Digitally-mediated coordination in healthcare: the effects of teleconsultation on doctor-to-doctor relational coordination

BACKGROUND

Digitalization transforms the way in which interdependent work is coordinated, especially in healthcare settings. This work deepens the effect of teleconsultation use on health professionals' coordination. For this aim, we rely on Relational Coordination Theory (RCT), which explores coordination as an interactive process among group participants within the context of task interdependency.

METHODS

We collected data through an online survey administered to Italian specialist doctors between March and April 2023. 489 complete answers were gathered. Hypotheses have been tested through Structural Equation Modelling.

RESULTS

We found that teleconsultation frequency of use has a positive and significant effect on both components of relational coordination, confirming our hypotheses.

CONCLUSIONS

Theoretically, this research contributes to our understanding of the effect of digitally mediated coordination mechanisms on relational coordination. In practice, we shed light on the organizational implications of telemedicine under a novel perspective, focusing on the role of professional interactions in digitally mediated work and providing useful elements for the organizational design of telemedicine.

Exploring the role of professional identity in the implementation of clinical decision support systems-a narrative review

BACKGROUND

Clinical decision support systems (CDSSs) have the potential to improve quality of care, patient safety, and efficiency because of their ability to perform medical tasks in a more data-driven, evidence-based, and semi-autonomous way. However, CDSSs may also affect the professional identity of health professionals. Some professionals might experience these systems as a threat to their professional identity, as CDSSs could partially substitute clinical competencies, autonomy, or control over the care process. Other professionals may experience an empowerment of the role in the medical system. The purpose of this study is to uncover the role of professional identity in CDSS implementation and to identify core human, technological, and organizational factors that may determine the effect of CDSSs on professional identity.

METHODS

We conducted a systematic literature review and included peer-reviewed empirical studies from two electronic databases (PubMed, Web of Science) that reported on key factors to CDSS implementation and were published between 2010 and 2023. Our explorative, inductive thematic analysis assessed the antecedents of professional identity-related mechanisms from the perspective of different health care professionals (i.e., physicians, residents, nurse practitioners, pharmacists).

RESULTS

One hundred thirty-one qualitative, quantitative, or mixed-method studies from over 60 journals were included in this review. The thematic analysis found three dimensions of professional identity-related mechanisms that influence CDSS implementation success: perceived threat or enhancement of professional control and autonomy, perceived threat or enhancement of professional skills and expertise, and perceived loss or gain of control over patient relationships. At the technological level, the most common issues were the system's ability to fit into existing clinical workflows and organizational structures, and its ability to meet user needs. At the organizational level, time pressure and tension, as well as internal communication and involvement of end users were most frequently reported. At the human level, individual attitudes and emotional responses, as well as familiarity with the system, most often influenced the CDSS implementation. Our results show that professional identity-related mechanisms are driven by these factors and influence CDSS implementation success. The perception of the change of professional identity is influenced by the user's professional status and expertise and is improved over the course of implementation.

CONCLUSION

This review highlights the need for health care managers to evaluate perceived professional identity threats to health care professionals across all implementation phases when introducing a CDSS and to consider their varying manifestations among different health care professionals. Moreover, it highlights the importance of innovation and change management approaches, such as involving health professionals in the design and implementation process to mitigate threat perceptions. We provide future areas of research for the evaluation of the professional identity construct within health care.

Sociomaterial perspective as applied in interprofessional education and collaborative practice: a scoping review

Learning and working together towards better health outcomes today have become more complex requiring an investigation on how interprofessional education (IPE) and interprofessional collaboration (IPC) practices could be sustained and further developed. Through a sociomaterial perspective, we can better understand IPE and IPC practices by foregrounding the material aspect of learning and working together and examining its relationship with humans and their interactions. This article aimed to examine existing literature that discusses the application of sociomaterial perspectives in IPE and IPC. A scoping review was conducted following Arksey and O'Malley's framework to explore the extent within the current body of knowledge that discuss how sociomaterial perspective is applied in IPE and IPC practices. A systematic database search was performed in September 2021 to retrieve literature published from 2007 onwards, with forty-three papers meeting the inclusion criteria. These papers included research articles, book chapters, conference papers and commentaries, with the majority originating from Europe. The thematic analysis revealed the following themes: (1) power as a sociomaterial entity shaping IPE and IPC; (2) inclusion of non-health professionals in reimagining IPE and IPC practices, and (3) the critical understanding of sociomateriality. The findings suggest that a sociomaterial perspective can allow for the reimagination of the contemporary and future practices of interprofessionalism.

Work Un(Interrupted): How Non-territorial Space Shapes Worker Control over Social Interaction

Organizational research has long emphasized the importance of physical space in structuring opportunities for social interaction among workers. Using 14 months of field research during an office redesign at a large team-based sales company, I find that the adoption of non-territorial space—a change from assigned cubicles to an unassigned mix of spaces—substantially increased worker control over social interaction. Whereas the old territorial space rendered workers constantly accessible to others, the new non-territorial space altered information about workers’ location and availability preferences, enabling new strategies for hiding in the space and signaling availability to others through workspace selection. This led to greater reliance on virtual or asynchronous communication technologies, and less unwanted interruption in the new non-territorial space. The findings identify how the non-territorial dimension of office space affects worker control over social interaction. They also reveal the social practices through which individuals actively use material and symbolic resources in the physical environment to avoid cognitive and temporal costs of unwanted interruption. The study complements dominant structural accounts with a richer theorization of individual agency—while physical spaces certainly structure opportunities for social interaction, they also structure the strategies that individuals can use to actively manage social interaction.

“Collaborating” with AI: Taking a System View to Explore the Future of Work

In the wake of media hype about artificial intelligence (AI)/human collaboration, organizations are investing considerable resources into developing and using AI. In this paper, we draw on theories of technology in organizations to frame new directions for the study of what it means to work “with” AI. Drawing on prior literature, we consider how interactions between users and AI might unfold through theoretical lenses which cast technology as a tool and as a medium. Reflecting on how AI technologies diverge from technologies studied in the past, we propose a new perspective, which considers technology as a counterpart in a system of work that includes its design, implementation, and use. This perspective encourages developing a grounded understanding of how AI intersects with work, and therefore ethnography, building on thick descriptions, is an apt approach. We argue that relational ethnographic approaches can assist organization theorists in navigating the methodological challenges of taking a counterpart perspective and propose several strategies for future research.

Toy story or children story? Putting children and their rights at the forefront of the artificial intelligence revolution

Policymakers need to start considering the impact smart connected toys (SCTs) have on children. Equipped with sensors, data processing capacities, and connectivity, SCTs targeting children increasingly penetrate pervasively personal environments. The network of SCTs forms the Internet of Toys (IoToys) and often increases children's engagement and playtime experience. Unfortunately, this young part of the population and, most of the time, their parents are often unaware of SCTs' far-reaching capacities and limitations. The capabilities and constraints of SCTs create severe side effects at the technical, individual, and societal level. These side effects are often unforeseeable and unexpected. They arise from the technology's use and the interconnected nature of the IoToys, without necessarily involving malevolence from their creators. Although existing regulations and new ethical guidelines for artificial intelligence provide remedies to address some of the side effects, policymakers did not develop these redress mechanisms having children and SCTs in mind. This article provides an analysis of the arising side effects of SCTs and contrasts them with current regulatory redress mechanisms. We thereby highlight misfits and needs for further policymaking efforts.

Learning from the Failure of Autonomous and Intelligent Systems: Accidents, Safety, and Sociotechnical Sources of Risk

Efforts to develop autonomous and intelligent systems (AIS) have exploded across a range of settings in recent years, from self-driving cars to medical diagnostic chatbots. These have the potential to bring enormous benefits to society but also have the potential to introduce new-or amplify existing-risks. As these emerging technologies become more widespread, one of the most critical risk management challenges is to ensure that failures of AIS can be rigorously analyzed and understood so that the safety of these systems can be effectively governed and improved. AIS are necessarily developed and deployed within complex human, social, and organizational systems, but to date there has been little systematic examination of the sociotechnical sources of risk and failure in AIS. Accordingly, this article develops a conceptual framework that characterizes key sociotechnical sources of risk in AIS by reanalyzing one of the most publicly reported failures to date: the 2018 fatal crash of Uber's self-driving car. Publicly available investigative reports were systematically analyzed using constant comparative analysis to identify key sources and patterns of sociotechnical risk. Five fundamental domains of sociotechnical risk were conceptualized-structural, organizational, technological, epistemic, and cultural-each indicated by particular patterns of sociotechnical failure. The resulting SOTEC framework of sociotechnical risk in AIS extends existing theories of risk in complex systems and highlights important practical and theoretical implications for managing risk and developing infrastructures of learning in AIS.

Uncovering the affective affordances of videoconference technologies

Purpose

The purpose of this study is to examine the role of videoconferencing technologies for mediating and transforming emotional experiences in virtual context.

Design/methodology/approach

Drawing on empirical data of video conferencing experiences, this study identifies different constitutive relations with technology through which actors cope with actual or potential anxieties in virtual meetings. It draws on the phenomenological-existential tradition (Sartre and Merleau-Ponty) and on an interpretive phenomenological analysis (IPA) to conceptualize and illustrate the role of affective affordances in virtual settings.

Findings

The study identifies four different body–technology–other relations that provide different action possibilities, both disclosing and concealing, for navigating emotional experiences in virtual encounters of mutual gazing. These findings offer insights into the anatomy of virtual emotions and provide explanations on the nature of Zoom fatigue (interactive exhaustion) and heightened feelings of self-consciousness resulting from video conferencing interactions.

Originality/value

This paper builds on and extends current scholarship on technological affordances, as well as emotions, to suggest that technologies also afford different tactics for navigating emotional experiences. Thus, this paper proposes the notion of affective affordance that can expand current information system (IS) and organization studies (OS) scholarship in important ways. The focus is on videoconference technologies and meetings that have received little research attention and even less so from a perspective on emotions. Importantly, the paper offers nuanced insights that can advance current research discourse on the relationships between technology, human body and emotions.

Local Adaptation Without Work Intensification: Experimentalist Governance of Digital Technology for Mutually Beneficial Role Reconfiguration in Organizations

This 1.5-year ethnographic study of a U.S. medical center shows that avoiding loss of autonomy and work intensification for less powerful actors during digital technology introduction and integration presents a multisited collective action challenge. I found that technology-related participation problems, threshold problems, and free rider problems may arise during digital technology introduction and integration that enable loss of autonomy and work intensification for less powerful actors. However, the emergence of new triangles of power allows for novel coalitions between less powerful actors and newly powerful third-party actors that can help mitigate this problem. I extend the political science perspective of experimentalist governance to examine how a digital technology-focused, iterative collective action process of local experimentation followed by central revision can facilitate mutually beneficial role reconfiguration during digital technology introduction and integration. In experimentalist governance of digital technology, local units are given discretion to adapt digital technologies to their specific contexts. A central unit composed of diverse actors then reviews progress across local units integrating similar digital technology to negotiate a new shared understanding of mutually beneficial technology-related tasks for each group of actors. The central unit modifies both local routines and the technology itself in response to problems and possibilities revealed by the central revision process, and the cycle repeats. Here, accomplishing mutually beneficial role reconfiguration occurs through an experimentalist, collective action process rather than through a labor-management bargaining process or a professional-led tuning process.

To Engage or Not to Engage with AI for Critical Judgments: How Professionals Deal with Opacity When Using AI for Medical Diagnosis

Artificial intelligence (AI) technologies promise to transform how professionals conduct knowledge work by augmenting their capabilities for making professional judgments. We know little, however, about how human-AI augmentation takes place in practice. Yet, gaining this understanding is particularly important when professionals use AI tools to form judgments on critical decisions. We conducted an in-depth field study in a major U.S. hospital where AI tools were used in three departments by diagnostic radiologists making breast cancer, lung cancer, and bone age determinations. The study illustrates the hindering effects of opacity that professionals experienced when using AI tools and explores how these professionals grappled with it in practice. In all three departments, this opacity resulted in professionals experiencing increased uncertainty because AI tool results often diverged from their initial judgment without providing underlying reasoning. Only in one department (of the three) did professionals consistently incorporate AI results into their final judgments, achieving what we call engaged augmentation. These professionals invested in AI interrogation practices—practices enacted by human experts to relate their own knowledge claims to AI knowledge claims. Professionals in the other two departments did not enact such practices and did not incorporate AI inputs into their final decisions, which we call unengaged “augmentation.” Our study unpacks the challenges involved in augmenting professional judgment with powerful, yet opaque, technologies and contributes to literature on AI adoption in knowledge work.

The Unknowability of Autonomous Tools and the Liminal Experience of Their Use

Recently companies are increasingly adopting intelligent technologies, such as autonomous tools and artificial intelligence, to assist complex knowledge works that are traditionally carried out by human experts. These tools can independently learn and execute novel actions. The input–output relationships of these tools, however, are unknowable to human experts. This calls for analysis of how humans may work differently while interacting with such tools. To this end, we conduct a comparative case study at one of the world’s largest semiconductor manufacturers. We investigate how chip designers interact with two families of design technologies: one following a traditional designer-centric approach in which the designer knows what outputs particular inputs to the tools will generate, and another relying on autonomous tools that continually surprise the user. Our inquiry reveals that, when using autonomous tools, designers can hardly understand the design generated by the tools and become more like laboratory experimentalists in that their primary job is experimenting with different inputs and assessing the quality of the finished design. Their interactions with the tools are marked by ambiguity, and the design is moved forward along multiple design trajectories in accordance with a multifarious temporality.

Telerounding: A scoping review and implications for future healthcare practice

INTRODUCTION

Telerounding is slated to become an important avenue for future healthcare practice. As utilization of telerounding is increasing, a review of the literature is necessary to distill themes and identify critical considerations for the implementation of telerounding. We provide evidence of the utility of telerounding and considerations to support its implementation in future healthcare practice based on a scoping review.

METHOD

We collected articles from nine scientific databases from the earliest dated available articles to August 2020. We identified whether each article centered on telerounding policies, regulations, or practice. We also organized information from each article and sorted themes into four categories: sample characteristics, technology utilized, study constructs, and research outcomes.

RESULTS

We identified 21 articles related to telerounding that fit our criteria. All articles emphasized telerounding practice. Most articles reported data collected from surgical wards, had adult samples, and utilized robotic telerounding systems. Most articles reported null effects or positive effects on their measured variables.

DISCUSSION

Providers and patients can benefit from the effective implementation of telerounding. Telerounding can support patient care by reducing travel expenses and opportunities for infection. Evidence suggests that telerounding can reduce patient length of stay. Patients and providers are willing to utilize telerounding, but patient willingness is influenced by age and education. Telerounding does not appear to negatively impact satisfaction or patient care. Organizations seeking to implement telerounding systems must consider education for their providers, logistics associated with hardware and software, scheduling, and characteristics of the organizational context that can support telerounding. Considerations provided in this article can mitigate difficulties associated with the implementation of telerounding.

Waging War from Remote Cubicles: How Workers Cope with Technologies That Disrupt the Meaning and Morality of Their Work

Technologies are known to alter social structures in the workplace, reconfigure roles and relationships, and disrupt status hierarchies. However, less attention has been given to how an emerging technology disrupts the meaning and moral values that tether people to their work and render it meaningful. To understand how workers respond to such an emerging technology, we undertook an inductive, qualitative study of military personnel working in unmanned aerial vehicles, or drone operations, for the U.S. Air Force. We draw on multiple data sources, including personal diaries kept by personnel involved in drone operations. We identified three characteristics of drone technology: remote-split operations, remote piloting of unmanned vehicles, and interaction through iconic representations. Our analysis suggests that drone technology has revolutionized warfare by (1) creating distanciated intimacy, (2) dissolving traditional spatio-temporal boundaries between work and personal life, and (3) redefining the legal and moral parameters of work. Drone program workers identified with these changes to their working environment in contradictory ways, which evoked emotional ambivalence about right and wrong. However, their organization gave them little help in alleviating their conflicting feelings. We illuminate how workers cope with such ambivalence when a technology transforms the meaning and morality of their work. We extend theory by showing that workers’ responses to a changed working environment as a result of a remote technology are not just based on how the technology changes workers’ tasks, roles, and status but also on how it affects their moral values.

Brains exposed: How new imaging technology reconfigures expertise coordination in neurosurgery

This study explores the consequences of the uptake of novel medical technology for expertise coordination among specialists. Building on a 40-month field study, we show how the introduction of iMRI triggered a significant change in temporal, interactional and role dimensions of coordination. We trace the origin of those changes to the novel role the images started to play in surgery: iMRI generated new forms of visibility of the brain (offering real-time, more precise imaging) and new forms of ambiguity for clinical action (representing the brain undergoing manipulation). In response to this dual nature of images, specialists reconfigured how they engage with each other: aligning temporal rhythms of their corresponding work practices, shifting their interactions to focus more on dialog and synchronous mutual exploration of images, and delegating increased weight to radiological judgement for guiding immediate surgical action. We discuss the implications of our findings for research on expertise coordination and on the consequences of novel medical technologies for situated practice.

Customer acceptance of frontline service robots in retail banking: A qualitative approach

Purpose

The purpose of this paper is to explore what drives customer acceptance of frontline service robots (FSR), as a result of their interaction experiences with FSR in the context of retail banking services.

Design/methodology/approach

Applications of the unified theory of acceptance and use of technology and service robot acceptance model frame the exploration of customers’ interaction experiences with physical FSR to explain acceptance. A thematic analysis of information obtained through observations, focus groups and participant interviews was applied to identify themes.

Findings

This study identifies 16 dimensions that group into five main themes that influence customer acceptance of FSR in retail banking services: (1) utilitarian aspect, (2) social interaction, (3) customer responses toward FSR, (4) customer perspectives of the company brand and (5) individual and task heterogeneity. Themes 1 and 2 are labeled confirmed themes based on existing theoretical frameworks used; themes 3–5 are additional themes.

Practical implications

This study provides actionable suggestions to allow managers to reflect on their strategy and consider ways to design and improve the delivery of services that involve FSR.

Originality/value

This study adds to our limited knowledge of how human-robot interaction research in robotics translates to a relatively new research area in frontline services and provides a step toward a comprehensive FSR acceptance model.

Space and Sensemaking in High-Reliability Task Contexts: Insights from a maritime mass rescue exercise

The spatial environment shapes sensemaking in complex situations. While we know that actors in high-reliability task contexts often have a certain degree of control over their spatial environment, it remains unclear how they enact it and which effect this has on their sensemaking. In this paper, we use micro-ethnographic video data from two maritime mass rescue exercises to fill this gap. We find that actors that are under a high cognitive load enact space incidentally and fail to re-enact their spatial environment when problems arise. Instead, actors engage in micro-activities that temporarily mitigate the problems created by their space enactment. We develop a model on space and sensemaking in high-reliability task contexts that distinguishes between unenacted, enacted and lived space. Our findings point towards nested sensemaking, where the enacted spatial environment becomes part of the overall ‘story’ of an operation. Our findings have implications for our understanding of space and sensemaking in high-reliability task contexts, provide opportunities to improve high-reliability organizations’ performance and add to research on space and organising.

Social Robots on a Global Stage: Establishing a Role for Culture During Human–Robot Interaction

Robotic agents designed to assist people across a variety of social and service settings are becoming increasingly prevalent across the world. Here we synthesise two decades of empirical evidence from human–robot interaction (HRI) research to focus on cultural influences on expectations towards and responses to social robots, as well as the utility of robots displaying culturally specific social cues for improving human engagement. Findings suggest complex and intricate relationships between culture and human cognition in the context of HRI. The studies reviewed here transcend the often-studied and prototypical east–west dichotomy of cultures, and explore how people’s perceptions of robots are informed by their national culture as well as their experiences with robots. Many of the findings presented in this review raise intriguing questions concerning future directions for robotics designers and cultural psychologists, in terms of conceptualising and delivering culturally sensitive robots. We point out that such development is currently limited by heterogenous methods and low statistical power, which contribute to a concerning lack of generalisability. We also propose several avenues through which future work may begin to address these shortcomings. In sum, we highlight the critical role of culture in mediating efforts to develop robots aligned with human users’ cultural backgrounds, and argue for further research into the role of culturally-informed robotic development in facilitating human–robot interaction.

Losing Touch: An Embodiment Perspective on Coordination in Robotic Surgery

Because new technologies allow new performances, mediations, representations, and information flows, they are often associated with changes in how coordination is achieved. Current coordination research emphasizes its situated and emergent nature, but seldom accounts for the role of embodied action. Building on a 25-month field study of the da Vinci robot, an endoscopic system for minimally invasive surgery, we bring to the fore the role of the body in how coordination was reconfigured in response to a change in technological mediation. Using the robot, surgeons experienced both an augmentation and a reduction of what they can do with their bodies in terms of haptic, visual, and auditory perception and manipulative dexterity. These bodily augmentations and reductions affected joint task performance and led to coordinative adaptations (e.g., spatial relocating, redistributing tasks, accommodating novel perceptual dependencies, and mounting novel responses) that, over time, resulted in reconfiguration of roles, including expanded occupational knowledge, emergence of new specializations, and shifts in status and boundaries. By emphasizing the importance of the body in coordination, this paper suggests that an embodiment perspective is important for explaining how and why coordination evolves following the introduction of a new technology.

The Robot Makers

This article is an ethnographic exploration of robot anthropomorphism at a robotics company. It draws on a 10-month participatory ethnography among a robotics company, an anthropologist, and a social robotics research lab. In contrast to psychological methods, this anthropological participatory ethnography integrates all stakeholders’ insights, offering holistic understandings of robots’ in situ operations throughout the fieldwork, data-sharing, interviews, and analysis. In particular, this article unravels employee social constructions of the company’s self-driving factory transport vehicles, “the robots.” These robots are deployed across a variety of warehouses and factories in North America. Our results involve an assessment of six teams at the robotics company’s headquarters: those testing robots, those developing their hardware and software, and those working with customers. We unpack trends of anthropomorphism for each of these teams and across the company.

Gathering Expert Opinions for Social Robots’ Ethical, Legal, and Societal Concerns: Findings from Four International Workshops

Social robots, those that exhibit personality and communicate with us using high-level dialogue and natural cues, will soon be part of our daily lives. In this paper, we gather expert opinions from different international workshops exploring ethical, legal, and social (ELS) concerns associated with social robots. In contrast to literature that looks at specific challenges, often from a certain disciplinary angle, our contribution to the literature provides an overview of the ELS discussions in a holistic fashion, shaped by active deliberation with a multitude of experts across four workshops held between 2015 and 2017 held in major international workshops (ERF, NewFriends, JSAI-isAI). It also explores pathways to address the identified challenges. Our contribution is in line with the latest European robot regulatory initiatives but covers an area of research that the latest AI and robot governance strategies have scarcely covered. Specifically, we highlight challenges to the use of social robots from a user perspective, including issues such as privacy, autonomy, and the dehumanization of interactions; or from a worker perspective, including issues such as the possible replacement of jobs through robots. The paper also compiles the recommendations to these ELS issues the experts deem appropriate to mitigate compounding risks. By then contrasting these challenges and solutions with recent AI and robot regulatory strategies, we hope to inform the policy debate and set the scene for further research.

Close Encounters: Intimate service interactions in lap dancing work as a nexus of ‘self-others-things’

Drawing on ethnographic research on lap dancing work, this paper focuses on how the subjectivities, interactions and settings that constitute the lap dancing industry come into being through three interrelated processes of encoding, embodying and embedding. In considering how these processes combine to ‘enact’ the industry, the paper draws on Merleau Ponty’s understanding of the world as a dynamic nexus of ‘self-others-things’. Focusing on how this nexus shapes lived experiences of intimate service interactions, the analysis considers how dancers continually negotiate customers’ expectations of the service encounter given the ways in which these are: (i) encoded in depictions of lap dancing work in marketing and advertising materials on club websites; (ii) embodied by lap dancers through their interactions with customers; and (iii) embedded within the materiality of lap dancing clubs. The paper shows how intimate service encounters can be understood as the outcome of a nexus of ‘self-others-things’ through which particular organizational subjectivities and settings are brought into being through these three interrelated processes.

Quality and safety between ward and board: a biography of artefacts study

Background

There have been concerns about the quality and safety of NHS hospital services since the turn of the millennium. This study investigated the progress that acute NHS hospital trusts have made in developing and using technology infrastructures to enable them to monitor quality and safety following the publication in 2013 of the second Francis report on the scandal at Mid Staffordshire NHS Foundation Trust (The Mid Staffordshire NHS Foundation Trust Public Inquiry. Chaired by Sir Robert Francis QC.Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. HC 898. London: The Stationery Office; 2013).

Methods

A telephone survey of 15 acute NHS trusts in the Yorkshire and the Humber region, and a review of board papers of all acute NHS trusts in England for January 2015, were undertaken. The telephone survey was used to identify trusts for a larger field study, which was undertaken in four acute NHS trusts between April 2015 and September 2016. The methods included the direct observation of the use of whiteboards and other technologies on two wards in each trust, an observation of board quality committees, semistructured interviews and an analysis of the quality and safety data in board papers. Published sources about national and local agencies were reviewed to identify the trust quality and safety data that these agencies accessed and used. An interview programme was also undertaken with those organisations. The Biography of Artefacts approach was used to analyse the data.

Findings

The data and technology infrastructures within trusts had developed over many years. The overall design had been substantially determined by national agencies, and was geared to data processing: capturing and validating data for submission to national agencies. Trust boards had taken advantage of these data and used them to provide assurance about quality and safety. Less positively, the infrastructures were fragmented, with different technologies used to handle different quality and safety data. Real-time management systems on wards, including electronic whiteboards and mobile devices, were used and valued by nurses and other staff. The systems support the proactive management of clinical risks. These developments have occurred within a broad context, with trusts focusing on improving the quality and safety of services and publishing far more data on their performance than they did just 3 years earlier. Trust-level data suggest that quality and safety improved at all four trusts between 2013 and 2016. Our findings indicate that the technology infrastructures contributed to these improvements. There remains considerable scope to rationalise those infrastructures.

Limitations

The four trusts in the main study were, in part, purposively selected, and deliberately biased towards sites that had made progress with designing and deploying real-time ward management systems. This limits the generalisability of the study. The study focused more on the work of nurses and nurse managers, and has relatively little to say about the experiences of doctors or allied health professionals.

Future work

Future research might focus on the effects of mobile technologies and electronic whiteboards on acute wards, the value of current national data returns, and the uses and value of trust data warehouses.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Making Sense in Pitch Darkness: An Exploration of the Sociomateriality of Sensemaking in Crises

A brief failure of one item on the display of the information system (IS) on Flight AF 447 wrought havoc in the coordination between the pilots and the aircraft, leading to the loss of all 228 lives on board. In this essay, we ask the following question: How can the very instruments supposed to ensure our safety and make organizations more reliable lead a team to destruction? We propose that the imbrication of material and human agencies in such highly automated systems drives an attitude of “mindful indifference” (i.e., the capacity for experienced operators to distinguish problems that could turn into critical ones from problems that can be tolerated on account of the overall system reliability). An abrupt change in this imbrication provoked emotional distress and focused the pilots’ attention toward the machine, instead of triggering an organizational process of sensemaking. We highlight the role of leadership in such situations.

The Radical Flank Effect and Cross-occupational Collaboration for Technology Development during a Power Shift

This 12-month ethnographic study of an early entrant into the U.S. car-sharing industry demonstrates that when an organization shifts its focus from developing radical new technology to incrementally improving this technology, the shift may spark an internal power struggle between the dominant engineering group and a challenger occupational group such as the marketing group. Analyzing 42 projects in two time periods that required collaboration between engineering and marketing during such a shift, we show how cross-occupational collaboration under these conditions can be facilitated by a radical flank threat, through which the bargaining power of moderates is strengthened by the presence of a more-radical group. In the face of a strong threat by radical members of a challenger occupational group, moderate members of the dominant engineering group may change their perceptions of their power to resist challengers' demands and begin to distinguish between the goals of radical versus more-moderate challengers. To maintain as much power as possible and prevent the more-dramatic change in engineering occupational goals demanded by radical challengers, moderate engineers may build a coalition with moderate challengers and collaborate for incremental technology development.