Claus Bossen

Mobility Work: The Spatial Dimension of Collaboration at a Hospital

We posit the concept of Mobility Work to describe efforts of moving about people and things as part of accomplishing tasks. Mobility work can be seen as a spatial parallel to the concept of articulation work proposed by the sociologist Anselm Strauss. Articulation work describes efforts of coordination necessary in cooperative work, but focuses, we argue, mainly on the temporal aspects of cooperative work. As a supplement, the concept of mobility work focuses on the spatial aspects of cooperative work. Whereas actors seek to diminish the amount of articulation work needed in collaboration by constructing Standard Operation Procedures (SOPs), actors minimise mobility work by constructing Standard Operation Configurations (SOCs). We apply the concept of mobility work to the ethnography of hospital work, and argue that mobility arises because of the need to get access to people, places, knowledge and/or resources. To accomplish their work, actors have to make the right configuration of these four aspects emerge.

A web of coordinative artifacts: collaborative work at a hospital ward

This paper reports from a field study of a hospital ward and discusses how people achieve coordination through the use of a wide range of interrelated non-digital artifacts, like whiteboards, work schedules, examination sheets, care records, post-it notes etc. These artifacts have multiple roles and functions which in combination facilitate location awareness, continuous coordination, cooperative planning and status overview. We described how actors achieve coordination by using different aspects of these artifacts: their material qualities, the structure they provide as templates and the signs inscribed upon them that are only meaningful to knowledgeable actors. We finally discuss the implication for the design of CSCW tools from the study.

CareCoor: Augmenting the coordination of cooperative home care work

OBJECTIVES The present study aims to augment the network of home care around elderly. We investigate the nature of cooperative work between relatives and home care workers around elderly persons; present the CareCoor system developed to support that work; and report experiences from two pilot tests of CareCoor. METHODS We employed ethnographic fieldwork methods and conducted participatory design workshops to throw light on the nature of cooperative home care work, and to elicit implications for the design of an IT system that would support the work of relatives and home care workers around elderly persons. The design implications led to the development of a prototype, called CareCoor, which is accessible via a tablet PC and on the Internet. CareCoor was subsequently evaluated in two pilot tests. The first lasted a week and included three elderly, their next of kin and the affiliated home care workers, while the second test lasted for six weeks and involved five elderly people, their next of kin and relevant home care workers. RESULTS In the paper we make three major points, namely, (1) home care work is highly cooperative in nature and involves substantial coordinative efforts on the part of the actors involved, (2) the network of care around elderly can be augmented with new technology that allows all members of the network to follow, influence and be a part of the cooperative care of the elderly, and (3) CareCoor, the prototype introduced in this study, shows promise as it was well received during test and evaluation. CONCLUSION Home care work is increasingly important due to the ageing populations of Europe, the USA and large parts of Asia. Home care work between relatives and home care workers is inherently a cooperative effort, and can be facilitated and augmented by new information technology such as CareCoor. The pilot tests of CareCoor revealed promising results and will be further developed and evaluated in a larger test.

Impediments to user gains: experiences from a critical participatory design project

Actual studies of user gains from involvement in design processes are few, although a concern for user gains is a core characteristic of participatory design (PD). We explore the question of user gains through a retrospective evaluation of a critical PD project. We conducted ten qualitative interviews with participants in a project aimed at developing technology to foster engaging museum experiences and rethinking cultural heritage communication. Despite the use of established PD techniques by experienced PD practitioners, a significant number of frustrations relating to the PD process were prominent in the study. Based on these findings, we provide an analysis of impediments to user gains in PD projects in terms of unresolved differences between aims, absence of a clear set-up for collaboration, and different conceptions of technology.

Infrastructuring and Ordering Devices in Health Care: Medication Plans and Practices on a Hospital Ward

In this paper, we analyse physicians’ and nurses’ practices of prescribing and administering medication through the use of paper-based, and digitalized medication plans. Our point of departure is an ethnographic study of the implications of upgrading an electronic medication module (EMM) that is part of an electronic health record (EHR), carried out at an endocrinology department. The upgrade led to a temporary breakdown of the EMM, and a return to paper-based medication plans. The breakdown made visible and noticeable the taken-for-granted capabilities of medication plans in their paper-based and digital versions, and the distribution of functionalities between medication plans and clinicians. We see the case as an opportunity to analyse infrastructuring in health care, the process by which medical practices and artefacts become parts of social and technological networks with longer reaches and more channels through which coordination among distributed actors is enabled and formed. In this case, infrastructuring means an extended scope and intensity of the coordinative capabilities of medication plans, and an increased vulnerability to, and dependency on events outside the immediate loci of interaction. We particularly note the capacity of the EMM to facilitate different kinds of ordering of information and practices, and propose the conceptualizing of such digitalized artefacts as ‘ordering devices’. Ordering devices order information, stipulate action, and coordinate interaction across and within social worlds, and achieve this through the flexible support of different kinds of ordering.

Representations at work: a national standard for electronic health records

Representations are at work in IT technology. As plans of and for work, they enable cooperation, coordination, accountability and control, which have to be balanced off against each other. The article describes a standard developed for electronic health records (EHR) and the results of a test of a prototype built on that standard at a department of internal medicine in 2004. It is argued that the prototype did not support clinical work, which is attributed to the model of work embedded in the standard, called Basic Structure for EHR (BEHR). The article concludes by calling for critical conceptualizations of the relations between representation, work and knowledge production.

Designing for transformations in collaboration: a study of the deployment of homecare technology

Transformations in collaborative work due to the introduction of new technology are inevitable, but are often difficult to study. In this paper, we consider the patterns of transformation that are seen in a patient-physician relationship based on the introduction of homecare monitoring equipment. We report findings from interviews and fieldwork with patients and physicians participating in a clinical experiment of homecare monitoring. By studying both the group of patients who receive homecare-based treatment and the control group we were able to identify transformations in the collaborative activity as caused by the homecare monitoring technology. We apply activity theory as a theoretical basis for this analysis. We consider the implications of these findings for the design of pervasive health monitoring technologies.

Requirements engineering for a pervasive health care system

We describe requirements engineering for a new pervasive health care system for hospitals in Denmark. The chosen requirements engineering approach composes iterative prototyping and explicit environment description in terms of workflow modelling. New work processes and their proposed computer support are represented via a combination of prose, formal models, and animation. The representation enables various stakeholders to make interactive investigations of requirements for the system in the context of the envisioned work processes. We describe lessons learned from collaboration between users and system developers in engineering the requirements for the new system.

Context-descriptive prototypes and their application to medicine administration

A context-descriptive prototype is an interactive graphical animation, driven by a formal, executable engine, implemented in some programming or modelling language. The two main properties of a context-descriptive prototype are: (1) it is an integrated description that describes system, work processes, and context of use; (2) it is a formal description. Because of (1), designers, including users, are provided with a means to investigate the system in the context of the envisioned work processes. Because of (2), investigations into questions of formalisation and automation, not only of the system, but also of the work processes, can be made explicitly and become subject for discussions and further elaboration. We describe a concrete context-descriptive prototype of the hospital work process medicine administration and its support by a new pervasive system. We discuss findings from evaluation of the prototype in cooperation with nurses, and finally compare context-descriptive prototypes with other kinds of prototypes.

Participation, power, critique: constructing a standard for electronic patient records

This paper examines the scope of participatory design on the basis of the case of a national standard for electronic patient records (EPR) in Denmark. The relationship between participatory methods and techniques on the one hand and critical and emancipatory aims on the other is discussed within the framework of participatory design. Some argue that participation in itself entails striving towards democracy; others argue that the tendency to focus upon tools, techniques and the arena of single projects should be supplemented by emancipatory aims such as technology assessment and a critique of dominance. These issues are discussed through the controversies surrounding the test of a prototype application based on BEHR in late 2004, a standard for EPRs (Basic Structure for Electronic Health Records). I argue that participation is valuable, but that the scope of participatory design should also include critical conceptualizations of participation, power, methodology and knowledge. Finally, standards can be crucial cases to examine for participatory design, since they affect the work of many people and call for a focus on arenas beyond the single design project.