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The hospital building as project and matter of concern: the role of representations in negotiating patient room designs and bodies
Mock-ups, scale models and drawings are ubiquitous in building design processes, circulating between various stakeholders. They contribute to the gradual evolution of design, but what else can specific material forms of representations do for the building design and project? The full-scale model of a hospital single-bed room can be different in terms of detail and medium, but in what sense might it perform different and similar functions? The mobilization of multiple forms of representations and visualizations suggest that design materialization might have several important roles to play in negotiating the building design and project, including the exposition and resolution of controversy concerning size of spaces and bodies. The paper compares the use of two different forms of representation of the same imagined space—a single-bed room in a hospital, and produced for similar purposes—to ascertain what the optimum (or minimum) spatial requirements should be to allow effective care of patients. The first representations are physical mock-ups of a single-bed room for Danish hospitals where actual medical and logistical procedures are simulated using real equipment and real people. The second is a three-dimensional augmented reality model of a single-bed room for a new hospital in the UK, using a Cave Automatic Virtual Environment where the room is reproduced virtually at one-to-one scale, and which can be explored or navigated using head-tracker technology and a joystick controller. Drawing on Latour's concepts of matters of concern and matters of fact, we compare these two cases to provide insights into the way different media produce specific senses of the design or imagined space, with consequences for on-going design work, and for the settling of controversy over the sizes of spaces and bodies
How Places Matter. Telecare Technologies and the Changing Spatial Dimensions of Healthcare
Dominant discourses on telecare technologies often celebrate the erasure of distance and place. This paper provides a critical intervention into these discourses by investigating how spaces still matter, despite the move from physical to virtual encounters between healthcare professionals and patients. I argue that science and technology studies (STS) research on telecare, as well as other technologies, can be enriched by including a focus on place to understand the dynamic interactions between people and things. Adopting insights of human geographers, I show how places in which technologies are used affect how technologies enable or constrain human actions and identities. Whereas some spaces may facilitate the incorporation of technologies, others may resist technologies. A focus on how places matter is important for understanding how telecare technologies reorder and redefine healthcare. Although other healthcare technologies are also important actors in transforming healthcare, telecare technologies do this in a very specific way: they redefine the spatial dimensions of healthcare. To capture and further explore this changing spatial configuration of healthcare, I introduce the notion of technogeography of care. This concept provides a useful heuristic to study how places matter in healthcare. Although telecare technologies introduce virtual encounters between healthcare providers and patients, the use of telecare devices still largely depends on locally grounded, situated care acts. Based on interviews with users of several cardiac telecare applications, including healthcare professionals and patients in Germany and the Netherlands, the paper shows how patients’ homes and public spaces are important for shaping the implementation and use of telecare technologies, and vice versa. Last, but not least, telecare devices are implicated as well. The paper emphasizes the place-dependency of the use and meaning of technical devices by showing how the same technological device can do and mean different things in different place