Intermediaries and the Framing of Use-Practices in Design-Use Relations.

The paper explores how design-use relations – framed and facilitated through intermediary organizations and forms of organizing in the process of technology design as well as use – come to bear upon, yet, in turn, also are qualified through, users and other instances’ engagement through practices of domestication. By addressing the issue of intermediary engagements in the exploration and discussion of the role of users, the idea is to shed light on the shifting status and roles of users and other network elements in the hybrid configuration of practice(s). Both as relates to the practices of design, and of use, various network elements are in flux, serving at times as ‘intermediaries’ (here used in the delimited Actor-Network sense) and other times, as ‘actants’ in networks of relations. The paper grapples with the issue by drawing upon two delimited case studies, dealing with ‘public access defibrillators’ and ‘design for patient safety’, respectively. The first concerns automated external defibrillators which in recent times have cropped up as a recognizable fixture in the public domain (such as in train stations, exercise facilities, office complexes, airports, etc.). Often facilitated by authorities and/or organizations seeking to strengthen life-saving efforts for victims of cardiac arrest in public settings, particular focus on this case is the situation in Denmark, where legislation paved the way for making the devices available to the general public. Some other countries have instead relegated their use solely to trained individuals, who may be relied on to be present in the vicinity of where such defibrillators are located (e.g. specific personnel at a train station etc.). The second case takes up design for patient safety, where the overall focus in Denmark has been strongly anchored in a Human Factors approach – an orientation toward grappling with patient safety primarily through a focus upon the prevention of unintended consequences by the user. The seemingly fixed conception of the technology, and hereby the role of use-practices in care, is challenged through the case. The paper draws upon the domestication of technology to unfold the temporally emergent character of use-practices, and the analytical broadening of the ‘user’ conception to encompass various units of analysis. Hereby hybrid dimensions of domestication and socio-material underpinnings in and across seemingly distinct units are addressed (Lie & Sørensen 1996, Sørensen 2005). The paper discusses how partial framings through intermediary engagements can hereby be discerned and engaged productively in the analysis, making otherwise plausible relations – by way of juxtapositions and reframing – visible through re-presentation (Law 2002, Cooper 2005). The relevance of intermediaries for design is addressed, where the cases in point show how aspects of use, and hereby the role of users and use-practices, are implicated and distributed through enactments in the heterogeneous orderings and networks of relations in design and use. These are articulated and become manifest through mediations – at once opening up and enabling, while also delimiting and constraining, how the design-space vis-a-vis realms of enactment in use-practices, may come to be engaged.