Pernille Bjørn

Virtual team collaboration: building shared meaning, resolving breakdowns and creating translucence

Managing international teams with geographically distributed participants is a complex task. The risk of communication breakdowns increases due to cultural and organizational differences grounded in the geographical distribution of the participants. Such breakdowns indicate general misunderstandings and a lack of shared meaning between participants. In this paper, we address the complexity of building shared meaning. We examine the communication breakdowns that occurred in two globally distributed virtual teams by providing an analytical distinction of the organizational context as the foundation for building shared meaning at three levels. Also we investigate communication breakdowns that can be attributed to differences in lifeworld structures, organizational structures, and work process structures within a virtual team. We find that all communication breakdowns are manifested and experienced by the participants at the work process level; however, resolving breakdowns may require critical reflection at other levels. Where previous research argues that face‐to‐face interaction is an important variable for virtual team performance, our empirical observations reveal that communication breakdowns related to a lack of shared meaning at the lifeworld level often becomes more salient when the participants are co‐located than when geographically distributed. Last, we argue that creating translucence in communication structures is essential for building shared meanings at all three levels.

Designing for collaborative interpretation in telemonitoring: Re-introducing patients as diagnostic agents

PURPOSE We investigate why clinicians experience problems interpreting implantable cardioverter-defibrillator (ICD) data when the patient is absent, and we explore how to re-introduce patients into the socio-technical setup of telemonitored interpretation practices. METHOD An action research study with a design interventionist perspective was conducted to investigate the telemonitoring arrangement for chronic heart patients with ICDs and to identify the nature of the collaborative practices involved in ICD data interpretation. We diagnose the main challenges involved in collaborative interpretation practices. These insights were used to re-design the socio-technical setup of the telemonitoring practices by designing and building a web-based, patient-centric, collaborative application, myRecord, to re-introduce the patients as active participants into the telemonitoring setup. Finally, we introduce myRecord at Copenhagen University Hospital and evaluate the new practices and the collaborative technology related to the transformed role of the patients. RESULTS The interpretation of ICD data is a collaborative practice engaging clinicians and patients and involving three separate collaborative processes: interpretation of numbers; interpretation of general condition; and patients interpretation of own condition and ICD data. In a collocated setup, these three interpretation processes are entangled and seamlessly interrelated. However, in the current telemonitoring setup, only the interpretation of numbers process is fully supported, neglecting the two other processes, and, in particular, the role of the patient. By re-introducing patients into the socio-technical setup of telemonitoring through myRecord, our design acknowledges the collaborative nature of the interpretation process. However, re-introducing patients transforms their role, and leads to new transformed telemonitoring practices, different from both the current telemonitoring setup as well as from the collocated setup. CONCLUSION Telemonitoring practices of patients with ICDs involve three entangled collaborative processes, whereas the existing socio-technical setup only mediate one. myRecord is designed as an add-on collaborative technology to mediate the two remaining collaborative processes. We argue that myRecord solves some of the problems with ICD data interpretation inherent in telemonitoring practices by providing a collaborative, asynchronous space for healthcare practitioners and patients to mediate the two processes that are otherwise lost. Our new socio-technical design also transforms the role of patients considerably, thus new studies should take these insights into consideration.

Steps toward a typology for health informatics

In this paper we outline a typology, which will be useful for those engaged in the design and customization of information systems in healthcare. Drawing on ethnographic case studies conducted in six healthcare settings in two countries, the typology outlined here is intended to identify possible sources of local variability of health care work practices, which need to be accommodated in local configurations of generic information systems.

Health care categories have politics too: Unpacking the managerial agendas of electronic triage systems

While investigating the resistance to the electronic triage system, ETRIAGE, at the emergency department of British Columbia Children’s Hospital, we revisit the wellknown CSCW-debate about THE COORDINATOR concerning the politics of standardized categories. Examining the history as well as the design of ETRIAGE, we reveal four basic assumptions about triage work in emergency departments, which are reflected in the design of the ETRIAGE application and related to the managerial agenda of controlling costs in hospitals. We find that ETRIAGE has an embedded surveillance-capability, which challenges the professional authority of nurses’ work and removes discretion from the individual. We argue that the resistance towards ETRIAGE should be understood in terms of experienced nurses’ disputing the assumptions about their professional practice that are embodied within such systems rather than general resistance to change or resistance to technology.

Boundary factors and contextual contingencies: configuring electronic templates for healthcare professionals

In this paper, we propose an approach to balance the legitimate and yet conflicting perspectives between standardization and reconfiguration embedded within hospital information systems (HIS) design activities. We report on an action research study of the customization process of an electronic triage and tracking system that was reconfigured to be used in eight Canadian emergency departments. We argue that during HIS design activities, it is essential for both practitioners and system designers to articulate and identify which aspects can be standardized without constraining important local flexibility and which aspects require local reconfiguration to function in a particular work context. To identify these differences, we suggest an analytical distinction between boundary factors and contextual contingencies, which can be used in a design and reconfiguration process. We argue that the process of designing shared electronic templates should be perceived as a common design process, where multiple stakeholders articulate, identify, and negotiate boundary factors and contextual contingencies. Boundary factors are then represented within the shared electronic system, whereas contextual contingencies form the basis for constructing localized versions of the shared application. All local versions include both boundary factors and the reconfigured contextual contingencies.

A cross-case analysis of technology-in-use practices: EPR-adaptation in Canada and Norway

PURPOSE To identify and characterize enabling factors that support a continuous adaptation of technology and work practices in the health care sector. METHODS Cross-case analysis of two longitudinal ethnographic studies of managing the gradual adaptation of electronic patient records, one in Canada and one Norway. RESULTS The cross-case analysis revealed that technology-in-use practices developed more rapidly in one of the cases, and one of the major driving forces was the establishment of a special committee and the associated project meetings. Based on the literature and grounded in the empirical observations, we complement and expand the notion of project meetings as composed of continuous reflection-on-practice activities to construct technology-in-use practices. CONCLUSION We characterize reflection-on-practice activities as frequent encounters of negotiations of work practices and technology use, providing internal actors a space for systematic evaluation of suggested changes. Further we argue that representatives of the affected professions should not only participate, but also have a mandate to make and evaluate decisions of the technology-in-use practices of the particular group.

Does Distance Still Matter? Revisiting the CSCW Fundamentals on Distributed Collaboration

Does distance still matter? Reporting on a comparative analysis of four ethnographic studies of global software development, this article analyzes the fundamental aspects of distance as depicted in the famous paper “Distance Matters.” The results suggest that, although while common ground, collaboration readiness, and organizational management are still important aspects for distributed collaboration, the arguments concerning coupling of work and collaboration technology readiness need to be refined. We argue that in working remotely, closely coupled work tasks encourage remote workers to spend the extra effort required in articulation of work to make the collaboration function. Also we find that people in distributed software development have already made collaborative technologies part of their work, and individuals are comfortable with them; thus, collaboration technology readiness takes a different shape in this setting.

Dissenting in reflective conversations: Critical components of doing action research

Reflective monitoring of research practices is essential. However, we often lack formal training in the practices of doing action research, and descriptions of actual inquiry practice are seldom included in publications. Our aim is to provide a glimpse of self-reflective practices based on our experience of enacting action research. Our engagement in a large action research project brought about many dilemmas and uncertainties related to our roles and interventions. We focus on these uncertainties as a way of opening the ‘black box’ of action research ‘in the making’. We conceptualize a methodological reflective approach that provides space for taking seriously uncertainties experienced in the field as these can be a catalyst for learning and sharpening our theoretical and empirical skills as action researchers. Through first-person inquiry, we investigate how our reflective conversations gradually evolved into second-person inquiry. We argue that enacting second-person reflective conversations renders alternative strategies for handling uncertainties through articulation of the tacit assumptions within particular empirical situations. Finally, we argue that reflective conversations should be understood and handled as iterative, open, and inquiring processes within a trust relationship, and should not be limited to any particular value schemes of action research.

Artefactual Multiplicity: A Study of Emergency-Department Whiteboards

Whiteboards are highly important to the work in emergency departments (EDs). As a collaborative technology ED whiteboards are usually placed in the dynamic centre of the ED, and all ED staff will approach the whiteboard regularly to organize their individual yet interdependent work. Currently, digital whiteboards are replacing the ordinary dry-erase whiteboards in EDs, which bring the design and use of whiteboards in ED to our attention. Previous studies have applied the theoretical lenses of common information spaces, coordination, and awareness to the investigation of whiteboard use and design. Based on an ethnographic study of the work practices involving two differently designed ED whiteboards, we found these concepts insufficient to explain one essential characteristic of these heterogeneous artefacts. In this paper, we suggest an additional theoretical concept describing this characteristic of heterogeneous artefacts; namely artefactual multiplicity. Artefactual multiplicity identifies not only the multiple functions of heterogeneous artefacts but also the intricate relations between these multiple functionalities.

Technology Alignment: A New Area in Virtual Team Research

Technology use and adaptation are the center of attention in research on virtual teams. Through empirical observations from six interpretative cases of virtual teams, we suggest conceptualizing the relationship between technology-use practices and collaborative practices as a technology-alignment process. We define technology alignment based upon four key perspectives on technology-use practices: continuous iterative process, reflection-on-action activities, malleability and reconfigurability, and transformation. Moreover, we show how these four key perspectives influence the design, the outcome, the task processes, and the socioemotional processes of the particular virtual team.