Reflections on 25 Years of Ethnography in CSCW

Experiences and Expectations of Information and Communication Technologies in Flexible Assertive Community Treatment Teams: Qualitative Study

BACKGROUND

Flexible Assertive Community Treatment (FACT) is a model of integrated care for patients with long-term serious mental illness. FACT teams deliver services using assertive outreach to treat patients who can be hard to reach by the health care service, and focus on both the patient's health and their social situation. However, in Norway, FACT team members have challenges with their information and communication (ICT) solutions.

OBJECTIVE

The aim of this study was to explore Norwegian FACT teams' experiences and expectations of their ICT solutions, including electronic health records, electronic whiteboards, and calendars.

METHODS

We gathered data in two phases. In the first phase, we conducted semistructured interviews with team leaders and team coordinators, and made observations in FACT teams targeting adults. In the second phase, we conducted semistructured group interviews in FACT teams targeting youth. We performed a thematic analysis of the data in a theoretical manner to address the specific objectives of the study.

RESULTS

A total of 8 teams were included, with 5 targeting adults and 3 targeting youth. Due to the COVID-19 pandemic, we were not able to perform observations in 2 of the teams targeting adults. Team leaders and coordinators in all 5 teams targeting adults were interviewed, with a total of 7 team members participating in the teams targeting youth. We found various challenges with communication, documentation, and organization for FACT teams. The COVID-19 pandemic was challenging for the teams and changed the way they used ICT solutions. There were issues with some technical solutions used in the teams, including electronic health records, electronic whiteboards, and calendars. Lack of integration and access to data were some of the main issues identified.

CONCLUSIONS

Despite the FACT model being successfully implemented in Norway, there are several issues regarding the ICT solutions they use, mainly related to access to data and integration. Further research is required to detail how improved ICT solutions should be designed. While FACT teams targeting adults and youth differ in some ways, their needs for ICT solutions are largely similar.

Habits Over Routines: Remarks on Control Room Practices and Control Room Studies

The evolution of computer tools has had profound impacts on many aspects of control rooms and control room studies. In this paper, we discuss some key assumptions underpinning these studies based on a new case of the electricity distribution control rooms, where the reliability of the electricity infrastructure is managed by a combination of planning and real-time maintenance. Some of these practices have changed remarkably little over the past decades – partially because they have been considered to have been ‘digitalized’ since the 1950s and have continued to amass digital solutions from different periods. Hence, the gradual transformation of control room work demands nuanced attention, both conceptual and empirical. To outline a framework for this work, we provide a conceptualization of organizational routines, habits, and reflectivity and synthesize existing CSCW and control room literature. We then present an empirical study that demonstrates our concepts and shows how they can be applied to study cooperative work. By addressing these aims the paper complements, and advances, the important topics recognized in this special theme issue and hence develops new research openings in CSCW. We address the necessity to avoid implicit determinism when analyzing new digital support tools and suggest focusing on how working habits mediate social changes, distribution, and decentralization in representing the power distribution in control rooms.

Designing Digital Participatory Budgeting Platforms: Urban Biking Activism in Madrid

Civic technologies have the potential to support participation and influence decision-making in governmental processes. Digital participatory budgeting platforms are examples of civic technologies designed to support citizens in making proposals and allocating budgets. Investigating the empirical case of urban biking activists in Madrid, we explore how the design of the digital platform Decide Madrid impacted the collaborative practices involved in digital participatory budgeting. We found that the design of the platform made the interaction competitive, where individuals sought to gain votes for their single proposals, rather than consider the relations across proposals and the larger context of the city decisions, even if the institutional process rewarded collective support. In this way, the platforms’ design led to forms of individualistic, competitive, and static participation, therefore limiting the possibilities for empowering citizens in scoping and self-regulating participatory budgeting collaboratively. We argue that for digital participatory budgeting platforms to support cooperative engagements they must be revisable and reviewable while supporting accountability among participants and visibility of proposals and activities.

People First, Data Second: A Humanitarian Research Framework for Fieldwork with Refugees by War Zones

War begets crises that are among the most urgent areas requiring help from the international HCI/CSCW community; yet too few scientists address it using context-based, participatory field methods and by engaging in country and regionally based, longitudinal partnerships. Drawing on the author’s ongoing eight-year engagement as a design ethnographer with UNHCR Jordan and region for the Syrian War, this paper discusses Humanitarian Research as a framework for guiding HCI/CSCW research in conflict zones with displaced persons. Based on the principle of “People First, Data Second,” Humanitarian Research is explained with illustrative examples along with the nature of war and UNHCR’s protection mandate, the research challenges and ethical roles of HCI scientists in conflict zones and how these roles entwine with refugee stakeholders, NGOs, country actors, and university IRBs.

Inverted Hierarchies on the Shop Floor: The Organisational Layer of Workarounds for Collaboration in the Metal Industry

Workarounds, or practices that deviate from the official pathway to a target, are frequent phenomena in the organisational context. With respect to collaboration, they highlight an area of mismatch between normative versus lived work practices, and therefore depict a relevant research area deeply rooted in computer supported cooperative work (CSCW). Building on the theory of hierarchical opposition by Louis Dumont and empirical data collected through ethnographic research at a company classified as a small- and medium-sized enterprise (SME) in the German metal industry, this paper addresses the emergence of workarounds in collaborative work processes by setting them into the wider organisational context. The organisational layer of analysis reveals that workarounds emerge to cater for inversed information power relations and information asymmetries in the shop floor setting, which require communication to flow against the hierarchical slope between planning and execution functions. By applying an organisational lens to the concept of workarounds, this paper contributes a novel empirical analysis that confirms the value of workarounds as a source of insight into collaborative practices.

Putting the social back into sociotechnical: Case studies of co-design in digital health

OBJECTIVE

We sought to examine co-design in 3 contrasting case studies of technology-supported change in health care and explain its role in influencing project success.

MATERIALS AND METHODS

Longitudinal case studies of a seizure detection and reporting technology for epilepsy (Southern England, 2018-2019), a telehealth service for heart failure (7 UK sites, 2016-2018), and a remote video consultation service (Scotland-wide, 2019-2020). We carried out interviews with 158 participants and collected more than 200 pages of field notes from observations. Within- and cross-case analysis was informed by sociotechnical theory.

RESULTS

In the epilepsy case, co-design prioritized patient-facing features and focused closely around a specific clinic, which led to challenges with sustainability and mainstreaming. In the heart failure case, patient-focused co-design produced an accessible and usable patient portal but resulted in variation in uptake between clinical sites. Successful scale-up of video consultations was explained by a co-design process involving not only the technical interface, but also careful reshaping of work practices.

DISCUSSION

A shift is needed from co-designing with technology users to co-designing with patients as service users, and with healthcare staff as professionals. Good co-design needs to involve users, including those who engage with the technology-supported service bothdirectly and indirectly. It requires sensitivity to emergence and unpredictability in complex systems. Healthcare staff need to be supported to accommodate iterative change in the service. Adequate resourcing and infrastructures for systems-focused co-design are essential.

CONCLUSIONS

If co-design focuses narrowly on the technology, opportunities will be missed to coevolve technologies alongside clinical practices and organizational routines.

A New Method for Structured Integration of User Needs in Two Health Technology Development Projects: Action Sheets

An early integration of users and stakeholders is needed for a successful innovation process. Nonetheless, the integration of users is often hard to realize - especially when dealing with persons with chronic diseases. In addition, patients or users in general often are not able to formulate the requirements in a technical manner. Therefore, even if user requirements are collected, it is not certain that the developers know or understand 'what is really wanted'. To overcome these 'gaps', we have developed so-called Action Sheets (AS). This article presents the use of AS in two projects: the development of health technologies for people with cancer (INFOPAT) and dementia (QuartrBack). Depending on the project context, group sessions were conducted with different stakeholders to identify the needs of (potential) users. Within the INFOPAT project, ten focus groups were conducted with patients, physicians and other healthcare professionals. In QuartrBack stakeholders like e.g. care professionals, technical assistance organizations and citizens participated in two focus groups and three world cafés. Their requirements were then 'fed' into the technology development by the use of AS. AS appear to be a promising tool to make user needs based on social values more tangible and implementable into technology development processes. In addition, it shows up that four phases seem to be necessary for transferring identified user and stakeholder needs into AS, which can therefore be seen as essential to translate non-technically formulated requirements into technically feasible ones. The case study shows as lessons learned that despite the successful integration of user needs, context-sensitive adjustments are still necessary.

A Historical View of Studies of Women’s Work

This paper places observational studies of women’s work in historical perspective. We present some of the very early studies (carried out in the period from 1900 to 1930), as well as several examples of fieldwork-based studies of women’s work, undertaken from different perspectives and in varied locations between the 1960s and the mid 1990s. We outline and discuss several areas of thought which have influenced studies of women’s work - the automation debate; the focus on the skills women need in their work; labour market segregation; women’s health; and technology and the redesign of work – and the research methods they used. Our main motivation in this paper is threefold: to demonstrate how fieldwork based studies which have focussed on women’s work have attempted to locate women’s work in a larger context that addresses its visibility and value; to provide a thematic historiography of studies of women’s work, thereby also demonstrating the value of an historical perspective, and a means through which to link it to contemporary themes; and to increase awareness of varied methodological perspectives on how to study work.

Strengthening Interprofessional Requirements Engineering Through Action Sheets: A Pilot Study

BACKGROUND

The importance of information and communication technology for healthcare is steadily growing. Newly developed tools are addressing different user groups: physicians, other health care professionals, social workers, patients, and family members. Since often many different actors with different expertise and perspectives are involved in the development process it can be a challenge to integrate the user-reported requirements of those heterogeneous user groups. Nevertheless, the understanding and consideration of user requirements is the prerequisite of building a feasible technical solution. In the course of the presented project it proved to be difficult to gain clear action steps and priorities for the development process out of the primary requirements compilation. Even if a regular exchange between involved teams took place there was a lack of a common language.

OBJECTIVE

The objective of this paper is to show how the already existing requirements catalog was subdivided into specific, prioritized, and coherent working packages and the cooperation of multiple interprofessional teams within one development project was reorganized at the same time. In the case presented, the manner of cooperation was reorganized and a new instrument called an Action Sheet was implemented. This paper introduces the newly developed methodology which was meant to smooth the development of a user-centered software product and to restructure interprofessional cooperation.

METHODS

There were 10 focus groups in which views of patients with colorectal cancer, physicians, and other health care professionals were collected in order to create a requirements catalog for developing a personal electronic health record. Data were audio- and videotaped, transcribed verbatim, and thematically analyzed. Afterwards, the requirements catalog was reorganized in the form of Action Sheets which supported the interprofessional cooperation referring to the development process of a personal electronic health record for the Rhine-Neckar region.

RESULTS

In order to improve the interprofessional cooperation the idea arose to align the requirements arising from the implementation project with the method of software development applied by the technical development team. This was realized by restructuring the original requirements set in a standardized way and under continuous adjustment between both teams. As a result not only the way of displaying the user demands but also of interprofessional cooperation was steered in a new direction.

CONCLUSIONS

User demands must be taken into account from the very beginning of the development process, but it is not always obvious how to bring them together with IT knowhow and knowledge of the contextual factors of the health care system. Action Sheets seem to be an effective tool for making the software development process more tangible and convertible for all connected disciplines. Furthermore, the working method turned out to support interprofessional ideas exchange.

Technology as Teammate: Examining the Role of External Cognition in Support of Team Cognitive Processes

In this paper we advance team theory by describing how cognition occurs across the distribution of members and the artifacts and technology that support their efforts. We draw from complementary theorizing coming out of cognitive engineering and cognitive science that views forms of cognition as external and extended and integrate this with theorizing on macrocognition in teams. Two frameworks are described that provide the groundwork for advancing theory and aid in the development of more precise measures for understanding team cognition via focus on artifacts and the technologies supporting their development and use. This includes distinctions between teamwork and taskwork and the notion of general and specific competencies from the organizational sciences along with the concepts of offloading and scaffolding from the cognitive sciences. This paper contributes to the team cognition literature along multiple lines. First, it aids theory development by synthesizing a broad set of perspectives on the varied forms of cognition emerging in complex collaborative contexts. Second, it supports research by providing diagnostic guidelines to study how artifacts are related to team cognition. Finally, it supports information systems designers by more precisely describing how to conceptualize team-supporting technology and artifacts. As such, it provides a means to more richly understand process and performance as it occurs within sociotechnical systems. Our overarching objective is to show how team cognition can both be more clearly conceptualized and more precisely measured by integrating theory from cognitive engineering and the cognitive and organizational sciences.

Infrastructures for healthcare: From synergy to reverse synergy

The Danish General Practitioners Database has over more than a decade developed into a large-scale successful information infrastructure supporting medical research in Denmark. Danish general practitioners produce the data, by coding all patient consultations according to a certain set of classifications, on the entire Danish population. However, in the Autumn of 2014, the system was temporarily shut down due to a lawsuit filed by two general practitioners. In this article, we ask why and identify a political struggle concerning authority, control, and autonomy related to a transformation of the fundamental ontology of the information infrastructure. We explore how the transformed ontology created cracks in the inertia of the information infrastructure damaging the long-term sustainability. We propose the concept of reverse synergy as the awareness of negative impacts occurring when uncritically adding new actors or purposes to a system without due consideration to the nature of the infrastructure. We argue that while long-term information infrastructures are dynamic by nature and constantly impacted by actors joining or leaving the project, each activity of adding new actors must take reverse synergy into account, if not to risk breaking down the fragile nature of otherwise successful information infrastructures supporting research on healthcare.