The camera as an actor: Design-in-use of telemedicine infrastructure in surgery

Abstract

This paper describes the evolving interrelationship between a pre-established work practice and a new technology, with an emphasis on how the technology itself participates in the process and introduces changes, while at the same time being changed itself. The case study concerns the introduction of multimedia communication technology into a surgical operating theatre. Concepts from Actor-network theory are found to provide a useful perspective on the description and analysis of the case. The technology and the work practice are viewed as a new heterogeneous actor-network, whose configuration changed continuously. These changes are conceptualised as alignment attempts where the different actants' interests are translated and inscribed into e.g. artefacts, rules or routines. The alignment of this heterogeneous network was achieved through a continuous process of design, test and redesign of different configurations of people, practices and artefacts. The relevance of the findings is discussed, related to how we may think about design of open and generic technologies. Viewing design as design of configurations; the creation of a well-working mix of people, practices and artefacts, may be a helpful and relevant design metaphor.