Atish Rajkomar

Patients’ and carers’ experiences of interacting with home haemodialysis technology: implications for quality and safety

BackgroundLittle is known about patients’ and carers’ experiences of interacting with home haemodialysis (HHD) technology, in terms of user experience, how the design of the technology supports safety and fits with home use, and how the broader context of service provision impacts on patients’ use of the technology.MethodsData were gathered through ethnographic observations and interviews with 19 patients and their carers associated with four different hospitals in the UK, using five different HHD machines. All patients were managing their condition successfully on HHD. Data were analysed qualitatively, focusing on themes of how individuals used the machines and how they managed their own safety.ResultsFindings are organised by three themes: learning to use the technology, usability of the technology, and managing safety during dialysis. Home patients want to live their lives fully, and value the freedom and autonomy that HHD gives them; they adapt use of the technology to their lives and their home context. They also consider the machines to be safe; nevertheless, most participants reported feeling scared and having to learn through mistakes in the early months of dialysing at home. Home care nurses and technicians provide invaluable support. Although participants reported on strategies for anticipating problems and keeping safe, perceived limitations of the technology and of the broader system of care led some to trade off safety against immediate quality of life.ConclusionsEnhancing the quality and safety of the patient experience in HHD involves designing technology and the broader system of care to take account of how individuals manage their dialysis in the home. Possible design improvements to enhance the quality and safety of the patient experience include features to help patients manage their dialysis (e.g. providing timely reminders of next steps) and features to support communication between families and professionals (e.g. through remote monitoring).

Strategies for conducting situated studies of technology use in hospitals

Ethnographic methods are widely used for understanding situated practices with technology. When authors present their data gathering methods, they almost invariably focus on the bare essentials. These enable the reader to comprehend what was done, but leave the impression that setting up and conducting the study was straightforward. Text books present generic advice, but rarely focus on specific study contexts. In this paper, we focus on lessons learnt by non-clinical researchers studying technology use in hospitals: gaining access; developing good relations with clinicians and patients; being outsiders in healthcare settings; and managing the cultural divide between technology human factors and clinical practice. Drawing on case studies across various hospital settings, we present a repertoire of ways of working with people and technologies in these settings. These include engaging clinicians and patients effectively, taking an iterative approach to data gathering and being responsive to the demands and opportunities provided by the situation. The main contribution of this paper is to make visible many of the lessons we have learnt in conducting technology studies in healthcare, using these lessons to present strategies that other researchers can take up.

Coping with complexity in home hemodialysis: a fresh perspective on time as a medium of Distributed Cognition

The existing literature on Distributed Cognition (DCog) mostly presents the temporal distribution of cognition in terms of system evolution that happens over time. In this paper, we illustrate how cognition can also be distributed through time in more immediate ways, through four principles we developed while studying how renal patients cope with the complexity of home hemodialysis. These principles are temporal assignments to tasks to aid prospective remembering; temporal arrangement of tasks to help deal with anticipated problems; temporal distribution of a task plan to avoid omission of steps; and temporal re-arrangement of tasks to reduce peak complexity. Like the physical environment, the time continuum is an external medium that can support distributed cognitive processes, serving as a representation for task reminders and allowing actors to organize the order, duration, and spacing of tasks to reduce complexity in cognitive work. These principles can highlight problems and opportunities in the design of socio-technical systems, by explicitly considering time as another medium that can be used to support DCog in short-term activity.

Situated Interactions of Lay Users With Home Hemodialysis Technology: Influence of Broader Context of Use

This paper presents the preliminary results of our ongoing study on the situated use of home hemodialysis technology by lay patients and carers. The aim of the study is to understand the context in which users interact with the technology, and the strategies they adopt during interactions. In a first phase of the study, we used a Distributed Cognition approach to gather data during visits to patients’ homes. The findings showed that the broader context influenced interactions with the technology. To consider the broader context, we re-conceptualized our analysis in terms of systems, and to allow a structured analysis of these influences, we are developing a Contextual Factors framework in a second phase of the study.

Towards a formal framework for reasoning about the resilience of dynamic interactive systems

It is well known that systems built with resilient components are not necessarily resilient systems. Nevertheless, when studying the resilience of work systems characterised by continuous inter-operations among humans and devices, analysts generally concentrate only on localised interactions among humans and devices. Consequently they fail to capture the distributed nature of the mechanisms that guide interactions in dynamic interactive systems. In this paper, as a result of work on the resilience of medical systems with respect to human error, we propose a framework for reasoning about the resilience of complex dynamic interactive systems. To do this we exploit concepts from three different areas: the automated synthesis of resilient systems, formal methods for user-centred design, and distributed cognition.