of discretion, she shrugged and said: “That is just because the pharmacy will receive a bonus from the health authorities every time we show a tester”. So even though having been told many times by a lot of different pharmacists that one of the highest priorities was discretion, money was certainly also a top-priority, maybe not to the pharmacists, but to the pharmacy as a whole. There are various roles within the pharmacies that have to be played by the pharmacists, and sometimes they clash. Here the role of the understanding priest clashed with the role of the seller, which is described later on.

Pharmacists: The motherly type

The metaphor of pharmacists as priests also describes one of the dilemmas that pharmacists meet on a daily basis. One of these dilemmas for the pharmacists is being understanding and still be authoritarian. Because of the weird names and explanations of the products, the customers are more or less unaware of what is going on. Therefore the pharmacists just have to tell them what to take sometimes.

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This is where the pharmacists act as authorities. Other times the pharmacists are more understanding in order to help the customers in the best way. They will, in the understanding role, talk about themselves and their experiences with medication or an illness with the customer. But as one of the female pharmacists told me: “We want to be as understanding as possible, but sometimes our integrity would be lost if we are too understanding. If a man with erection problems comes in, we can give him advice, but we cannot really be understanding in that way. He just needs to trust our expertise”. Just like people have to trust a priest without knowing if he really has a link to God.

Pharmacist: the modern times’ alchemist

Not many customers actually know what they buy, and they would not know what to buy just by looking at the content of the box or the name of the medication. This gave inspiration for the metaphor of the pharmacists being a sort of alchemists dealing with mystery in the box. One might say, a mystery that will ease the people’s sufferings. People gladly pay what it costs and they seldom complain about the price as long as they think it can help them. Since the packaging of the medicine does not state all that much the customers rely perfectly on the advice given to them by the pharmacists, whom they might not even know. The box gives a brief introduction to what it contains and what it is good for. The customers are usually explained what the medication is and how they need to take it by the pharmacists. If they are taking medications on a regular basis, they are occasionally being suggested substitutions3. Some customers are suggested substitution but is being loyal to what they know, and therefore, prefer the old kind they are taking, albeit the known medication being a bit more expensive. During my observation in the waiting room, a man entered the pharmacy and was offered a cheaper kind of medicine to which he replied: “No, I want the usual kind. I am sick of being a guinea pig for the pharmaceutical companies”. Even though he was offered a cheaper medication in a different package, he refused to take it, because he felt as if the people selling and producing his medication were thinking of him as a test-subject.

“Give me the highest amount of drug, I can take!!”

Another incidence during my study was a man who needed headache pills. He said he wanted some Panodil or Pamol. The pharmacists started lining the prices of the two up, and said that per piece, Pamol was cheaper right now. The customer asked the pharmacist if it was the same, she told the customer that it had the same working drug4. Then he asked: “Is it the same amount of working drug in them both? Because if it is then I might as well take the cheapest”. So there is a difference in the prices and the names of the various medications, even though the actual workin drug is the same. This confuses customers, and they usually, without the guidance and advice from the pharmacists, just take what they know. For the customers the

3 “Substitution” is what pharmacies call the optimisation of medication, which has the same

ingredients and sometimes even is made by the same companies, but that has a different name and price. The company is by Danish law obliged to suggest the cheaper medicine. 4 Different medicine might have the same ingredient, which by the pharmacists was called working

drug in order to simplify it for the customers. This would be the drug in the medicine that would give the effect of the medication.

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pharmaceutical world can be a jungle, and the pharmacists can be the people guiding them in the jungle. To stay in the church metaphor, this form of medication and guidance reminded me of a sort of religious sacrament. The guidance is for the few, and the sin for the many. The customers have absolutely no idea about products within the pharmaceutical industry. The customers are being told what medications they need, and that the medications then might cost 50 Danish crones or it might cost 500 Danish crones. For the customers, the easing and soothing mystery that the pharmacists/alchemists present before them in small colourful boxes is the essential thing. The money comes secondary in this industry.

Learning pharmacists

In order for the pharmacist to be the best guide possible about all these topics they are required to be updated about rules, prices, updates, ingredients, intakes, etc. of medications. This is a very important part of being a pharmacist: The pharmacists are never fully educated in the sense that they have to continually learn. Medication and the rules for getting state-grants for medication are changing all the time, and it is expected of the pharmacists that they stay updated all the time. That is why there always are many meetings and courses that pharmacists attend to, in order to go home to their pharmacy and update their colleagues. The customers do not care about the names of the medication, because they expect the pharmacists to have full control over the situation. It is therefore the pharmacists’ reputation and professional pride that is on the line, in case they would fail to stay updated. Professional pride is manifested through the pharmacists being true to the names of the medication as well. The pharmacists would never call Panodil a headache pill to a customer; they would call it Panodil and explain its functionality. Behind the customer counter, there is a large shelf where the medication is ordered. All the traffic of the medicaments go out from here. In this way it reminded me of a form of central, for instance a bus-terminal from where the busses are being sent out on their routes. It was from that shelf that the medicaments were packed, and categorised in order of where they had to go afterwards. At one of the pharmacies they had categorised the “central” by the effect of the medicaments placed on the shelf, by doing this the pharmacists ordered the medication after the symptoms of the customers. In that sense the medications were placed with other medicine that dealt with the same symptoms. This could be heart illnesses, respiratory illnesses, pregnancy prevention, migraine, skin illnesses etc. The “central” in the back of the pharmacy

Pharmacists as sales-people

People are willing to pay, like the man who did not care about the price at first but only at what medicine, Panodil or Pamol, had the most working drug. Inhere lies one of the dilemmas of being a pharmacist, a dilemma of the two roles: advisor and

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seller. People are willing to pay anything, and people are also aware of the fact that the pharmaceutical industry knows they are willing to pay anything. But just because they are willing to pay it does not mean that they are willing to pay anything for anything. The pharmacists interviewed said that they prioritised good advice and not the sale. At first they all said: “we are specialists within our fields, we are not sales-people”.

The monopoly of pharmacies

The pharmacies are the only places that are allowed to sell prescribed medicine in Denmark; therefore they do not have many competitors in that field, and the integrity of the pharmacies then lie in their reputation of how the pharmacies deal with the monopoly on medication-sales. However for the sale medicine and the other health products, such as sun blocker, vitamins, anti-smoking products, cough medicine etc. there are many competitors, which is forcing the pharmacy into a sort of sale-strategy. After having confronted the pharmacists with this in the interviews, they started to point to this dilemma as being one of the pharmacists’ major challenges today. There is a lot of money within the above mentioned products, but as one of the interviewees said: “We are specialists on the health area, we are not salespersons”, after a little talk about the funding in a pharmacy she furthermore said that: “We think it is a shame when people have to pay 400 kr. for a sun-blocker, but at Matas they gladly charge 600 kr., so it is a huge industry and why would we not have a piece of that too”. Pharmacists do see themselves as an educated guide on the area of medication. Pharmacists are, however, not merchants in that way, although they do recon that there would be a lot of money to get. This presents a dilemma, where pharmacists have to balance between these two roles. Should the salesperson role take upperhand, integrity of the pharmacists would suffer.

“I have what you need!!”

For instance a pharmacist talked about her colleague who sold many bottles of a wine, called “soulwarmer”. Every time a customer got into the store and needed something for an illness, the pharmacist could practically sell them a bottle of soulwarmer. The pharmacist would simply say: “Are you hurting? Then have a bottle of sourlwarmer” or “Do you have a cold? Then have a bottle of soulwarmer”, and

customers bought it (Ingildsen 2006). She had the sales-role to a large extent. If we try to transfer this to the church metaphor we could see this as the church-box, where our priests would like people to pay but no more than the people would like to spend. And just like in a church, money is nice to have, but it is the spiritual that weighs more. Various products found at the pharmacy, which also are sold at Matas

In this case there was an ambivalent attitude towards money. Money is nice to have, but it should not come first. The fact is that though they have monopolised sales on prescribed medicine, they still have many competitors on some of the other products

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they sell. When going from one sort of product to another, the roles of the pharmacists switch accordingly. Pharmacists switch between specialist and merchant several times in a day.

Pharmacies as in-betweens

It is as an “in-between” of doctor offices and regular stores, that the pharmacies are quite interesting compared to other places. The pharmacies are sort of in between, as mentioned in the beginning. They are not mere doctors, but also not mere merchants; the pharmacies can be seen as the line dividing these two. Thus the pharmacists acts as the spokespersons of the customers to the doctors, and vice versa.

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Different views on ethnography

Characterising user-ethnography

In order to define user-ethnography, an understanding of the characteristics of ethnography will be provided. This is done in order to differentiate and define user-ethnography as it is used in this thesis. Some of the characteristics that have been used in literature about ethnography are:

Our examination of a range of contemporary overviews of ethnography (e.g. Taylor, 1994; Toren, 1996; Rachel, 1996, Baszanger & Dodier, 1997) Leads us to suggest that a prototypical case of ethnography would be characterized by the following 10 features (the order in which these are listed is arbitrary)

1. Situatedness – data are collected by a participant observer who is located within the

everyday context of interest (e.g. a community of practitioners). 2. Richness – the observer studies behaviour in all manifestations, such that data are

gathered from a wide range of sources including interviews, team discussions, incidental conversations, documents as well as non-verbal instructions.

3. Participant autonomy – the observees are not required to comply in any rigid, pre-determined study arrangements.

4. Openness – the observer remains open to the discovery of novel or unexpected issues that may come to light as a study progresses.

5. Personalization – the observer makes a note of their own feelings in relation to situations encountered during data collection and analysis.

6. Reflexivity – the observer takes a reflective and empathetic stance in striving toward an understanding of the observee’s point of view, the observer taking account of, rather than striving to eliminate, their own affects upon the behaviour of the observees.

7. Self-reflection – the observer must acknowledge that any interpretative act is influenced by the tradition to which they themselves belong.

8. Intensity – observations must be intensive and long-term, such that the observer should become immersed in the ongoing culture of the observee’s environment.

9. Independence – the observer must not be constrained by pre-determined goal-set, mind-set or theory.

10. Historicism – the observer aims to connect observations to a backdrop of historical and cultural contingencies.

(Ball & Ormerod 2000, p.150)

Ball & Ormerod (2000) suggest a guide towards detecting “a prototypical ethnography”. They have deducted these characteristics, by analyses of ethnographies within design. However, not all characteristics necessarily have to be present in ethnography. The ten characteristics will provide researchers with a view on how central the ethnography is to classical ethnography (Ball & Ormerod 2000, p. 150). When looking at the ten characteristics, it is very important to note that they are used in two different practices. The two practices are: How to act when conducting ethnography, and what to have in mind when conducting ethnography. In this sense ethnography is being viewed as a method, and hence the characteristics describe the role of the ethnographer. Ethnography is also well known as a written account. In this thesis the method will be applied for a written user-ethnography as it is presented in the chapter: “User-ethnography”. The method was applied when I went out to the pharmacies, and hence gave me a set of direction towards writing the

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user-ethnography. When reading this thesis the distinction between ethnography as a method and user-ethnography as written account is important to keep in mind, since the emphasis here will be on user-ethnography as a written account. Hence the difference of words: ethnography and user-ethnography. The user-ethnography refers to the written ethnography that has been written for design about a culture relevant for design, in comparison with ethnography that refers mostly to the ethnographic methods.

Different practices within ethnography

These ten characteristics are trying to define ethnography. However, there have been attempts in order to alter the definition of ethnography. This shows that ethnography is flexible, and thus can be altered in order to fit most design-research purposes. This is also why there is a distinction in the words: ethnography and user-ethnography. To show that there are different perceptions of ethnography, a short overview follows. There have been various attempts to go beyond ethnographic methods by changing or altering the characteristics of that ethnography (Ball & Ormerod 2000), (Crabtree et al. 2000), (Hartswood et al. 2002), just to name a few. They have all worked on adapting ethnography to fit the context in which it were to be used, by either combining it with another tradition such as cognition (Ball & Ormerod 2000) or participatory design (Hartswood et al. 2002) or simply by creating a more methodological approach for the ethnography (Crabtree et al. 2000). These are not necessarily worse or better, they are just alterations of the ethnography in order to gain the most out of the ethnography within the specific setting. Sometimes there are not enough resources for a thorough ethnographic investigation, which requires alternative approaches such as a “quick and dirty” ethnography (Rouncefield et al. 1994). The “quick and dirty” ethnography is relaxing on the “intensity” characteristic by Ball & Ormerod (2000), but since the ethnography still holds the other nine characteristics it can still be applied as ethnography. This simply shows that there are many different usages on ethnography, and that a further definition of user-ethnography as it is used in this thesis has to follow. This point will be addressed further, later.

The impressions of ethnography

In order to define and establish a characterisation of user-ethnography a discussion about the various impressions of ethnography and its role will be stated. After this a discussion about user-ethnography and how it relates to this will follow. Crabtree (1998), for instance, gives us the example of ethnography being the means to fulfil the gap between the current technology and the technology in the future:

Future workshops, mock-ups, and scenario construction are frequently employed in concert with prototyping as techniques of requirements specification. While effective in enabling user participation in design, these particular prototyping techniques are subject to an endemic problem of systems design. Specifically, in emphasising future possibilities, the danger of “tunnel vision” and thus, of coming up with perfect technological solutions to the wrong set of work problems.

(Crabtree 1998, p. 93)

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Here Crabtree (1998) argues that ethnography is a means of aiding the correction of this “tunnel-vision”, where designers often come up with a perfect solution to the wrong problem. Ethnography, Crabtree argues, can be used as a way of avoiding the “tunnel vision”, keeping the focus on the real setting, and thereby the real “what is going on”. It is furthermore argued that when doing user centred design (UCD)5 techniques, such as user studies which can be seen as an ethnographic method, designers quite frequently engage users out of context, and the techniques, therefore, may not have the desired effect that designers are looking for.

On the other hand, what users find relevant in the course of participatory design activities is not necessarily what they find relevant in the course of accomplishing work. No matter how artfully provided for, the problem of explicating enacted practice in alternate contexts cannot be fully resolved.

(Crabtree 1998, p. 103)

When talking about ethnography within user centred design, ethnography is the link between the culture and the future requirements definition that allows the designers to focus on the “real” problems and not only the ones conveyed during a future-workshop, scenario, or other common UCD techniques. Rouncefield et al. (1994) give the example of their “quick and dirty” ethnography made in a small office environment where they did not have many resources in the terms of time and money. Rouncefield et al. (1994) were restricted in the sense that there no funding was available in order to develop any new software or hardware, so all they could do was to work with the existing work-practice of the culture under study.

Arising from this is the importance of understanding the “real world” conditions of work rather than having design rely on idealisations, which tend to ignore the circumstances, the contingencies, the mix of skills, the local knowledge, and more, which are ineradicable ingredients of “real world” work.

(Rouncefield et al. 1994, p. 275)

Idealisations of a culture are something to avoid in terms of design since it tends to leave out important issues that are essential to good design-solutions. In that sense it could be argued that the entire purpose of ethnographies, or user studies, used within UCD is to shed light on the things that are implicit and usually hidden away from designers.

A major point in ethnographically inspired approaches is that work is a socially organized activity where the actual behaviour differs from how it is described by those who do it.

(Simonsen & Kensing 1997, p. 82)

In other words this means that ethnographies are used in order to make the “invisible visible” by shedding light on the things that usually are out of the awarenesses of

5 User Centred Design will in this thesis, be defined as a method of designing with focus on the users.

By doing studies about the user, and by making user-portraits, workflow-charts, scenarios, etc. the UCD-designers are able to manifest their studies into something that can aid the designers in the design-process by giving them a starting point for requirement-analysis. The designers, furthermore, have some techniques for testing the designed, through UCD.

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designers. Simonsen & Kensing (1997) argue that an advantage of the ethnography is to see how work is organized, instead of hearing it from interviewed workers. The ethnographer in the context of the work observes the work-practice. The same thing is argued for in a study about air traffic controllers (Hughes 1992):

The purpose of an ethnographic approach is not so much to show that work is socially organized (which is rather easy) but to show how it is socially organized

(Hughes 1992, p. 116)

Again we see how the argument is building around ethnography being a method for seeing and sensing how work is organised around the place and the people. In this study, small paper strips were found to be of higher value than first presumed, which was informed by the ethnography. In these papers there has been a strong argument for the ethnography to be a way of understanding the work of others, by getting “close” to it and hence avoid the normative account of work.

The problem is not that normative accounts are incomplete, or that actual practice fails to realize them, but that by definition normative accounts represent idealizations or typifications.

(Suchman 1995, p. 61) It is thus that the ethnography can provide insight into the work-practice, and thus be a better alternative for designers to avoid stereotyping and typifying the relevant work-practices.

The extra level of user-ethnography

The argument that user-ethnography can contain more than the idea of “explaining” in order to inform design has also been presented:

…the supposition that ethnography conveys an overall impression of “what life is like” or “tells it as it is” is profoundly mistaken.

(Anderson 1994, p.155) Here Anderson (1994) argues that ethnography and its conveyance is mistaken. One might ask then, if ethnography is not simply about observing and getting an understanding of what “life is like” then what is it? In order to try to move towards an understanding of what user-ethnography is, a discussion about what it is not will firstly be presented. In UCD, user studies are made in order to get an impression of the “real life” on a worksite. These user studies try to convey an “overall impression of what life is like (Anderson 1994), and can thus not be regarded as user-ethnography. User studies are used as methods for designers to get an impression of the culture, and thereby enable the designers to focus on chosen issues. When doing user studies such as user descriptions, interviews, worksite visits, routine documentation, work-scenarios, personas etc. it might be the beginning of a user-ethnography, however user-ethnography contains more than that.

It is the patterns and the patterning that the ethnographer is looking for and not simply a realistic, behavioralized description or natural history.

(Anderson 1994, p.158)

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Button (2000) also addresses this point, but what Anderson (1994) calls the patterning, Button refers to as the “interactional what” (Button 2000). Both argue for an understanding of the implicit aspects, such as motivation, within a culture that thus cannot be included through descriptive accounts.

However, fieldwork that merely describes what relevant persons do may well be missing out on the constitutive practices of how they do what they do, the “interactional what” of their complexes of action

(Button 2000, p. 329)

It seems that user-ethnography goes beyond UCD techniques in the way that user-ethnography is not a way of describing the users and their habitual routines. User-ethnography is a way of finding patterns and patterning. By finding patterning, the ethnographer is trying to make data out of the observations made. This will be data that in the end might contribute to a larger understanding of the observed. Data that eventually will help see the bigger picture.

Data er noe som produseres underveis ut fra observasjoner. Og observasjoner blir først til data når observasjonerne kan begrepsfestes og teorifestes. (Eng): Data is produced out of observations. And observations will first turn into data when these observations can be conceptualised and theorised.

(Wadel 1991, p.195)

Thus the user-ethnography comes from data. This data comes from theorising the observations. In other words, data is the link between observations and user-ethnography. Furthermore the observations represent UCD techniques, and in this way it is the theorising that differentiates UCD methods from user-ethnography. The user-ethnography will be considered to include a theory, made on the basis of data. In this way user-ethnography includes an extra layer that defines user-ethnography as it is used in this thesis.

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User-ethnography as interpretative research

For the user-ethnography to differentiate itself from UCD-user studies, it needs to contain an element of theorisation. A discussion on how the user-ethnography can contain that extra layer of theorisation follows.

In fact, no amount of time and absorption will avail us if we do not have the analytic wit to extract the patterns from the stream of life going on all around. The ethnographer, then, is a transactor of sorts: a translator, a cultural broker, seeking to achieve an equivalence in value among ways of life by allowing us (although more and more today it is the other way round) to see ourselves in them.

(Anderson 1994, p.160)

An endeavour to treat culture as communication becomes the frame underpinning the rationale of the ethnography.

(Anderson 1994, p. 164)

This indicates that it is not enough just to follow the before mentioned ten characteristics. There is a need for a deeper layer within user-ethnography in order for it to be understood in the terms used in this thesis. It is not simply about mediating between ethnographer and designer, but about interpretation of the observed. The ethnographer thus uses her/him-self as a tool for observing, interpreting, evaluating, and reporting back about the site or situation observed. It is the “analytic wit” (Anderson 1994) that creates the layer of interpretation used within a user-ethnography, and that thus does not treat user-ethnography as mere communication. An elaboration of that statement is provided by Dourish (2006):

Ethnography is concerned with the member’s perspective and the member’s experience, but it does not simply report what members say they experience. Ethnography theorizes its subjects. Ethnography is interpretive, and indeed, ethnography’s outputs are often not analytic statements purely about members’ experiences, but about how members’ experiences can be understood in terms of the interplay between members and the ethnographer.

(Dourish 2006, p.543)

Again user-ethnography is directed more towards an interpretative theory. It is, for the ethnographer, about building their own interpretation of the observed in order for them not just to see, but to also understand. By interpreting the observed, a theorisation occurs, as described by Wadel (1991), and it is by these means the user-ethnography is filled with interpretation, which works as theory. According to Dourish (2006), this interpreting is arising out of the “interplay” between the ethnographer and the members of a culture. The understanding of the culture lies within the theory, which is originated by the ethnographer’s interpretation. The user-ethnography should therefore be able to trigger a better understanding about the culture under investigation. The understanding of a culture goes beyond observing in the sense that it tries not only to give a descriptive view on things but also tries to tell why, the things are done as they are. Hence, it is an explanation built upon descriptions that are being stated. However it is still important to note that it also is

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in the theorisation of user-ethnography is based on the knowledge and the points of view of the ethnographer. The ethnographer will therefore build theory, based on previously gained knowledge and life experience into the user-ethnography. It is not stated in the ten characteristics deducted by Ball & Ormerod (2000), However, it should be stated, since that therein is a profound idea for the ethnographer to be an outsider in order to reflect on the culture under investigation. This independence will be of value, since it often takes an outsider to question the everyday events that go on within a culture. User-ethnography is then a theory that will provide designers with an insight that has not been previously presented to them. In this sense the user-ethnography will give the designers a reframing of a site or situation they might have little or no previous knowledge about:

Rather than describing attributes of a population from some neutral position outside the field of view, accounts of cultural meanings and practices are inevitably created from particular standpoints that set up the lines of comparison and contrast between the speaker/writer and the persons and practices described.

(Suchman 1995, p. 63)

This indicates that the interpretation of the ethnographer, originates from the ethnographer’s own position towards a culture. It is, however, quite rarely the case that designers as human beings have no previous knowledge about the subject of design. This would mean that the ethnographer has pre-determined ideas about problems and design-solutions for those problems. Not only do representations of work involve perspectives and interests, but work has a tendency to disappear at a distance, such that the further removed we are from the work of others, the more simplified, often stereotyped, our view of their work becomes.

(Suchman 1995, p. 59)

Most designers would have a basic pre-perception about most cultures, so when Suchman (1995) indicates, the less knowledge there is about a culture, the more stereotyped it becomes, there would be a degree of stereotypes of most cultures. More will be said about the stereotyped perception and its effect on a design-frame.

User-ethnography’s contribution to design

After having discussed the layer of interpretation in user-ethnography, there are still unanswered questions about the value and relevance of user-ethnography within design. In the following pages a justification for the interpretative user-ethnography within design will be discussed. In other words, comments on how interpretative user-ethnography, might contribute to the design in comparison with the form of user studies not containing any theorisation used in UCD. The claim is that user-ethnography can help designers discover understandings within a culture, which can enable them in finding innovative design opportunities.

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What ethnography may offer designers concerned with productivity is not just detailed description of work routines and daily life with which to fix the features of the design, but an opportunity to open up the overall problem-solution frame of reference in the context of some proposed solutions to specific identified problems.

(Anderson 1994, p.170)

It is herein proposed that the designers will be able to distract from the pre-conceived perception of the design-subject and reframe the design into taking undiscovered innovative paths. This will be done by going beyond the scope of user studies into the theory located in the interpretation within the user-ethnography. This is made possible by going from producing a solution of a more or less obvious problem, into the possibility of enriching a context and thereby going beyond the problem solving thinking within design. Designers will thus be aided to go beyond solving problems to a state of mind where the importance lies within the enrichment of a site or situation. By taking this a step further many design opportunities will appear, and many possibilities within the design will present themselves. By reflecting on a culture, the designers open up their understanding of the culture. When opening up the minds, the designers see the culture differently and approach it in another way, where they move away from the “problem-solution framework (Anderson 1994):

We might suggest that what ethnography problematizes is not the setting of everyday practice, but the practice of design.

(Dourish 2006, p. 546)

By treating user-ethnography as an interpretation, a point is made about how this might enrich the designers’ approach to the culture. By presenting a theory the user-ethnography makes the site or situation in question more apparent and obvious. Thus the user-ethnography challenges the stereotyping suggested by Suchman (1995), since the user-ethnography designers’ understanding of the culture by making them reflect on it, in relation to their own culture. The interpretation in the user-ethnography will thus trigger some empathic understandings, which make the designers place themselves into the situation they are trying to enrich. This allows the designers to see things that are not only immediate apparent but also to understand why things are as they are. In other words user-ethnography broadens the designers’ understanding of a culture and triggers designer’s empathic stance towards that culture, hopefully making them realise that:

Brokenness is in the eye of the beholder. If you cannot be sure it is broken, think twice before setting out to mend it.

(Anderson 1994, p. 178)

User-ethnography is a way for the designers to gain an understanding of the culture, and achieve an insight into the motivations and customs of the people in the observed culture. This understanding is achieved through the interpretations made by the ethnographer. By interpreting the culture, a theory of the observed is being made.

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At its most basic level, a theory is a useful simplification, a mechanism for imposing a framework on the blooming buzzing confusion that is reality.

(Erickson 2006, p.5)

According to this statement user-ethnography can be classified as a theory. When the ethnographer interprets a culture, it is a simplification process that is going on. This simplification process helps the ethnographer by collecting all the observed into data. The collection and theorisation of the data is more than just a way for the ethnographer to mediate an insight into a culture. It is also a presentation of that culture seen with the background and the experiences of the ethnographer, and should also be regonised as such by the designers. Because it is the idea of people that are learning about a culture, need something to compare that culture with, before being able to define the details and the finesses of that culture. It is the old thought of not being able to know white before you have known black, the idea of everything being defined by its opposite. Defining other cultures requires a comparison and something to correlate it with, and this is where the contribution of the ethnographer comes into play. Thus the ethnographer and designers are not only reflecting on the culture under study, but also on their own culture and practices:

The representations ethnographers create, accordingly, are as much a reflection of their own cultural positioning as they are descriptions of the positioning of others.

(Suchman 1995, p. 63) When reflecting on their own and others’ positioning, there is an analysis going on. This analysis is what leads to an interpretation, which leads to a theory within the user-ethnography. It is that theory that in the end plays a large role within design. The theories presented in the user-ethnographies broaden the designers’ perceptions by bringing forth interpretative analyses of the observed. It is through the ethnographer’s “analytic wit” (Anderson 1994) that the largest contribution of user-ethnography is made for design. It is within that analysis made by the ethnographer, that the designers achieve a broadened understanding about the various aspects going on within a culture:

Amid ongoing discussion of the relation of ethnographic interests to those of design, recent workplace ethnographies provide both general frameworks and specific analyses of relations among work, technology, and organization.

(Suchman 1995, p. 63)

It is, in other words, the framework analyses of the relations within a culture that help broaden the designers’ understanding. The user-ethnography makes the designers reflect on other cultures, but also on their own, and thus makes them move away from the requirements analysis. This is mainly due to the broadened understanding achieved through the user-ethnography, which “does not sit well with” the user-ethnography (Crabtree & Rodden 2002).

Requirements analysis is essentially reductionist in character then, which does not sit well with ethnographic inquiry.

(Crabtree & Rodden 2002, p. 70)

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User-ethnography as a discourse for design

After having presented the view of user-ethnography as a theory arisen out of the interpretation made by the ethnographer, an elaboration of the user-ethnography as theory follows. As mentioned before, user-ethnography will, in this thesis, be dealt with as containing an extra layer of theorisation. In order to define a theory and see the advantages of theorisation in a user-ethnography, a discussion about theories and its contributions will be provided. Providing such a discussion will argue that the interpretation made by the ethnographer is theory, and through that discussion, the advantages such a theory might bring with it are established. A theory might consist out of two things:

1) A simplification of the world’s reality 2) A frame for debate

(Erickson 2006)

When taking a closer look at these two statements, a larger understanding of how this relates to user-ethnography emerges. In these ways a theory, in general, can be helpful within a design team in two ways: 1) The theory in the user-ethnography can provide designers with a fast glance of the theorised, in order for the designers to gain a simple understanding of a culture, which is not that simple. This will provide designers with a common frame of the context of the users. With such a context of the users, the theory might provide a “lingua franca6” (Erickson 2005), and a shared understanding that eventually will help keep the team members on the same track when talking about design. By supplying the designers with such a terminology they will also be able to communicate to members outside the design/research team. It is the common and shared language that puts the investigated culture into a “box”, which in metaphorically terms can then be manipulated with, in or outside the design-team. It is the frame of simplification that makes the account much more comprehensible and easier to deal with. There is however a balance between over- simplifying and not simplifying enough Too much simplification will result in the theory losing some of its value, too little simplification will make current account difficult to comprehend (Erickson 2006, p.6). 2) A frame for debate within a theory is closely linked together with simplification of the culture. Within the simplification of the world lies some solidness in the way a theory is being dealt with. User-ethnography as a theory, can provide the designers with a shared understanding of the culture being researched. This enables the designers to articulate and refine a common ground, which may stand as a basis for a dialectic debate and understanding. The designers’ understanding of a culture evolves over time because of the ongoing debate in the design team.

6 Here “Lingua Franca” is used as a definition of a common language that is understood by all.

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In particular, a theory can serve as a framework for debate within a discipline and, as a consequence, over time the theory is articulated and refined in response to the debate resulting in a more complex theory, or possibly multiple versions of the theory.

(Erickson 2006, p.5)

Here Erickson (2006) argues for the development of a theory. When a theory is being presented, the designers will discuss the theory. On the background of that theory, a broader theory or alternative versions of the original theory will emerge (Erickson 2006). The designers can thus develop a theory of their own, as well as synthesise that theory with others, in the process. To shortly sum up the previous two chapters, an outline of ethnography as it is discussed in this thesis, has been created. There are many different meanings and classes of user-ethnography, hence user-ethnography can be used in many ways. In this thesis user-ethnography will be used with a large emphasis on the extra interpretation and the analysis, which provides the user-ethnography with a theoretical stance. It is, in the end, this theory of user-ethnography that will be basis for the arguments made in this thesis. This theory is to broaden designers’ understanding and to open up their “problem-solution framework” (Anderson 1994) Furthermore, the theorisation is about providing designers with a “lingua franca” and a “frame for debate” (Erickson 2005). It is very important to note than when the word “user-ethnography” appears hence onwards, it has the form discussed in this chapter, with a large focus on the theorisation of user-ethnographies. User-ethnographies are also defined as being in a written form, like it is in the chapter: “user-ethnography: going to the sacred pharmacy”.

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Pharmacy-ethnography and Moggill community-ethnography

The empirical data provided for analysis on the theoretical framework stated in the earlier chapters includes research data about the Brisbane design-dialogue, which was a workshop ran on the Moggill community-ethnography (Can be seen in its full in Appendix 1), along with the pharmacy-workshop. Professor Jacob Buur and Professor Margot Brereton wrote the Moggill community-ethnography. Before going into the discussion about how these relate to the stated theoretical framework, a short introduction will be provided of the Moggill community-ethnography, followed by a discussion about the ideas that acted as grounds for the decisions made in the pharmacy-ethnography. The Moggill community-ethnography will then be related to the theoretical framework, whereafter the pharmacy-ethnography will be related to the theoretical framework. Finally the two will be compared in order to establish general characteristics of the two, somewhat different, user-ethnographies.

Brisbane design dialogue

The project was about a smaller community, close to Brisbane in Australia, called Moggill. The user-ethnography was given to designers in order to inform some initial design ideas about the community, and how to make people loiter more in the shopping mall. Professor Jacob Buur was working alongside Professor Margot Brereton in Australia on preparing the user-ethnography that was about the Moggill community. Together they made the user-ethnography based on common observations. Brereton is the insider that lives in the community, and Buur is the outsider coming into the community with a different understanding and a different set of values. The user-ethnography as such consisted of two main categories:

1) Belonging to the community 2) Growing with the community

(Buur & Brereton 2005)

The user-ethnography was about living in the community. Thus the former would be a sort of “static” being in the community, whereas the latter could be seen as a “dynamic” being in the community. Both the categories of static and dynamic were presented to designers in the form of a diagram or chart. This made the theories more visual. The two presented categories were: 1) “Belonging to the community” theorised the structure of the community, and how the community relates to the individual. This category tries to characterise the relationship one has to the surrounding people and contexts in a community. Taking a stance in the individual, there are “barriers” to cross in order to approach and gain relations with other people. These barriers are being presented as: the “awareness barrier”, the “bonding barrier”, and the “engagement barrier”. The “awareness barrier” divides the individual from the implicit groups, such as school, hobby clubs, church, shops etc. These are implicit groups and are achieved implicitly in an unintentional manner. For example, when parents send their children

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to school, the parents are implicitly members of the groups of parents from that school. The “bonding barrier” divides the individual from various friendships. The “engagement barrier” divides the individual from the different sorts of interest organisations. When crossing the “engagement barrier”, there is a more conscious choice involved, than when crossing the “awareness barrier”. The groups behind the “awareness barriers” might be the same as the implicit groups mentioned above. However the involvement with these groups requires more commitment and engagement in the interest organisations, than in the implicit groups. Examples of these could be a school board community, a community association, a sports coaching etc. The “bonding barrier” also requires engagement, but is more informal than the “awareness barrier”. Thus the theorisation lies within the three groups that an individual is surrounded with. Furthermore, the sort of “barriers” that have to be overcome in order to engage with other people, is included into the theorisation in the user-ethnography. 2) “Growing with the community”, as the former category, takes its stance within the individual. However this theory does not present a static relationship between people in the sense, that the community is moving/growing alongside with individuals in the course of time and incidents. Usually in the daily course, families have their own way of living, and the community just goes on around a family. However, sometimes incidents occur where either the community or the family is taking another course and this might collide with the other party. In this category there is an individual vs. collective theory. Whenever a collision is on the way, this might be because of long-term community development such as motorway plans or plans for building a shopping centre, which means the family is forced to make a directional change in their daily course. This might be manifested by the family making a change or shifting a balance in how they engage in the community (Buur & Brereton 2005). The user-ethnography and the Brisbane design-dialogue will be applied more comprehensibly later.

Pharmacy-ethnography

Before going into an analysis about the user-ethnographies, the method of writing the pharmacy-ethnography will be discussed along with the qualities that were implemented into it. This is done in order to achieve a comprehension of the decisions made within the method of writing user-ethnography. Such a comprehension is of importance to the conclusions derived in this thesis.7 The user-ethnography is written in accordance with my work at a company located in Holbæk, Denmark called Invisense. Invisense is a company specialising within the development of health applications incorporated within mobile phones. The company develops applications that aim to simplify the life of long-term patients and their experiences with medication. The collaboration between Invisense and I was carried out from July 2005 until May 2006. This collaboration includes user interviews, and

7 There may be many ways to construct a user-ethnography. But when discussing the details of the

construction of this user-ethnography, it is a means of linking this method of writing a user-ethnography with the conclusions drawn in the end. A note has therefore to be made about the variables in the conclusions drawn, about other forms of ethnographies.

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design dialogues on pharmacies. These along with some field-studies at Tølløse apotek, carried out by Pernille Ingildsen, helped me with the data for writing my user-ethnography. Thus the data-collection was a joint effort between Invisense and myself.

The development of the user-ethnography

The pharmacies that were visited were Løve Apoteket in Sønderborg (Field notes in Appendix 2) and Tølløse Apotek in Tølløse (Field notes in Appendix 3), which was a study carried out by Pernille Ingildsen from Invisense. After these two studies some preliminary ideas for the user-ethnography emerged, which was then tried out and tested in an observation at Jernbane Apoteket in Sønderborg (Field notes in Appendix 4) a couple of weeks later. Jernbane apoteket and Løve apoteket are bigger pharmacies, and Tølløse apotek is a small distribution-place with only one employee. The method of data collecting was mainly observation. I would be located in the waiting room among the customers and thus sensing what the waiting time involves, and trying to get a feel of how one feels in such a waiting room. Observations were also made behind the counter, in order to get a feel of the stress and work-practices that are going on amongst the pharmacists. Furthermore, extensive interviews and dialogues with pharmacists were conducted in order to achieve an understanding of pharmacies. Each of the pharmacies contributed with observations that either varied or were similar to observations at the other pharmacies. One thing in the user-ethnography that was confirmed at all pharmacies was the dilemmas of the various roles of pharmacists, which was the seller, the advisor, the authoritarian, the alchemist etc. The customers’ attitude towards discretion also seemed to be quite similar, so that the customers would be discrete at all pharmacies. A thing that varied a lot in various pharmacies was the organisation of employees. While at one pharmacy the pharmacists switched to be a team-leader, the pharmacists at another pharmacy had an employee whose job description was team-leader. Thus the main variable between pharmacies was how the pharmacists decided to act as pharmacists, and how they prioritised their various roles. This shows that the three different pharmacy visits have been a way of relating and comparing the various pharmacies. Studying different kinds of pharmacies had the advantage of being able to deviate more general methods and customs in a pharmacy, from the local based methods and customs. Pharmacists would within local based customs and methods, have achieved a work practice that deviated from other, general work practices at a pharmacy.

The qualities included in the user-ethnography

Some qualities were chosen in order for the pharmacy-ethnography to be applicable for design. These are being listed below, along with the qualities out of the Moggill community-ethnography that inspired some of these qualities in the pharmacy-ethnography. The user-ethnography written by Buur and Brereton gave some insights into what the pharmacy-ethnography should contain, since the Moggill community-

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ethnography has some qualities that seemed to inspire the designers quite well within the workshop-session. These qualities were:

a) It is comprehendible b) It is broad and specific at the same time c) It is provocative

In the following I will give a more detailed description of these three qualities. a) The Moggill community-ethnography is comprehendible because it is easy to explain and easy to understand. This was due to the level of abstraction made within that user-ethnography. The Moggill community-ethnography is visual, where one might get an idea just by looking briefly at it. The visual aspect is the graph; however, a metaphor might have done just as well. It is by these visualisations that the designers get associations to other well-known cultures. By including the graph, and hence presenting the user-ethnography in a visual manner, the Moggill community-ethnography made it quite comprehendible for the designers, since the user-ethnography operated in terms that are known and used by the designers. Relating this to the pharmacy-ethnography, the pharmacy-ethnography included metaphors and stories in order to make it comprehendible. b) The Moggill community-ethnography was broad and specific. It is broad in the sense that it is focused on the small town community and tried to explain the various relationships there might be within that community and how these relationships are correlated and divided from each other. The user-ethnography is quite specific since it is Moggill community that is under study. However it is also a study about a small town community and they might not be that far apart from each other. So it is a user-ethnography about Moggill and there are therefore presented things that are quite specific to the Moggill community compared to other local communities, but it is also about small towns, and it might fit to most small communities in the world. The pharmacy-ethnography is thus an account of general pharmacies as such, but since the main study was carried out at Løve apoteket, the pharmacy-ethnography will also be specific to Løve apoteket. c) The Moggill community-ethnography is still provocative in the sense that the user-ethnography reframed the designers’ percetion about Moggill. The Moggill community-ethnography, made designers that knew the small community think about it in another way. This might be understood as a way of provoking. Because if designers have not thought about the user-ethnography in the way it is presented, before, the designers may find that the user-ethnography goes beyond their understanding and this will question the designers perception. This questioning will help move the designers’ perception of the culture. In design terms the user-ethnography is able to provoke a reframing of the culture and thereby open up designers’ minds, trying to provoke “thinking out of the box”. The pharmacy-ethnography is made provocative, through its church concepts and metaphors. But also some of the stories and statements were incorporated in order to achieve provocation in the sense of questioning.

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Besides these three qualities inspired from the Moggill community-ethnography, an additional four qualities were added to the list of qualities that were seen as desirable in the pharmacy-ethnography. These qualities were listed in order for the user-ethnography to fit within the purpose of design. Therefore each of the qualities listed has a purpose in relation to design. An elaboration of each of them and their relevance to the design-process follows. A user-ethnography should:

a) be able to stand alone b) be short c) try to make the “strange familiar and the familiar strange” d) contain a form of interpretation made by the ethnographer

a) The user-ethnography should be able to stand on its own, so that the design team can try to interpret it in their own way, as discussed in the chapter “User-ethnography as interpretative research”. This means that the user-ethnography should be self-explanatory and not need further explanation. This is an attempt of building an extra layer on the analysis of the pharmacies investigated, so that the user-ethnography does not limit the ideas generated by the designers. Instead the user-ethnography lets them explore its content. This is meant as an extension of the above mentioned “broad and specific at the same time” quality. b) The quality that the user-ethnography should be short, is an elaboration of the idea that it should stand alone. The user-ethnography should tell as much as possible in as little space as possible. This, again, prevents too much narrowing of the designers’ minds in such a way that the designers are being limited in their ability to reframe the culture. Furthermore it has the aspect of giving a few strong points that can trigger discussions and design potentials. Too many points might seem confusing and unstructured, while the power of the few would be to keep a clear overview while focussing on the main issues found by the ethnographer. By keeping it short and powerful, it still has yet enough data for the designers to elaborate on the theories presented in the user-ethnography without making the designers read a novel, which only a few design teams would have the time to do anyways. c) The user-ethnography should try to render the strange familiar and the familiar strange (Anderson 1994). This is a way for the user-ethnography to open up the designers’ minds. The user-ethnography can help make the designers wonder and thereby aid them in a discovery of unforeseen design opportunities. The quality of “rendering the strange familiar” and vice versa is a way of reframing the designers’ perceptions of the culture. This quality is closely related to the “provoking” quality, in that the quality of rendering the strange familiar and the familiar strange is a means of provoking the designers to reframe their perception and positioning, and thus achieving a broader understanding of the culture.

While viewing other cultures, then, not only do we hold a mirror to our own; we also ask questions about ourselves.

(Anderson 1994, p. 159)

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This means that designers are being provoked into reframing their perception, by the “Hermeneutic circle8” (Klein & Meyers 1999), and it is within this hermeneutic circle that the quality finds its justice. The designers ask questions about themselves and about the culture under study, and thus the designers achieve a broader understanding of their own perception and positioning towards the researched culture. In the pharmacy-ethnography, this quality was implemented into the user-ethnography with help from the concepts and the metaphors, which combined, questioned the designers’ perception and positioning towards the pharmacy culture. d) The user-ethnography should contain an interpretation provided by the ethnographer. This is the recurring idea of a user-ethnography being an interpretative theory, where the culture observed is being theorised through the interpretation of the ethnographer. The influence of theory within design should have the effects discussed in the previous chapter. These were the qualities that were chosen for the user-ethnography in order for it to contain an element of theorisation and thereby achieve its potential for design. Since some instruments of aiding to the before-mentioned qualities were mentioned, a definition and description of the instruments follow.

The instruments used in the user-ethnography

Some instruments were used in the user-ethnography in order to achieve the qualities that have been mentioned. A discussion of the strengths of each instrument is provided. The instruments are:

a) Metaphors b) Stories c) Dilemmas d) Concepts e) Statements

a) Metaphors were used as a way to “render the strange familiar and the familiar strange” (Anderson 1994). It was a way for people to understand what the essence of certain acts or utterances might resemble. It was a swift way for the designers to get a comprehension of the interactions going on in a pharmacy.

8 The idea of the hermeneutic circle suggests that we come to understand a complex whole

from preconceptions about the meanings of its parts and their interrelationships. (Klein & Meyers 1999, p. 71)

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Lakoff og Johnson påpeker at “human thought processes are largely metaphorical” og at metaforer ikke er “mere language”. De mener at metaforbruk “unites reason and imagination” i hva de betegner som “imaginative rationality”. Metaforer, mener de videre, er et av våre viktigste verktøy “for trying to comprehend partially what cannot be comprehended totally”.

(Eng) Lakoff and Johnson points out that “human thought processes are largely metaphorical” and that metaphors are not “mere language”. They believe that the use of metaphors “unites reason and imagination” into what they refer to as “imaginative rationality”. Furthermore they believe metaphors to be one of our most valuable tools “for trying to comprehend partially what cannot be comprehended totally”.

(Lakoff and Johnson in Wadel 1991, p. 200)

So to rephrase what Lakoff & Johnson (in Wadel 1991) state. Metaphors are instruments in order for the ethnographer to make the audience get a partial understanding of a culture, “that cannot be comprehended totally” (Lakoff & Johnson in Wadel 1991). The metaphors are an instrument aiding in the understanding of the culture, by “uniting reason and imagination” (Lakoff & Johnson in Wadel 1999) b) The primary function of the stories was to bring in the lives, of people that are being studied, to designers’ comprehension. The stories make the user-ethnography more vivid and by being descriptions. Like in a book people start by wondering why and then later on when they get a sense of that person, or they get a feel of “knowing” that person, they start to see some reasons for the behaviour of the people being read about. Stories are a way of stating the factual and explaining some of the features that have been observed through anecdotes about the settings in which everything happened. Stories also aid in creating “a relationship” between the people under study and the audience of the user-ethnography. Thus the designers might get closer to the people they are designing for. Stories provide the designers with accounts of people and situations, which the designers can discuss. In that discussion the stories will provide the designers with a common ground as stated by Erickson (2006). c) Dilemmas were described and implemented from the field notes taken from the pharmacies (appendix 2, 3, and 4). Dilemmas were stated in order to understand the behaviour, value and beliefs of the people of study. The pharmacists have certain ways of doing things and dilemmas are a way of describing what people are doing and what sort of consequences their actions will have. Describing dilemmas can help the audience of the user-ethnography to understand the motivations and reasons for the pharmacists’ behaviour. The quality of dilemmas have the same effect as stories, and make the persons described in the user-ethnography come alive, almost as they would in a book where the characters almost are brought to life. In such a case the readers know the next move of these characters because the readers are beginning to be able to recognise character traits, and are therefore able to empathetically place themselves in the characters’ position. d) Concepts are used as a theory in the user-ethnography. Concepts are means for the ethnographer, to conceptualise the observed, and thus interpret it. Concepts are thus a means for aiding the reframing of a culture under study.

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Der er viktig at vi som forskere er oss bevisst når vi går fra å bruke våre informanters språk og begreper til våre egne “konstruerte” språk og begreper.

(Eng) It is important that we as researchers are aware of going from using our informants’ language and concepts to our own “constructed” language and concepts.

(Wadel 1991, p.150)

As Wadel (1991) states, it is really important that the ethnographer is aware of when the concepts are interpretive, and when they are taken from the culture under study. If this is not clearly stated in the user-ethnography it might cause some confusion by the audience of the user-ethnography, since that audience cannot be sure of the purpose and context of the concept. e) Statements are also an instrument, which reframe the perception of the designers. Statements can come from the ethnographer or from one of the people within the culture, who in the case of the pharmacy-ethnography would be either a customer or a pharmacist. The quality of statements can be used for triggering design-discussions because these statements are most often point of views that one can agree or disagree with. Is the statement originated from the ethnographer, it is the ethnographer’s interpretation, and thereby theorisation. Therefore the effects of this theorisation relate to the effects of reframing the designers’ perception. These are the five instruments that aided the user-ethnography with achieving the seven qualities that are to give the user-ethnography its theoretical element. Since the instrument later on will be evaluated, it is important to keep a note on them. Through an evaluation a pattern of the instruments’ effect and influence on the design-outcome within the workshop on the background of the pharmacy-ethnography emerges.

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Brisbane Design Dialogue

The theoretical framework described in the previous chapters, formed a base for a discussion on the Brisbane design dialogue. The Brisbane design dialogue was the workshop performed on background of the Moggill community-ethnography. Thereafter a similar discussion is made on the pharmacy-ethnography, and finally a comparison between the two will be made. The purpose of such a comparison is to find generalities within the two user-ethnographies.

Moggill community-ethnography design-outcome

The participants in the workshop came up with different designs based on the various methods. It is therefore important to note in the final design, that the user-ethnography was only one of the methods applied in order to inform the participants’ design decisions. Some of the aspects in the design-outcomes are informed by the user-ethnography. A short description of each of the design-outcomes follows:

1) The meeting tree. Three artefacts in the shape of a tree, a necklace, and a solar system all make it possible for the user to keep track of friends. The tree had coloured marbles that signal whether a friend would like to be contacted or not. The necklace had some pearls on it with the same principle, so that friends could find each other. And finally the “solar system”, had planets that symbolised different people and the user were then able to see who were close and who were far away.

2) The information pond. This is a pond in the mall where it is possible for

people to display information of any sort in the pond. Video, picture, text, games, etc are all accessible when approaching the pond. It is thus possible for the users to leave messages for each other. The main purpose of the pond is to motivate people to loiter in the mall.

3) The voting hand. With a voting product, in the shape of a hand with

thumbs up or down, the user can now vote in an openly democratic way. When voting, the hand will either go thumbs down (for no) or thumbs up (for yes), leaving the other voters capable of seeing which has been voted for.

Buur & Brereton (2005)

The brainstorming session

After the user-ethnography was presented to the participants in the Brisbane design dialogue, the participants went out to do a brainstorming session on the topics in the user-ethnography. The participants used a large piece of paper spread out on some tables. It seemed that there were two main groups within the workshop. One group tried to support the coming together of the community through IT systems. The other group tried to rewrite the theory of the user-ethnography, by discussing it and thereby developing the theory of the user-ethnography further. Thus the theory applies in the two ways discussed previously. The theory makes the world more

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comprehensively and easier to understand. However, the theory also creates a form of debate, where the designers elaborate on the theory explained to them (Erickson 2006). The participants started challenging the concept of “barriers”, which led to a discussion about the theory of “barriers”. One of the participants challenged the concept by drawing the “barriers” from the user-ethnography on the paper.

The brainstorming paper, showing the redrawn “barrier” theory

These “barriers” started generating ideas that could be related to the community in a specific way. This helped the designers raise some questions. Some of the questions raised were:

Can the barriers move? Shouldn’t they be bridges? Which way do newcomers enter into the community?

How does the river (referred to as “Moggill Moat”) as a barrier surrounding the community relate to other “barriers”?

(Buur & Brereton 2005)

By asking these questions the designers took the theory within the user-ethnography and related it to their specific situation of designing. The “barriers” were challenged into real barriers (river), and were later transformed into bridges9. It seemed that the theory was a way of rendering the strange into the familiar. The designers took the abstract theory and made it very concrete and specific by using the terminology of the theory and compare it to their own experiences and previous knowledge of the community. Hence they moved from the concept of “barriers”, to actual barriers and later on to bridges. The questions raised, were reframing the theory presented to them. The participants placed the more abstract theory into the specific context in which the participants worked. This reframing made the participants ask questions about how to overcome the “barriers”, by critically question these “barriers” and eventually even changing the “barriers”, it gave the participants something to work

9 Highway bridges across the river were initially one of the focuses within the Moggill project.

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with. The theory provided them with a base for debate and discussion, which they could alter in the way they wanted. The participants reframed the theory, but in a dialectic manner, so that the theory also reframed their understanding. This reframing of understanding and theory took the participants’ discussions to various places. The participants began to see the design opportunities within the frame of “barriers vs. bridges” and used this to explore larger design opportunities. In other words the brainstorming made on the background of the user-ethnography, provided the participants with a set of frames that were not problematic to the observed and discussed focuses. The user-ethnography provided the participants with a neutral theory that let them expand their understanding of the culture. Thus, the theory challenged the participants to go beyond the “problem-solution framework” (Anderson 1994)

…the contribution that ethnography may make is to enable designers to question the taken-for-granted assumptions embedded in the conventional problem – solution design framework.

(Anderson 1994, p.158)

As Anderson (1994) states, this is how the user-ethnography intervenes in the participants’ thoughts about the Moggill community. When the participants recapture the user-ethnography on paper, they start to to manipulate the theories in the user-ethnography, and are able to include the things that are on their minds, thus this is a form of dialectic synthesising. The user-ethnography opened up a new discussion and seemed to stimulate the way the participants saw the design opportunities. The user-ethnography questioned their understanding of the context, which made them question the context. This was a chain-reaction that made the participants approach their material in a different way. User-ethnography contributes to the questioning as is said by Anderson (1994) above, and in the previous chapter. User-ethnography contributes to the opening up to the design opportunities, by providing an alternative way of approaching design instead of the classical “solution to a problem” approach. This is furthermore, as Anderson (1994) states, done in the context of the observed culture.

Informed by the user-ethnography

In the following I have chosen to focus on design-outcome one, which is the three devices: meeting tree, necklace, and solar system. I will show the ways in which the discussion and brainstorming based on the user-ethnography may have influenced the final design-outcome. There is a possibility that the design was also informed by other methods, because this was a workshop presenting several methods. However, it seemed to me, that this was the design-outcome most informed by the user-ethnography, as it had a lot of elements of the user-ethnography within it. It also seemed that these designs originated from the brainstorming session based on the user-ethnography, where the participants tried to make bridges out of “barriers”.

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The meeting tree, which had red and green marbles to show whether a friend would like to be contacted, the necklace with same function, and the solar system which would show the user where her friends are.

In the user-ethnography developed by Buur and Brereton (Appendix 1), the theory argues for an exclusion of people from other people by conceptual “barriers”. The theory “barriers” might be something that most people can relate to when it is presented to them, however only a few would be able to apply it, while interacting or living within a community. It seemed that the user-ethnography clarified the “sense” of interacting between people. The user-ethnography is going a step further in order to create awareness. Awareness about how people live, but also why they live the way they do. When talking about people surrounded with various “barriers”, the discussion proposes a base and reasoning for some of the people’s actions. The user-ethnography goes beyond mere descriptions and provides a theory of why people do what they do. Thus the user-ethnography does not try to represent the user in any way, instead, it tries to bring designers’ attention to the details of the users’ enactment (Crabtree 1998, p.97), which brings us back to the understanding of the lives of the users. The link between the user-ethnography and the tree design, in which large emphasis has been laid on the breach of these “boundaries”, emerges. The participants’ own interpretation of the user-ethnography played a big role in the design as well. The presentation of a user-ethnographic theory, in this case, provided the participants with a focus (“barriers”). The participants then, challenged this focus into something they could work with (“barriers” as bridges). The participants used the redefined theory to come up with innovative and creative designs, namely, the tree, the necklace, and the solar system. It seems that Anderson’s (1994) idea of the user-ethnography supplying designers with an insight and understanding into a culture, which will let them “play” around with innovative designs, worked in the case of the Brisbane design dialogue. The user-ethnography presented about Moggill actually did inform the participants. The participants were presented with a theorised concept (“barriers”). This theorised concept triggered the participants’ understanding of the culture, and thus made them able to manipulate that theory in order to reframe their design frame. In this sense the user-ethnography reframed the participants’ understanding of the culture, and thus made them design within that new culture, which ended up with three designs for bringing people together.

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Reflection session on the user-ethnography

In the end of the design workshop a simple interview was conducted, where the participants gave their view on some of the methods and theories tried throughout the day. It seemed that the openness of the user-ethnography helped the participants by providing them a flexible base for design-discussion. In the following, names of the participants have been made anonymous.

…specificity of the ethnography was what made it useful… that in it served a purpose that it framed, I think, and that it gave us a starting point.

(Allan from the Brisbane Design Dialogue 2005)

The part of “Lingua Franca” (Erickson 2006) comes into play here. The specificity is about the topic of the user-ethnography and the fact that it is written in a way that the participants could relate to it. One might say, that the user-ethnography brought a strange culture to the participants in a familiar way (Anderson 1994). The user-ethnography gave the participants a starting point for discussion, which lead to a redefinition of the theory, which led to the design.

And then also the ethnography seminar was useful because it gives you a foundation of you know, who are we actually designing for…

(Brian from the Brisbane Design Dialogue 2005)

The participants gained an understanding of whom they were designing for, and were therefore able to relate to the people within the community culture. The user-ethnography informed, in many ways, the design-outcome, in ways where the theorisation of the user-ethnography broadened the understanding of the participants in a dialectic interaction. As it was said above: “It gives a foundation…” and a starting point for discussion. By doing this, the user-ethnography provides a frame for debate inside and outside the design team. Thus the participants were able to turn the theory in the user-ethnography into a theory they could relate to. This theory led to the designs that trigger people’s interrelationships. Within the following analysis of the pharmacy-workshop, a closer look at how the user-ethnography informed the design will be provided.

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Pharmacy-workshop

At a workshop, the user-ethnography was used in practice. The purpose of the workshop was for the participants to design based on the background of the user-ethnography. Based on the participants’ designs and the way they “used” the user-ethnography, indications of the strengths of the user-ethnography emerges. Furthermore, these strengths are seen in relation to the designers, and are able to give an indication of how the user-ethnography informed the designs.

The workshop

Ten design-students present attended at the two-hour workshop, at which they were divided into three teams. The tables, at which the participants were sitting, were situated beside each other, and that may be a variable to some similar design-outcomes, since the groups were able to listen to what was said at the other tables. After having been introduced very briefly about the workshop, without any introduction to the user-ethnography or the aim of the workshop, the participants were asked to read through the user-ethnography. The lacking of further

introduction was done in order to test the quality of the user-ethnography being able to stand-alone. After the participants had read it through in silence, a document with tasks and questions was placed on their tables. The first task was to reflect on the written user-ethnography, and relate their experiences to the user-ethnography. The questions asked were:

Have you ever been to a pharmacy, and what were your experiences there? How do these experiences comply with the ethnography? Was there anything in the ethnography that you found surprising?

The participants in silence took some post-it notes and started to write down their experiences. There was some discussion about the experiences of the participants and how they related to the user-ethnography. More will be said about that discussion later. The participants were then asked to find “context-related design opportunities” for the pharmacy, customers, and pharmacists. The participants listed some design opportunities they had found from their discussions about the user-ethnography and their own experiences in pharmacies. Finally, the participants were asked to come up with a design outcome that might fit in with any of the found design opportunities. After some time, in which, the participants had found design opportunities and had come up with some design-ideas, they were asked to give a short presentation of their design-outcome, and explain in what ways they found the user-ethnography had informed their outcome. This triggered an open discussion between all of the

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participants about the validity of the user-ethnography. More will be said about this discussion later. During the discussion on the user-ethnography and its relations to personal experiences, there were some general topics that were mentioned within the three teams. The teams all had multinational participants, and this started a discussion about the validity of the user-ethnography in comparison to pharmacies in their own countries. For example one stated that: “This is definitely not the case in Mexico, where all people do not have money to pay what it costs.”10 And: “In US at the pharmacies, the pharmacists fill in a lot of different medication in a box, so the customers do not get anything in pre-packed boxes”. The participants also dicussed their own attitudes towards pharmacies: “I go to the pharmacy to buy cream and toothbrushes etc. Their products are not different, but I can get better and more qualified consultation”, “I worry about my health when going to a pharmacy, because I know that what the other customers have might be contagious.” and “Sometimes I went to the pharmacy with something private, and then the pharmacy was full and then I left again”. Another point in the conversation was the agreement about the “sacredness” of the pharmacies. One of the participants stated that: “I know what this means. When I go into a pharmacy I have to tell my son, not to touch anything, ask the customers any awkward questions, and simply just to be still”. Another comment from a group was: “It is really just like the church, where the pharmacists puts themselves higher than the customers, just like a priest”. Then one said: “If you felt you were allowed to speak up and go around, it would not be so uncomfortable, so taking away the sacredness”. The church-metaphor and its relation to pharmacies was also discussed. Statements about these were: “Churches brings you closer to God, pharmacies just links you to the physical world”.

The design-outcomes

A closer analysis follows of how these statements and reactions indicate how the user-ethnography informed the design-outcomes. First a description and presentation of some of the design-outcomes will be given. This is done to look at the discussions that led to the design outcomes, and to see how these discussions were triggered by the user-ethnography.

10

On the issue of whether people would pay what it cost or not.

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The design-outcomes were:

1) The smart entrance 2) The personal and private pharmacy 3) Drug ATMs 4) Global drug-tube 5) Instant pharmacy messaging

The other designs that were in the workshop were mostly alternatives or variations out of these five ideas. These five were the most varied and comprehensive design-concepts. They were all designed using the pharmacy-ethnography. 1) The smart entrance, was an idea of the pharmacy having a scanner in the doorway, and when a person entered the pharmacy with a prescription, the scanner detects the prescription. After detecting the prescription, the scanner would initiate the order at the pharmacist’s screen and the pharmacists would then start packing the right medication. Furthermore the scanner initiates the monitors around in the pharmacies, which would then show the relevant information for the customers with the particular condition. This was created to fill the waiting time of the customers with constructive content. 2) The personal and private pharmacy is a rearrangement of the pharmacy and a slight change in the work-routines of the pharmacists. The idea is about changing

the pharmacy in the way that counters are lined up in a parallel manner instead of one large serial line. This would have the effect that the pharmacists will not talk out into the room, where everyone can hear what is being said. The change in the work-routine would be that the customer will have one pharmacist through out the entire service, so that there would not be a pharmacist for taking the order, one pharmacist for finding the medication, one pharmacist for delivering it etc.

3) Because there was a lot of attention paid to the privacy issue in the workshop, participants came up with the idea of drug-ATMs, where customers can place their prescription and then get their medication through the “ATM”.

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4) The global drug-tube is an idea combines the privacy issue of the drug-ATM with the certainty and the clearance that pharmacists can provide. The idea is that there would be a lot of tubes going from doctor’s offices and pharmacies to drug ATMs in the street. Whenever people are uncertain about what to take or how to take it, they can go to either the doctor or the pharmacy in order to ask the questions and pick up the medication. If they know exactly what to get, they simply go to the ATM on the street and simply get it sent from a pharmacy close by. 5) The last design-outcome is the instant pharmacy messaging, where the customers can go into a pharmacy in order to get their medication. Instead of going to the counter, in the pharmacy, to ask their questions, the customer could go to one of the hidden monitors and write their question, so that there are not any uncomfortableness, asking the question at the counter where everyone are able to hear that customer. The pharmacist is then able to answer immediately in a private manner, so that nothing is spoken outlout by anyone.

How the user-ethnography informed the design

All these designs were in one way or another informed by the user-ethnography, taking a closer look at the designs gives an indication of what it was in the user-ethnography that may have informed these outcomes. There are three topics from the user-ethnography that had a large influence on the design-outcomes. The three recurring topics in the designs were:

1) Privacy, customers did not feel comfortable talking to the pharmacists as long as other people were able to hear them. Designs that in some way were centred around this point were the “personal and private pharmacy”, the “drug ATM”, the “global drug tube”, and the “instant pharmacy messaging”. All of these designs tried to make the interaction between pharmacists and customers more discrete, either by removing the interaction completely (drug ATM, global drug tube) or by re-arranging the pharmacy so that the pharmacy would better suit the needs of the customers (Personal and private pharmacy).

2) The division of customers used by the pharmacies. Green, yellow, and red.

Green customers are customers that come in and get their medication, nothing more. Yellow customers are customers that may have a question or two about their medication and/or condition. Red customers are customers

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that might need more detailed counselling than the other two customer types. This topic was used in the “drug ATM”, and the “global drug tube”. In these designs there was an attempt to, in one way or another, divide people into these colour-categories, depending on the customer’s needs and desires. The topic of the division of customers is a bit different than the privacy topic and the waiting time topic, because it was only used as an instrument to help out on the two other topics. The topic of division of customers thus not an aim in itself, but a good way of helping towards the aims.

3) The topic of waiting time, inwhere the participants’ aim was reduction or

meaningful waiting time. This topic seemed to have informed the “smart entrance”, the “drug ATM”, the “personal and private pharmacy”, and the “global drug tube”. These four designs dealt with waiting time, and were focused on, how and how much customers had to wait.

These three topics were the main points that were treated in the workshop. This is an indication that there was something inspiring in the way they were presented in the user-ethnography. When taking a look at the user-ethnography and how the above-mentioned topics actually were presented, it shows that some of them simply were mentioned briefly. The topic of waiting time was the only topic, which was elaborated in a full section. The introduction of the pharmacy separating people into colours depending on how much guidance and counselling they need, was merely mentioned in a few sentences. The privacy topic was mentioned in a few lines and the story of the woman that needed to test the loud asthma inhalator. This shows that provocation and information for the design process does not depend on the amount written about a certain topic in the user-ethnography. A few lines seemed to have a larger influence than a complete section. Because the three topics were in both the user-ethnography and in the designs, this is an indication that the user-ethnography did inform in some way or another the design-outcomes. However, there were instruments, which informed the design outcome in different ways. In the following sections, the instruments used within the topics: privacy, division of customers, and waiting time, will be discussed in order to establish the means by which the participants were informed. These instruments will give an idea of the strengths of the user-ethnography. In the end the ways in which, the user-ethnography informed the design will be discussed.

The instruments of the user-ethnography

During the discussions, in which the five concepts were designed, some instruments were present. Instruments within the discussion of the three topics: privacy, division of customers, and waiting time. These instruments were used in the discussion, and led the discussion in a direction that led to the design-outcomes. These instruments are aspects within the user-ethnography that together shaped the three topics. Within the privacy topic some of the aspects that were discussed were: The concept of “sacredness” in the pharmacy, the statement about the authority that the pharmacists have, the story about the woman and the loud asthma inhalator, the statement about the shame of talking to pharmacists about something personal and

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private, and the statement about the attention of the customers which was quite similar to the personal and private shame statement.

The topic “division of customers” was built on the statement of pharmacies talking about red, green, and yellow customers. The last topic was the waiting time. Within this topic, emphasis was placed on the statement about the implicit and expected waiting, the story about the woman who said, “one could sit and grow a beard”, the statement of according to the law there are things that the pharmacists have to do, and lastly the story about the man who got annoyed when being asked these questions, that

the pharmacist have to ask. In general terms we se that the main instruments that had an effect on informing the design were:

- Stories - Statements - Concepts

These instruments were a part of the user-ethnography, but still these instruments acted in a certain way during the design part. In the following section, a discussion is provided, about how the participants used the user-ethnography, and what role the user-ethnography and the instruments played in the designs.

User-ethnography as provocation

The user-ethnography, and its instruments, provoked the participants in ways in which it moved the designers’ perception of pharmacies. It triggered personal experiences and ideas about pharmacies. The user-ethnography made the participants aware of their own stance towards pharmacies. For instance the participants from abroad, whom were provoked into reflecting on how pharmacies work in their own countries. In this sense the user-ethnography asked challenged the designers’ perceptions about pharmacies that the participants had. It provoked the participants to ask questions, and thus to “render the strange familiar, and the familiar strange” (Anderson 1994). When asking and imposing a question, the user-ethnography in many ways reframede that very same perception. The user-ethnography provokes the participants into seeing things from a different perspective, which, in the end, will be an idea generator. The participants will simply get new ideas when seeing the culture in a new light. Thus, the user-ethnography makes the participants ask questions about the “traditional problem-solution framework” (Anderson 1994). The stories had some of this provoking element within the user-ethnography, and made the participants take a stand of their own. The one story, about the man that was offered a substitution, but did not want it because he was “tired of being a guinea-pig”, triggered this stance: “I think he is wrong, they just want to help him and offer him a cheaper medicine”. This person had already made up her mind, and

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knew her stance on ,and her perception about pharmacies. However, another participant stated that: “In Mexico they will show me two kinds of medication, and then I do not know which one to choose”. In this case the discussion was of triggered by a differing stance, which leads into different perceptions. The provoking character of the user-ethnography here lies within the various beliefs and ideas of the designers. These ideas and beliefs are being challenged either by a story in the user-ethnography or by a team member with an opposite view (As the case with the two participants discussing a story from the user-ethnography). Another instrument that was used to provoke and challenge the perceptions and beliefs of the participants was the concepts used in the user-ethnography. The concept of “sacredness” in the pharmacy had this effect. The participants in the beginning were wondering a bit about this “sacredness”, but later on they came up with their own interpretation of the word and started to come up with definitions of what was sacred and what was not. Their perceptions and beliefs were being challenged. In one case, it seemed that after some time of wondering about the concept, one of the participants agreed with the concept: “Pharmacies are sort of sacred, because you feel you have to whisper, and that adds to an uncomfortable feeling, where you feel guilty and claustrophobic”. The mere mentioning of the word “guilty” shows a reframing of this person’s perception of the pharmacies. “Guilty” suits and fits within the concept of a church, which is included in the user-ethnography. Inhere this person was provoked to look differently at pharmacies.

User-ethnography as communication

The user-ethnography besides provoking the participants’ perceptions also provided them with a “lingua franca” (Erickson 2006). The theory presented in the user-ethnography gave the participants a common ground for debate and discussion. The user-ethnography synthesised the participants’ use of concepts. When the participants used or redefined any of the concepts that were stated in the user-ethnography, they got closer to a common understanding of the concept and its definition. The concepts would expand the participants vocabulary, in the sense that the concepts gave them words they could use indifferently compared to the other team members. The team members were all on the same page, whenever one of these concepts was used. The concepts were used a lot: “If you felt you were allowed to speak up and go around, it would not be so uncomfortable, so taking away the sacredness”. This is an example of a situation the concept “sacredness is used”. The participants defined the concept “guilt”, when talking about uncomfortableness, silence etc. and by these means the concept had been filled with a connotation that the team members all could relate on. The word was now loaded with meaning that did not have to be said explicitly each time. The participants had adopted the concept of the user-ethnography, and were using it as such a concept of “Lingua Franca”. By loading the connotation into the concept, the participants got a focus and their design framework was provoked beyond the problem-solution framework. By the connotation of the word, the participants were able to find a design-opportunity they would like to work on, and it was not to a “simple problem”, it was more towards creating a different attitude and feeling within and towards pharmacies. This is a design opportunity that has the potential to inform a variety of design-outcomes. The instrument of stories was quite helpful for the

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participants to get a better insight and understanding of situations that occur in a pharmacy, and thus allowed the participants to use the stories as a remedy to create clear communication. The story about the old woman who told me during my field studies that “one can sit and grow a beard”, was one of these stories. The story let the participants use it as an instrument, to discuss their points of views about pharmacies. Stories act as instruments for communicating perceptions about pharmacies. One of the participants said: “I was actually surprised that there is some implicit expectation about the waiting time, that means she waits, receives her medication and still she is a little upset when leaving the pharmacy”. In this case the story worked as a provocation, but also as an instrument of communication, that could be used, in order to discuss what goes on in a pharmacy.

User-ethnography as a frame of discourse

Lastly we have the third way in which the user-ethnography was valuable in informing designs. This is closely connected with the user-ethnography as communication since the user-ethnography provided the participants with a common ground. This common ground was not placed within the language and the concepts used; such as it is within user-ethnography as communication, but within the understanding of the concepts. Furthermore, the user-ethnography by synthesising the understandings of the user, gave them topics to talk about. The participants could talk about their understanding of pharmacies, hence the user-ethnography acted as a starting point for the participants to reflect on the motivations and the actions of the customers and pharmacists. This would lead to an improved understanding of what goes on in a pharmacy, and more importantly why things happen in a pharmacy the way they do. All the instruments helped the participants talk around a topic. The stories helped the participants understand the feelings and points of views of the customers. The participants got a feeling of what the customers thought about the pharmacies11. So when one of the participants said that: “I think he got them wrong, they are not testing him, they are simply offering him a cheaper product”, the story as an instrument, gave the participants a foundation for discussing their understanding of a pharmacy. The participant did not agree with the customer, but she did understand the customer’s point of view. The participant knew that the customer thought he was being tested, and thus the participant’s understanding of some customers and how they look at pharmacies had broadened. Furthermore it gave the participants a story to talk about, and in the design-process, that man in the story could be used within scenarios in order to try out design-concepts. The statements, as an instrument, provided the participants with contexts instead of people, which was more the case with the stories. The statements enhanced the insights of work practices, and hence the participants were able to use those insights to trigger the discussion around something. The participants now had insights that could trigger discussions about certain topics. For instance the pharmacists’ colour-division of customers was one of these triggered discussions. The participants had achieved a broader understanding of the pharmacists’ view on customers, and used it in a design-outcome (The private and personal pharmacy,

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Disregarding if the participants agreed or not, which is not the important aspect here. The indication lies on how the participants used the user-ethnography in the way that it broadened their understanding, not whether or not they agreed with the written story at hand.

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and the global drug-tube). Because of the newly gained insights and broadened understandings of the work practices, the motivation behind the work-practices was understood Even theories about the customers were made: “Some people just go to a pharmacy in order to get comfort and confirmation”. This was stated on the basis of a discussion triggered by the pharmacists’ colour-division of customers. Here one found that some customers go to the pharmacy in order to get rid of their insecurity about their medication. In the pharmacy the pharmacists will more than gladly assist these people, and there should be room for them, so the participants of that team decided to divide the customers into those who needed guidance and those who needed confirmation. The concept of the “sacredness” in pharmacies, provoked the participants. But also aided in synthesising the participants’ understanding of pharmacies. When the user-ethnography questions the designers’ perceptions with the concepts as a means, the participants take up the concept in a group and discuss it. During that discussion that is triggered around the concept, the participants synthesise their understanding of pharmacies in relation to the concept. When one of the participants states that: “Pharmacies are sort of sacred, because you feel you have to whisper, and that adds to an uncomfortable feeling, where you feel guilty and claustrophobic”, the participant has been provoked by the concept to reframe her perception towards religious connotations. But furthermore her understanding is broadened, and this is shown by the participant’s use of words within the team. In this way the concept of “sacredness”, synthesises the team-members’ understanding in a dialectic way, where they discuss and argue for and against each other’s understandings until the team members have reached a common ground. The instruments propose a base for the participants that the discussions can revolve around and then lead into various directions. In this way the user-ethnography proposes a starting point for the design dialogue: “You need privacy, which you do not need if you just need to pick up a prescription”. This was an utterance made in a discussion about the shame that some customers feel, and this lead to the design-team wanting to divide the customers. This discussion was triggered by the story of the woman having to test an asthma inhalator. Here the story provided a starting point for the discussion, and hence a common ground for the participants to meet on, so that the team members would not misunderstand each other.

Understanding-broadening

When looking at the three ways that user-ethnography informs design: user-ethnography as provocation, user-ethnography as communication, and user-ethnography as a frame of discourse, some generalities appear. These three ways of informing design have the quality, compared to the traditional UCD methods, that they give a better understanding into the culture being studied. By questioning the designers’ understanding, the user-ethnography manages to trigger discussions, which can lead to design-outcomes that are focused beyond the “problem-solution

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framework” (Anderson 1994). The understanding broadened by the user-ethnography in many ways makes the design “melt-in” with the culture (Johanssen & Petterson 2001). Thus the understanding of the culture makes it easier for the designers to see opportunities, compared to traditional UCD methods where the same understanding into a culture is not achieved, but where the culture is only discussed and not questioned. Some of the methods within UCD do not have the same theory laden qualities, such as the concept of “sacredness”, that informed the designs in the workshop. The understanding broadened by the theory in the user-ethnography made it possible to identify with the pharmacists and customers and hence gain an understanding of the pharmacists’ customs and motivations for their practices. Now that we have looked at the understanding and the three ways in which the workshop-participants had their understandings broadened, a comparison between the Moggill community-ethnography and the pharmacy user-ethnography and their design-outcomes will be provided. This is done in order to compare the means within the user-ethnographies that informed the designers. Establishing these means would give an indication of whether the discussed qualities of the user-ethnography only was within that case, or if the qualities take on a general character.

Comparison with the Brisbane design dialogue

When comparing the workshop conducted on the basis of the pharmacy user-ethnography with the workshop run on the Moggill community user-ethnography, there are some generalities. First of all, it seemed that the user-ethnographies were quite good in provoking and triggering discussions about the validity of the observations made. The user-ethnographies provoked questions to the readers, and these questions trigger discussion since there are many points of view about the topic in question. Thus the idea of medication and people gladly paying for it, triggered a discussion in the design team since there were different points of view to it. This dialectic discussion then led to a synthesised and common understanding of the theories of the culture. The user-ethnographies provided the participants with provoking starting points that led them go on with some of the aspects taken from the user-ethnographies. This could be the word “barriers” from the Moggill-ethnography, or the word “sacred” taken from the pharmacy-ethnography. These two concepts were so general and yet laden with theory about the cultures that the concepts were open to interpretation, which at both workshops seemed to be a quality of the user-ethnography, since this led to discussions about what interpretation to use for design. The designers would define the concepts or even challenge them, which was the case with the concept “barriers” that was challenged into “bridges” (Buur & Brereton 2005). The thoroughness of the user-ethnographies was also something that worked really well in the sense of informing design-outcomes in both the case of the Moggill community-ethnography and the pharmacy-ethnography. They were both covering a multiplicity of aspects, and that gave the designers an overall impression and understanding of what they had to design for. This overall impression broadened the view of how the designers approached the design opportunities. The participants would seek out aspects, and then use these aspects out of their context in order search for the design opportunities (for instance the global drug tube, which was

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informed with the idea of categorising customers into colours). This was also the case in the Moggill community-ethnography where the “barriers” were challenged into “bridges”, and then informed the design outcomes, which linked people together in various ways. In the understanding gained out of the user-ethnography, the designers were able to comprehend the culture. Thus designers’ perceptions were reframed, which in the end also reframed the view on how they approached the design-outcome. When the concept of “sacredness” was challenged or questioned, there was an abstraction happening that reframed the designers’ perceptions of pharmacies. This had a large influence on the design-outcome in the sense that this abstraction from the culture, influenced by the user-ethnography, made the designers look into the culture and find opportunities instead of looking for distinct problems to solve. The designers now focused more on the enrichment of aspects in the culture, instead of a “fixing” of these aspects.

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Conclusion

To conclude on the two workshops each conducted on their own user-ethnography, which were the Moggill-ethnography and the pharmacy-ethnography. The Moggill-ethnography (In full in Appendix 1) was a presentation and was more visual, than the pharmacy-ethnography. However they both informed the participants of the workshop in similar ways. The user-studies made in a UCD approach included workflow descriptions, user-portraits, interviews, workshops, scenarios etc. and have some of the same instruments as the presented user-ethnographies. However the user-ethnographies added another dimension to the presentation of users, compared to the UCD user studies. It theorised the observations, which had the effect that it informed the designers and triggered discussions by the use of “Lingua Franca”, and with the starting points of provoking concepts that led to a dialectic discussion. The largest difference between the UCD approaches and the ways in which the user-ethnography informed the design-outcomes was the theory that was implemented into the user-ethnography. This was mainly manifested by the concepts that were in the user-ethnography. But there were also other instruments that had the effect of theorisation, either by creating theory in itself, or by supporting the other concepts and relations in the user-ethnography. So altogether the instruments that had a large influence in the user-ethnography were:

- Concepts - Stories - Statements

These were present in the pharmacy-ethnography. Since the Moggill-ethnography was presented in a visual way, it did not contain these instruments in the same way, but it still had the qualities of the written instruments. Trying to transfer the qualities of the instruments to the Moggill-ethnography, the theorisation of the community would be the concept of “barriers” that are put up in order to divide the three groups of people that an individual or a family interacts with. The stories are not that widespread here, but the relations that the individual can relate to such as school, job, church, sports clubs, etc. can be seen as stories since it has the same effect. The stories create empathy, on the grounds of the proximity to the designers. Every designer has gone to school, been shopping, gone to church, or simply just lived in a similar community and can therefore relate to the things that are going on in such a community. Furthermore, the stories form the Moggill community-ethnography gave the designers a common ground for starting a discussion. In this sense the designers were able to discuss and hence also synthesise their perceptions about small communities. The statements would be the hidden aspects within the pharmacy-ethnography, the statements thus explain about unfamiliar motivations and customs of the people in a culture. In the Moggill-ethnography the hidden things could be the descriptions of how people live their lives, why they moved to Moggill, why they moved away from Moggill etc. So albeit

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the instruments were not the same, the effects were the same in both user-ethnographies. The ways, in which these user-ethnographies informed the design, was by provoking the designers. The user-ethnography provoked them about what they knew before, and by the four before mentioned instruments the user-ethnography made the designers reflect on their knowledge and perceptions about the culture under investigation. Thus the user-ethnography made the designers reflect and in this reflection they would think about their own experiences compared to the experiences written about in the user-ethnography. This can be related to the “rendering the strange familiar and the familiar strange” (Anderson 1994). In this sense the concepts and the relations, which formed the theories in the user-ethnography, reframed the culture under study, and hence moved the perceptions of the designers. This had the effect that the designers got a broader understanding of the customs and motivations of the people in the studied culture. Furthermore, the user-ethnography, by challenging the perceptions of the designers. provided them with a common ground that would let them synthesise their perceptions. In the discussions triggered by the user-ethnography they would know what to talk about, and hence build up a common understanding of what and whom they were designing for. In this process of synthesising, they also build up a “lingua franca” (Erickson 2006), which is supported by the theorised concepts within the user-ethnography. In that sense the theorised concepts of the user-ethnography, did have the same effect as the one Erickson (2006) talks about. It synthesised the ways in which they would use a concept, and this would be within the team as well as outside of the team. The mere synthesising of the concepts is also a way of reflection for the designers, a reflection that will lead them out of the “problem-solution framework”. This is done by the understanding achieved out of the debate and the reflection on the user-ethnography, which aids in the moving from the problem-solution framework, and towards an enrichment of the culture of the study. When achieving a broader understanding of a culture, the designers gain empathy, and thus do not look for problems to solve. Hence one might say that when the user-ethnography challenges the designers’ perception on the culture, it also challenges the designers’ perception of design. So when looking back at the statements of Anderson (1994) and relate it to the theory of Erickson (2006), some clear links can be made. The user-ethnography has hence in this thesis been shown to be of great value in broadening the understanding of the designers by being a theorising the culture under study. The user-ethnography triggered questions and discussions, and in this way fitted the characteristics of a theory provided by Erickson (2006). It was in these three ways that the user-ethnography had value in the design: By provoking, by triggering communication, and by being a frame of discourse.

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References

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Appendix 1 The Moggill community-ethnography

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Appendix 2 User studies on pharmacies - Løve Apoteket

Behind the counter The pharmacy has a counter where they serve customers, and some computers in the back where one cannot see what is going on. The counters are organised as a semi-circle that is rounded in a corner. At the counters there are two things going on, people are picking up their medicine by handing in a prescription, or they take a number and wait for their turn in order to shop what they like. This might be painkillers, cough drops, vitamin pills etc. It might however also be that the customer has handed in his prescription, and went outside for some reason. After returning back in he has to take a number and wait for his turn in order to pick up his medicine. It can either be done by handing the prescription in to the pharmacist or put it in a “crack” in the desk. In that case it will take half an hour for it to be done so it can be picked up. For the people that are waiting a red clamp will be put on their prescription, the people that hand theirs in and will return in order to pick it up will get a green clamp on them so that the pharmacists will know what sort of prescriptions there are and how many are waiting for their medication at any given moment. This will aid a decrease of waiting time. In an interview the head-chemist told me that they aim for a maximum waiting time, where out of the waiting customers 90 % should be served within 5 minutes, and for the customers that bring a prescription 90% should be served within 10 minutes. Furthermore she told me that usually they can keep up with these numbers, although it might vary sometimes. So one week they cannot keep it, but then the other week they beat it. There are five different stands, ordered with the prescription hand in on one side and the other things, such as purchases of cough drops and other non-prescriptive medicine, on the other. Depending on the flow there are one to five pharmacists on the stand. Due to new IT systems, they are not allowed to work two on the same log-in, which they were allowed to in the old system. The pharmacists are helpful in any way they can and will try to comply with anything the customer might need. For instance a girl walked in at a time, and needed cork. The pharmacists in a serious manner, told her that they did not have anything like that. They probably did before where they had a laboratory, but they have not had any for ten years. The girl tells her that it is for a joke, where one of her friends is afraid of the water and that they planned on building her an old-fashioned cork belt for her birthday. The pharmacists, although there a quite a few customers in the pharmacy still takes her time to advice the girl about restaurants or cafés that might have corks like that. Research is a common thing for the pharmacists since it happens that users come in without knowledge of what they need, and sometimes they cannot even remember their doctor in which case the pharmacists has to search the computer. A lot of the prescriptions are namely online on a so-called “prescription hotel”, where any pharmacy in Denmark can log into the system

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and find the prescription for a certain customer. This makes the pharmacies able to update the system immediately during a transaction. Behind the counter there are shelves with medicine on them, behind them there is a smaller room filled with computers. The shelves contain prescriptions and a large deal of the medicine that is handed out. There is mostly medicine and these are categorised into diseases, so that there are certain groups telling the staff what sort of disease the customers have and then they can faster find the medicine although they do not know it. So it is sorted after symptoms and not by any means of itself, such as for instance its name or its effect. These categorisations could be heart and blood illnesses, respiratory illnesses, stomach illnesses etc. So the placement of the symptom within the body is quite crucial here to where the medicine is placed behind the counter. According to the staff themselves this is due to the speed of the delivery of the medicine, it is however also in order for the staff to learn about diseases and new medicine since they can orient them about medicine and disease at the same time and hence draw a circle between them in order to gain knowledge of both. So in this sense the staff shows a lot of learning initiative, where they seem eager to learn more. The entire setting is also build up in a way where it is allowed to “learn”. So the entire communication is quite friendly. For instance at a time an older man comes up to hear whether the pharmacy has some kind of cloth for his back. The pharmacist tells him that they do not have such a thing since it usually has to be custom-made by a specialist. She tells him where he can go if he still wants to pursue such a thing, and how much it approximately will cost him. One of her co-workers hear this, and as soon as they get out behind, her colleague asks her what she told him. The pharmacist calmly explains what she said and why she said it. Afterwards I ask the colleague why she asked, and she said because she heard the question, but would not know what to answer, and by asking the pharmacist she will get an idea of what to say in case anybody would ask her that question. The staff in this way seems very considerate towards each other, and they show a lot of concern about each other. In this way they might be thought of as a big family that takes care of one another. The tone of voice is very quiet and nice, and at no time what so ever during my observations there did I hear a sarcastic cruel remark, not even did I hear a voice raised in spite of the confusion and the many people there sometimes were at the other side of the counter. This might be because of a sort of tranquillity that the pharmacists have in their job. They seem very quiet and serious when they talk to customers. So in this sense it could though feel as if they were very “motherly” as persons, and that they had a genuine interest in the well being of other people. An example of this: at some time one of the students had just been outside in order to some delivery of medication. She comes in with red cheeks, and a bit of a freezing look on her face. One of the other pharmacists (that day’s team leader) says she looks cold, where as the student replies that she just were outside. The team leader takes her hands and puts them on the student’s

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cheeks in an attempt to help her warm them. The student looks very calm as if there is nothing unusual about this, and as if that this is just how things go within this pharmacy. It is here the research is conducted for finding medication. It is also here where the staff “practices” the new system, and thereby keeping themselves updated. They also do a lot of statistics here, since this is one of the things that keep the pharmacy going, by giving them a tool to know what days there are going to be many customers. This is quite specific for this pharmacy and is a local thing, I am told by the head-chemist. She says that she has not heard of other pharmacies that do the same since it would take a year of data gathering before anybody can use it, and most pharmacies do not want to do a year of research first. By doing these statistics the head-pharmacist knows how many employees might be needed on any certain day. These statistics are divided into colours so that a “red day” will be a day where there are more than 600 hundred customers and a “yellow day” more than 500, a “green day” is below 500 customers. They also use the same system to see how many prescriptions there are (Prescriptions roll in on the printer and a prescription is therefore not equal to a customer). It is also behind the counter where pharmacists pack the medication that goes out of the house. This pharmacy has subdivisions three places, and the medicine is therefore packed. The subdivisions mainly hand out the prescribed medication. Once again we see how the division of colour helps a lot. In small boxes marked with a coloured sticker on, yellow, brown or red shows where the box is going. So when the people that deliver the medication is going out they can get a quick and quite trustworthy overview of what goes where. Furthermore it is behind the counter where the pharmacists check the prescriptions that have gotten in. They look for doses and indication. Doses meaning the amount of medication that needs to be taken and indication shows what the medication is for. Often the doctors for some reason put one or another wrong on the prescription. Sometimes the doctors does not send the prescription at all in which case the pharmacists calls him in order to correct the error. This happened a couple of times during my visits. The system is a bit slowly so this was mainly the error, however there were two cases where the doctors simply did not send the prescription. So there is a lot of conversation going on with the doctors here. After having checked the prescription the pharmacist puts her initials on the label of the medication. The prescription is checked when it goes in either from the printer or by the customer, when the label is put on, and when it is handed out to the customer so most medicine is being checked three times before going out to the customers. In an interview with Helvig it seems that pharmacies are in a “closed economy” where a lot of money is simply distributed in between them with health care and social supports. This means that a pharmacy has to live up to some standards in order to make money. This is done by checking statistics such as what to pay, what medicine, what people, what health care etc is cheapest and most popular. They have to stay updated all the time with new medicine and about what medicine is the cheapest. According to the law, they have to try to sell the cheapest to the customers all the time. This is due to the

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fact that the state pays more than half of all medicine costs in Denmark, she tells me. However the customer can at any time decline the medicine and stick to the one they know, although this might be more expensive and thought medicine itself might be the exact same. She says that they do not make much money, since that is not their primary concern. They want to be a pharmacy that people trust, and know will give good advise on any issue that they might have. I was present at a Friday morning meeting, which was a bit unusual because this only happens every other week. Usually a staff meeting begins at 09:00 in order to discuss “the colour of the day” and new research that they are supposed to be aware of. For example on this particular Friday the news was that young people might not gain anything out of nicotine gum. They also talk about new interesting things that has happened to any of them. There is a rotation order where they all switch in order to become a “team leader”, and the team leader will then every morning guide them through the day. There might happen a lot of rotation where people need to attend different things such as delivery of medicine, purchase of products and clothes, cleaning of the cellar etc. It is hence the team leaders job to divide these daily routines so that everybody can try to do it all. They also switch during the day so that they the people at the counter do not have to stand there an entire day, but also get the opportunity to go behind the counter and help out with the packing of medicine. Only the chemists, which there were three of in this pharmacy, is allowed officially to check the doses and the indication of the medicine. However every other Friday there is also a meeting starting at 08:00 where heavier updates are discussed. On this particular meeting I attended, the issue was the coming allergies season where people with severe pollen allergies were discussed. Once again it was an update about who to talk to about what, and what medicine to advise to use etc. They would sit around a square table in the lunchroom, some people would sit on a stool by the window since the table is too small, and some would just stand and walk around. There were Danish pastry on the table and the entire setting and the mood was quite social and informal. The day’s team leader talks about the various tasks and some talk about a meeting they attended or a course where they learned something that they would like to talk to pass on to their colleagues. I am being introduced to the group and given permission to see everything, and talk to everybody, and at this time a pharmacist turns around to me and says: “It is not everyday we have Danish pastry”. It did not seem as if it was supposed to be funny, it was probably more an attempt to fight against the stereotype that that pharmacists do not do that much. They also talked about the customers, and once again we see a categorisation of colour, where the “green” customers were people that simply needed to pick up their medicine and then leave again, “yellow” customers have a few but relatively simple questions and “red” customers are the people that only describes their symptoms more or less and need a lot of guidance in order to help them get the right medicine and the right amount of it (Helvig later on explained that there always has been a tradition within the

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pharmaceutical world to categorise things in a visual manner) . They also predicted a higher amount of “red” customers since that is what the statistics have shown in the pollen-season the other years, and hence they concluded that a higher amount of staff in that period might be a good precaution to take. After these two meetings everyone almost flew out of the room in order to clean up as much as was possible in the last ten minutes before they would roll up the safety doors and let the customers in. As a psychological factor they always open at 09:28, which is two minutes before they are supposed to. This is done in order to cause a positive effect on the people that are waiting outside, opposed to the negative effect it might cause when they would open at for instance 09:32. Right before they open the person with the finger on the button looks around her, and asks if everybody is on their place. She gets a positive sign back, and then she asks if they are all ready, again a positive sign. Thereafter she says “Then lets open”, and she pushes the button to the door. This seems very much like a sports team of some sort, where everybody has to be on their positions when the game starts in order to achieve as good as possible. Also the looking around and encouraging the team spirit in a form of “us vs. them” attitude resembles quite much the one that might be on any athletic team. In front of the counter There are usually many people in the waiting room waiting for their medicine. Pharmacy politics is that they prefer the people to stay and wait for their medication instead of leaving and then get back in, since this will be seen from the pharmacy as being two different customers. But since there are up to 500 prescriptions a day, it will be around 1 minute for each customer, and this means that there might be some people stacked in there waiting for the medicine. However there seems to be a sort of withdrawal from the people, most of them seems to stick to themselves more than in other stores. When waiting for the medicine most of them stand towards the counter watching, without making much eye contact with anyone. Some people (mostly men) would walk around and look at the shelves around in the store. However not many do this. People might also stand or sit and look at the floor. It seems that this is a place where people have a tendency of not wanting to intrude on others and do not want others to intrude on them. Is it because of the characteristic of the pharmacy that it is like this? Is it due to the amount of personal topics that most people withdraw; is it a form of courtesy? From the beginning onwards I feel ashamed to observe people, some even look at me, and my immediate response is to look away. In the morning there were many older customers that seemed to know each other. This could probably be referred to as the clientele that is there quite often, These might know each other, perhaps even from the pharmacy where they have met each other quite a few times. They would talk about each other’s children and lives in general in a friendly and non-intrusive manner. However although there is a lot of waiting there seems to be a relaxed mood among the customers. There is not as much aggravation about the waiting as one might have thought. People are kindly waiting for their medication without many forms of stressed outbursts.

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However an older woman at one time after having been served, looks at me and says: “then one can sit here and grow a long beard”. This was in many ways interesting. Was it an utterance in order to show me sympathy since she might have thought I was a customer? Was it an utterance of aggravation? Or was it simply a kind remark said in a minute’s boredom? As discussed people minded their own business a lot, older people might talk to each other about simple stuff. A common chitchat between them considering the weather and light remarks about the pharmacy was quite usual, which did not seem to be the case with younger people. When they would talk to anyone it would be to a relative or a friend (who quite often were present, in particular with the very young people). The conversation between these two would be very low and with a quite close body stance, where there would not be much space between the two having the conversation. As mentioned before there are two sorts of services, the advise on medication and the advise on things that one might buy in a pharmacy without being ill, in this pharmacy’s case it might be various skin-products it could also be teeth products, band aids, birth control products etc. It might also seem that there is a difference in the way people interact when they get in, depending on if they are one kind of customer or the other. To use the categorisation and distinction used by the pharmacy itself, it seemed that the customers that wanted to pick up their medication were “green”, a few of them “yellow” customers. However for the people that needed a skin-product for instance, it seemed that a majority of them would be “red” customers where a thorough and deep guidance were required in order to advise them in the best way. In this case it did (although I quite often were told, that no one was trying to “sell” anything for the benefit of the money, only for the benefit of the customer) seem that the pharmacists were as sales-personnel in any other store. They would listen and then take the customer on a small tour through the products that might concern them, and they would be explained about benefits of the different products so that the customers could make a stand on what product they could use. So although money may not be the primary concern but the well being of the customers, it seemed that the approach the pharmacists would take was quite like the one that people would see in other stores. A count in two hours around 1-3 o’clock estimate shows that there seems to be a peak around 50-60-year-olds in the customer-group in the pharmacy. From here it is more or less stagnating to both sides of that age group. However there is not much difference in the various age groups. It is quite as a mountain if we look at the demographic graph, that 50-60 is probably the most common age group, and 0-10 and 90-100 are the least represented ages, for self-evident reasons. 0-10 is only in there with their parents, and the 90-100-years-old are not highly represented since, they usually either get their medication brought, or collected by a helpful soul. Sometimes the customers want to help the pharmacists, where they can see the medication behind the counter. However as mentioned before, the medication needs to be checked before it is handed out. This is probably due

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the structure of the pharmacy, where the counter where the medication is being labelled and packed is right behind the customer counter. So the customers sometimes can see their medication standing on the counter behind them, and simply wants it handed out immediately. The pharmacists will then explain the procedure to them, and then it turns out ok. This almost resembles the counter at any McDonald’s restaurant, where the people can stand in front of the counter and see the people prepare the meal right behind the counter. So this is a sort of transparency, that might show the people that there is noting suspicious going on behind there. Pharmacy in general The pharmacy in general is run by Helvig who has been there as a chemist since 1990, she is 60-years-old and has been in the business since 1971, she has however worked in pharmacies a lot of places, for instance some years in Switzerland. She said the one of the main things for the pharmacy was to provide a safe medical expedition. So they would always have an educated chemist present to control the prescriptions and see if they were correct. They are 3 chemists, 12 pharmakonomer and 3 phamakonom students. The pharmacy also delivers to private people and elderly homes and hospitals. About 25% of all their sales are delivered.

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Appendix 3

User studies on pharmacies – Tølløse apoteksudsalg

Tølløse apotek er et lille apotek hvor en farmakonom står for driften af hele apoteket. 3 gange dagligt modtager hun recept medicin og andre forsyninger fra hovedapoteket i Hvalsø. Apotekeren på denne dag hed Karen (Anonymiseret), hun er her i Tølløse 2 gange om ugen. De øvrige dage er hun på Hvalsø apotek. Observationer: apoteker adskiller sig fra andre butikker på flere måder:

1) folk køber stort set kun hvad de er kommet for at købe, der er stort set ingen impulskøb, det er høst en pakke lakrisal eller lignende.

2) Stort set alt salg foregår mellem apoteksekspedient og kunde, selvom nogle varer kan findes foran skranken er det helt almindeligt at spørge ekspedienten direkte uden at lede selv.

3) I det man kommer ind ad døren er man i dialog med det samme, med mindre der er kø. I køen venter man tålmodigt på at det bliver hans tur.

4) En meget stor del af varerne er ikke synlige for kunden. Hvis kunden ikke kender til et givent produkt er det meget vanskeligt at blive opmærksom på det. Således kan man have en mindre lidelse (f.eks. sved) og ikke ane at der findes præparater på apoteket der kan gøre noget ved problemet

5) Varernes navne er mindre eller mindre umulige at udtale og huske. Der er således en stor magt til apotekeren som kender navnene på produkterne og ofte skal hjælpe kunderne med at finde ud af hvad et givent produkt hedder

6) En stor del af varerne er gemt i skabe og skuffer. Reklamer for givne produkttyper skal man ligefrem efterspørge for at man får dem

7) Man kan bruge det samme præparat i årevis, men får alligevel udleveret et forskellige fabrikat fra gang til gang

8) producenterne er nærmest usynlige for kunderne og de har som udgangspunkt ingen mening om de ønsker en producent frem for andre

9) Dette gælder dog ikke håndkøbsmedicin, hvor der findes reklamer: benadryl, otrivin, m.fl.

Overraskende var det i øvrigt at apoteket solgte så mange ”ikke apoteksagtige varer”, f.eks. katte og hundemad, forskellige slags saft, snaps, neglelakker, antirynke creme, lakridser, m.fl. I Tølløse er der ingen Matas så en del ”Matas agtige varer” sælges på apoteket (cremer m.m.) Der er ansat to chauffører til at køre rundt med recepter til alle apoteksudsalg og håndkøbsudsalg. Man kan indlevere en recept om formiddagen og får medicinen udleveret om eftermiddagen, på grund af denne rundbringning. For at dette skal fungere er der på Hvalsø apotek, hvor det hele pakkes en masse håndtering og rutiner og tidsskemaer der skal overholdes. Arbejdet i bagbutikken på Hvalsø må derfor være temmelig struktureret for at infrastrukturen skal fungere.

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Generthed. Nogle er ekstremt generte og kan næsten ikke få bare medicinnavnet over læberne, andre taler vidt og bredt om deres sygdomme. Et eksempel på en generthedssituation (genfortalt) er en kunde der ud af mundvigen spørger efter noget mod svamp. Apotekeren bliver herefter nødt til at spørge efter hvor svampen optræder. Ud af mundvigen bliver der så sagt ”forneden”. Det er en temmelig akavet situation for kunden. Men for apotekeren er det ”ligesom at sælge en liter mælk”. Apotekspersonalet har tavshedspligt, men det kan godt være noget bøvl at betjene kunder som man mødes med til hverdag, f.eks. hvis man betjener kunder i sin hjemby. Hvis man ser på kunderne var der typisk følgende typer: Den mest almindelige var en midaldrende kvinde, sød, venlig og med stor selvkontrol, som kommer ind og henter hjertemagnyler til sig selv. Det er også relativt almindeligt at man henter medicin for manden. Under min observation var der 2-3 stykker der hentede til deres mand, en (mand) til sin datter, en til sin kone og en til sin svigermor. Mændene der spørger efter medicin til andre ser typisk fuldstændig clueless ud. En kvinde kom efter en bestemt type medicin til sin søn mod krillerhoste. Imidlertid måtte A oplyse at det kun kunne købes på recept. Hvad gør jeg så. A fortalte at der var andre typer medicin, men det var ikke helt sikkert at de ville virke. Men moderen købte det alligevel. Der er en stor autoritetstro til A. Hun kan således anbefale noget og rådet vil ofte bliver fulgt af kunden. En anden almindelig kunde var en ældre langsom talende med dialekt og lange øjenbryn og kasket mand. Den tredje mest almindelige kunde var en ung pige efter p-piller. Der er mange skoler og efterskoler i Tølløse og A mener at forældrene tit beder børnene spise p-piller for at være på den sikre side. Der var få personer i 30-45 års alderen, det skyldes måske tidspunktet mellem 12 og 15, de kommer oftere senere på dagen, mange arbejder i København. Der var en enkelt mand med slips og høresnegl til mobilen i øret. Generelt når folk kommer ind går de direkte hen til skranken, tager huer og vanter af, læner sig gerne eller støtter sig til skranken og fremsiger ærindet. Herefter findes pungen frem fra tasken og der er en masse frem og tilbage med pengepunge og tasker. Ofte er beløbene temmelig store. Men de findes fra 20-30 kr op til 12-1500 kr. Mange bliver overrasket over at det er så dyrt, så skal A og kunde lige tale om medcintilskud og hvornår det sidst er blevet nulstillet. A forklarer adskillige gange hvor lang man er i medicntilskuddet. Apoteket er organiseret, således at de mest efterspurgte varer er lige under skranken, det handler især om smertestillende håndkøbsmedicin. Derudover er der lidt næsespray mod forkølelse, noget mod afføringsproblemer.

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Bag skranken er der forskellige typer medicin. En stor del er organiseret i et skuffesystem efter alfabetisk orden. Der er dog også et antal ”temaskuffer” med høfeber medicin, protese ting, sved ting, øre ting, negle (sakse, file, ..). Det er meget almindeligt at kunderne må forklare med fagter og lyde hvad de fejler og hvad der er galt. F.eks. jeg skal have noget (viser med hænderne) et eller andet til proteser – til at holde dem fast. Den bedste reklame er for apotekerne den fra mund til mund, det er for eksempel tilfældet med deres søbogård varerne. Alle kan se dem, men der er ingen der studerer hvad præcis det er. Enten ved man at man skal have det og så bestiller man netop det man skal have eller også bliver det overset. Nogle apotekere er dygtige til at lave mersalg. Et eksempel var en mand der kommer der tit og køber astma medicin til sig selv og sin kone. Men denne onsdag skulle han hente pennicilin til sin kone. Så skulle du tage at give hende en sjælevarmer. A selv er ikke så god til mersalg, føler si akavet og vil ikke presse kunderne til at købe noget. Det er meget med personlighed, hun beundrer for så vidt den meget sælgende farmaceut, hun får det til at lyde så naturligt og man er overhovedet ikke presset til at købe noget. Mildin og ceterizin er de to mest solgte varer mod pollen allergi Apoteket er en skrankebutik Typisk læner de sig om ad skranken, eller bruger den til at stille taske når pungen skal findes. Mange kunder ser ud i intetheden mens de står og venter., ellers ser de på ekspedienten for at se hvornår det er min tur. Nogle kigger lidt omkring, men butikken er en farvelade butik med masser og masser af farvestrålende dåser og æsker – en stor forvirring. Hvilket nok også er en af grundene til at man ikke finder sine ting selv, men går til disken og spørger. En enkelt kunde ønskede at se sig lidt omkring, men da der ingen kø var virkede det unaturligt og efter få sekunders kamp for at kunne se på tingene alene, overgav han sig og spurgte om varen. Langt de fleste handler foregår ret hurtigt. Recept handel: K: (NAVN) A: et øjenblik, går om i baglokalet og finder personen K Står og kigger lidt til højre og venstre for der hvor apotekeren lige var. Måske ser hun på varerne bag hylden A: (ADDRESSEN)? K: Ja A: slår varen ind, var der ellers andet K: har allerede fisket dankortet frem, klar til at betale, nej tak A: 66,50 skal du af med K: værsgo

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A: farvel, K farvel Nogle gange skal kunden have ekstra, 2-3 af kunderne havde det med på en seddel hvad de skulle have. Nogle skulle bare aflevere en recept og fik at vide hvornår de kunne hente medicinen. En enkelt indlevering var så ulæselig at hun ikke kunne gennemskue hvad det var og derfor ikke kunne sige om det var noget der var på lager i Hvalsø. Hun fik kundens telefon nr. og lovede at ringe igen. Recepten blev faxet til Hvalsø hvor de fandt ud af hvad det var, det var en helt ny type medicin som ikke var registreret (eller sådan noget) endnu. Den var vildt dyr og uden tilskud. Kunden havde bestilt 100, men de lavede det om til 50 for at undgå at brænde inde med 50 dyre tabletter. A kan godt synes at det er slemt med mersalg og føler at kunderne måske vil svare eller tænke at det er noget hun vil prakke dem på og så så sarkastisk spørge, og hvad koster så det? Mund til mund er langt den bedste metode til at sælge nye produkter som medicinhuskeren. Desuden er det ofte enten sådan at der ingen kunder eller at der står fire på nakken af hinanden. Hvis der er flere har man ikke tid til at spørge kunden nærmere ud. Det stresser også kunden som følte ikke at kunne være bekendt at tage for lang tid for dem der står bagved og venter. Telefonen ringer ret ofte, det er ofte Hvalsø apoteket der ringer. En kunde kommer ind og det første hun siger er: Det kan være det er et dumt spørgsmål men (grinder højt og forlegent, har I pimpsten her. Hun er 4+ årig og har rødt strit hår. På apoteket har de en mængde naturlægemidler, men ikke pimpsten, A ved dog at de har pulveret på apoteket. Der kommer en del unge indvandrer (mest) mænd. A kan ikke høre forskel på deres navne, så hun beder altid om deres sygesikringsbevis, så hun kan gå ind og finde medicinen og væres ikke på at det er den rette. For almindelige danskere, siger de som regel bare navnet. A læser adressen op og den skal de genkende, det er den eneste verifikation af at det er den rette kunde til den rette recept. Mange personer kender hun efterhånden så godt at hun ved hvad de hedder. Alligevel læser hun lige adressen op for at holde det som en del af rutinen, så hun aldrig glemmer det. Det er en vigtig del af kvalitetssikringen. Der kommer 4-5 indvandrere dagligt og se man på recepterne er 10-20% med indvandrer navne. Ved ikke hvorfor men der er ligesom flere indvandrere her end i Hvalsø og Osted. Derudover er der to pharm. folk der checker at medicinen er den rigtige. Den første sætter mærkat på og checker varenummer og underskriver med initialer i højre nedre hjørne. En anden checker dosis og skriver initialer til venstre herfor. Derudover checker den i skranken at det er rette mand/kvinde f.eks. ved at spørge om adressen.

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Der er flest kvinder blandt kunderne: 70-30. Selv store 5-10 kg sække med foder kan man købe. Det er en fantastisk god forretning betror A mig. En 45 årig mand kommer ind med en seddel, læser højt jeg skal have en flaske sød tranebærsafte – er den nu SØD? Desuden nitroglycerin, ja vi har kun 25, du kan jo også få dem på tilskud hvis du spørger efter en recept. Det er til svigermor, jeg ved ikke hvor mange hun har jeg må heller købe de 25 uden tilskud og så må hun får recept næste gang. Mange af de midaldrende damer der kommer har en lidt sød/sjov bemærkning. En kommer ind for at få en slags rynkecreme man kan tage på lige før man skal til fest og sås strammer det huden op. Det viser sig at være meget dyr for 4 gram, ja sikke en kilopris. De diskuterer lidt om det har hjulpet med de tidligere cremer i et lattermildt og venskabeligt samtale. A er ikke typen de bruger makeup, parfume m.m. men kan sagtens engagere sig i andres brug. På et tidspunkt er der to af kunderne der kende hinanden, de får en kort snak mens der hentes recept medicin i bagbutikken og den anden er ve dat pakke pung ned for at gå. A er farmakonom, det er en treårig uddannelse, mod farmaceuten som er en universitetsuddannelse på 5 år. Dette er en forudsætning for at få et apotek. Man kan ikke bare købe et apotek, man kan få ansøge og får det tildelt og så køber man det. Det er ikke alle farmaceuter der synes det kan være sjovt at have et apotek. Når man ansøger indstilles man prioriteret og det er sundhedststyrelsene der bestemmer hvem der får apoteket. Når man først har fået et skiller man sig ikke lige af med det, typisk bliver man der til man pensioneres. Der kommer en ind og skal have noget. De snakker om han skal bruge de ti dag eller i morgen, åh bare i morgen, de gamle har vist masser af tid til at komme igen… Nogle gange skal folk have noget hvor der er flere valg. F.eks. gummihandsker, der er to typer i plast og i gumme, skal det passe til din håndtyper, A finder forskellige frem så man kan overveje hvad man vil have. En anden gang drejer det sig om sprøjter og kanyler, det er nyt for manden at man skal købe kanyler for sig og sprøjter for sig. Han ve dikke umiddelbart hvor mange ml sprøjten skal være men efter at have set et par stykker beslutter han sig. Han er overrasket over at det ikke koster mere end et par kroner. Ellers er folk mest overrasket over at det koster så meget. Det giver som regel anledning til en snak om medicinstøtten.

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Ofte taler de også om det e r den samme medicin som sidst eller der er tale om en ny (substitution) det er ofte at kunden ikke helt kan huske hvad det gamle hed eller om det var den samme pakke. Der er dog ingen brok over skiftet, men A gør altid opmærksom på det. Nogle kommer hjemmevant in dog råber hej, der skulle være noget til mig. Andre er mere formelle og starter med at sige eget navn. Nogle ekspeditioner indebærer blot ganske få ord fra A og K’s side. En kommer ind og beder om hovedpinepiller. Hvad vil du have. Manden aner det ikke, så hun begynder at læse mulighederne op. Bare det billigste, jeg skal bare have et par stykker mod hoved pinen nu. Får en pakke til 16 kr. Vi taler med lægesekretæren om medicinhuskeren som mener at specielt de unge er uansvarlige med deres diabetes 1 medicin.

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Appendix 4 User studies on pharmacies - Jernbane Apoteket

Behind the counter Behind the counter there was a shelve where all the medicine would be packed for delivery on one side and then on the other side, the prescriptions would be prepared so that it could go out to the waiting customers. This could be called a “central” since all the (visible) interactions that go out, come from here. In this sense it is the heart of the pharmacy from the back of the store. People here are much faster than they are in the store. It is as if they press on a button on go a gear up when working out back. They run around really fast, trying to pick up on the things that they have to do, and still to listen and to pay attention to their colleagues who sometimes ask a question. It does not seem as if they are stuck to their work, in the sense that everybody do all sorts of work, depending on where they are needed. They are not afraid of dropping anything they have in their hands in order to go out in the store and help servicing the customers out there. In such a case, somebody else just takes over their job, where they left it. In that instance the pharmacists are really working together as a team. They also all seem interested in helping at all times, and the tone of voice is quite happy and funny, even though they are teasing each other a bit, nobody gets angry or upset about it. There are many people in the back, so some people have to be out of the room sometimes since they are not always needed. In these cases they go to the “training computers” upstairs where they can practice on the systems that are used in the pharmacy. Until there is a “wave” of people in the store and they can be called in order to help out in the store. The entire mood is quite lifted and it even though the pharmacists are working quite hard and have a busy schedule they still have time to joke a little around. As for instance as when the head-chemist finds some boxes of eardrops on the counter that is not unpacked. He looks onto his employees and says into the room. “What are these narcotics for, did nobody want it” A girl walks up with a smile on her face taking the list and starts registration the medication. She gives him a little remark about that that is all he has to do, if he has anything to say. So the tone is a little sarcastic and can be felt as a little joking about each other, even though I am quite certain that it is meant in a nice and friendly way. At least I do not find any signs or indications that it might be otherwise. There is even indication that there is a lot of respect towards each other and a cooperation, which was not immediately detected. For instance whenever somebody needs help in the store, one of the pharmacists will say that she just will help out there, and just leaves everything that she was doing and somebody else takes over as soon as the one can get to it. In that sense there is a current flow of work being done even though some people have to leave everything they are doing from time to time. People are standing up quite much in the back. This might be due to the fact that the room is quite small and there are only a few seats, by the computers

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that are located against some walls. This means they are a bit tugged away but still so close that the people standing by the shelves can get into contact with them. There is a large shelve towards the store where all the prescriptions that have been packed is waiting to get picked up by the customers that have ordered it. The entire shelf is filled with medication from floor to ceiling. The medication is ordered by last name of the customers, who ordered it. However there were several incidents where it did not work really well, and where the pharmacists had to go from the store and the computer into the shelf just to go back, because she forgot the name or because she could not find the medication she was looking for. The pharmacists are not stuck to one counter, the simply switch all the time. In front of the counter In front of the counter people are standing more in lines than at the other pharmacies. However there is still tendency of waiting and a “minding ones own business” mentality. The people here simply do not walk that much around, but in stead line themselves into queues. This might be due to the fact that the pharmacy is organised differently. It is more slim-lined than Løve apoteket. Thus the customers have to line up a bit more, since there is not much room to be in. The customers still do not feel comfortable that comfortable getting new medication/substitution. For instance a man comes in and is offered a substitution, whereto he responds: “No, I am sick of being a guinea pig for the pharmaceutical industry”. The pharmacist says: “ok, but the other medication will be a bit more expensive”, and she goes out and gets his new medication. People are also waiting, just as long as with the Løve Apoteket. Some are even beginning to get more aware of my presence, and start asking the pharmacists if I am observing them. The pharmacists kindly reply that I am there to learn from them. The customer have noticed my notebook, and my notes in it, and it seems that for a few this is quite interesting. The pharmacists also pays more attention to me compared to the pharmacists at Løve apoteket. Again the organisation of the pharmacies might have had an impact on this, since I am situated closer to the counters than I was at Løve apoteket. And several of the pharmacists actually seek eye-contact with me when something interesting happens in the store. Such as for instance when an elderly woman went into the pharmacy. She was just diagnosed with asthma and now needed to learn how to take the inhalator that the pharmacy would hand out to her. The pharmacist brings the customer two test-inhalators, without medication in it. But instead they give a squeaking sound in order to test whether the customer did it right. The pharmacist tried the first inhalator and it gave the squeaking noise. The other customers at the pharmacy all looked at her. And now the elderly woman had to try the inhalator and she got all red in the face, and politely took her medication again. Afterwards I am being told that the testing is done in order to get funding from the health authorities, which is done every time they use a tester. Because there are many people that do not take their medication correctly, and by funding the pharmacies, the health authorities hope to gain more knowledge about the inhalators and thus preventing people from taking the wrong medication.