Naja L. Holten Møller

Layers in Sorting Practices: Sorting out Patients with Potential Cancer

In the last couple of years, widespread use of standardized cancer pathways has been seen across a range of countries, including Denmark, to improve prognosis of cancer patients. In Denmark, standardized cancer pathways take the form of guidelines prescribing well-defined sequences where steps are planned and pre-booked in order to manage patient trajectories. They are different from typical medical guidelines because they combine both administrative and clinical prescriptions. A key issue related to the enactment of a standardized cancer pathway concerns the decision to initiate a pathway for a particular patient. Due to the limited resources within the Danish healthcare system, initiating cancer pathways for all patients with a remote suspicion of cancer would crash the system, as it would be impossible for healthcare professionals to commit to the prescribed schedules and times defined by the standardized pathways. Thus, sorting patients with symptoms of potential cancer becomes an essential activity. In this paper, we investigate the pre-diagnostic work of sorting patients with symptoms that may potentially be cancer. We identify and conceptualize the sorting practices for potential cancer patients in the pre-diagnostic work as being structured in layers of the interrelated, iterative practices of constructing, organizing, re-organizing, and merging the multiple queues within which each patient is simultaneously situated. We find that the ordering of patients in queues is guided by the formal sorting mechanism, but is handled by informal sorting mechanisms. We identify two informal sorting mechanisms with large impact on the sorting practices, namely subtle categorizing and collective remembering. These informal sorting mechanisms have implications for the design of electronic booking systems because they show that sorting patients before initiating a standardized cancer pathway is not a simple process of deciding on a predefined category that will stipulate particular dates and times. Instead, these informal sorting mechanisms show that the process of sorting patients prior to diagnosis is a collaborative process of merging multiple queues while continuously deciding whether or not a patient’s symptoms point to potential cancer.

Coordination by avoidance: bringing things together and keeping them apart across hospital departments

Coordination is central in CSCW systems design, where it is often considered as a process of bringing artifacts and activities together and making them part of a larger system. In this paper, we argue that existing conceptualizations of coordination in CSCW can be successfully extended with the notion of coordination by avoidance. We introduce this notion to describe particular coordination mechanisms whereby actors avoid routines or routes of actions when it conflicts with those of other actors. In a study of pre-diagnostic work, we found that actors coordinate by avoidance when they realize alternative routes of action or that a routine has to be set to a halt to ensure that practices stay coordinated. Routines in diagnostic work are for instance the rescheduling of patients and requesting of relevant patient records that are mundane practices, however, necessary when responsibility is shared or shifts between various actors collaborating to diagnose a patient. Thus, the contribution of this paper lies in empirically identifying practices of avoidance and extending dominant conceptualizations of coordination through the notion of avoidance. We identify four ways that actors coordinate their practices by avoidance; by demarcating, procrastinating, delegating and accommodating routines or routes of action. Furthermore, we conceptualize coordination by avoidance as a distinct type of coordination mechanism to be taken into consideration in CSCW information systems design.

The Clinical Work of Secretaries: Exploring the Intersection of Administrative and Clinical Work in the Diagnosing Process

Diagnostic work is often defined by the skill of clinicians whereas the contributions of non-clinicians, for example secretaries, tend to fade into the background. The secretaries are deeply involved in diagnostic work through the eligible administration of patients in the collaborative electronic information systems. This study explores the secretaries’ role in diagnostic work, focusing specifically on the context of diagnosing cancer. It identifies four key activities of secretaries that are essential for diagnosing patients: We argue that the secretaries’ role is positioned at the intersection of clinical and administrative practices and not limited to support of articulation work of clinicians and administrative work. Secretaries also carry out activities that fall under the core definition of clinical work. This clinical dimension of the secretaries’ work, we argue, should be embedded in the design of collaborative systems to support the diagnosing process.

The future of computing and food: extended abstract

The excitement around computing technology in all aspects of life requires that we tackle fundamental issues of healthcare, leisure, labor, education, and food to create the society we want. The aim of this satellite event was to bring together a variety of different stakeholders, ranging from local food producers, chefs, designers, engineers, data scientists, and sensory scientists, to discuss the interwoven future of computing technology and food. This event was co-located with the AVI 2018 conference and supported by the ACM Future of Computing Academy (ACM-FCA). The event followed a co-creation approach that encourages conjoined creative and critical thinking that feeds into the formulation of a manifesto on the future of computing and food. We hope this will inspire future discussions on the transformative role of computing technology on food.

Building Information Modeling: The Dream of Perfect Information

Over the past decade, Building Information Modeling (BIM) – an advanced modeling technology and associated set of processes to create, develop, and analyze digital building models – has emerged as one of the most promising approaches for improving the performance of building projects. It has been heralded as a ‘digital revolution’ and it is expected to improve collaboration, productivity, and product quality throughout the building life cycle by providing ‘perfect information’ on which to base the design and construction (Crotty 2012). However, little is known about the use of BIM in practice, and it has so far not been studied from a CSCW perspective. In this paper we present preliminary findings from a field study of a large hospital construction project in Denmark. The project is in its early phases, so the focus is on the role of BIM as a platform for collaboration among client, architects, engineers and future users regarding the conceptual design. Our findings suggest that recurrent reviews of the evolving digital model played a key role in the collaboration. We identified three kinds of design reviews: clash detection, scenario-based reviews and embodied reviews – each focusing on specific aspects of the conceptual design.

The future of clerical work is precarious

Community + Culture features practitioner perspectives on designing technologies for and with communities. We highlight compelling projects and provocative points of view that speak to both community technology practice and the interaction design field as a whole. --- Christopher A. Le Dantec, Editor

A Constructive-Critical Approach to the Changing Workplace and its Technologies

Implementation of technical systems into work practices can result in shifting the balance of power in terms of what is visible and what is hidden (Suchman 1994; Star & Strauss 1999) and in fun ...

In Due Time: Decision-Making in Architectural Design of Hospitals

We analyze the cooperative work involved in creating the architectural design of a hospital based upon digital technologies of the future, before we know whether future digital technologies will be mature and reliable enough for use. The entire process, from initial architectural design until opening of the hospital for patients, takes approximately 10 years, which is a significant amount of time considering the hitherto pace of digital technology development. Therefore, due time decision-making is essential. We conceptualize due time in cooperative design work as a quality measurement of whether “the right path” is followed when alternative future paths are available, without reducing the space for design maneuverability prematurely. But how do we determine the “right path” in due time? By exploring the ways in which artefacts are used to achieve due time decision-making on future digital technologies in hospital design, we find that artefacts are used to assess the relationship between dependencies and sequences of activities with the aim of pushing all irreversible decisions for design as far as possible. Thus, we argue that the practices of handling due time decision-making in complex cooperative activities are characterized as the practices of handling the relationships between dependencies, sequentiality, and irreversibility of the material matter (in our case the future hospital) shaping the course of action.

Achieving Continuity of Care: A Study of the Challenges in a Danish and a US Hospital Department

Continuity of care is a central topic for healthcare practice and is closely related to issues of collaboration. Thus, studying continuity of care from a CSCW perspective can help us understand what makes continuity of care in practice. In this paper, we show how collaborative technologies are appropriated differently in two cases, one in Denmark and the other in the US. We illustrate how this appropriation is dependent on challenges particular to the organizational context of work. Studying the practices in two different hospital departments we found that in practice achieving continuity of care depends on two main characteristics in the organization of work, namely (1) the constitution of roles and (2) the responsibility for care linked to the appropriation of collaborative technologies. These characteristics of the organization of work create different solutions to the challenges of discontinuity when physicians appropriate mundane collaborative technologies: patient records and pagers. To understand how continuity of care is achieved in practice we have to study the appropriation of technologies, the paper argues, and by comparing across cases we may begin to discern challenges that cut across context—and their different origins.