Understanding the Ecological Validity of Relying Practice as a Basis for Risk Identification

Understanding the reliability of hazardous organizations and their protective systems is central to understanding the risk they produce. Work on "high reliability organization" has done much to illuminate the conditions in which social organization becomes reliable in highly demanding conditions. But risk depends just as much on how relying entities do their relying as it does on the reliability of the entities they rely on. Patterns of relying are often opaque in sociotechnical systems, and processes of relying and being relied on are mutually influencing in complex ways, so the relationship between relying and risk may not be at all obvious. This study was an attempt to study relying as a social practice, in particular analyzing how it had ecological validity in a social organization-how practice was responsive to the conditions in which it took place. This involved observational fieldwork and inductive, qualitative analysis on an offshore oil and gas production platform that was nearing the end of its design life and undergoing refurbishment. The analysis produced four main categories of ecological validity: responsiveness to formal organization, responsiveness to situational contingency, responsiveness to information asymmetry, and responsiveness to sociomateriality. This ecological validity of relying practice should be a primary focus of risk identification, assessing how relying can become mismatched to reliability in certain ways, both when relying practice is responsive to circumstances and when it is not.

Working IT Out in Medical Practice: IT Systems Design and Development as Co-Realisation

Objectives: The paper explores possibilities for situating IT design and development work within the context of use so as to support the co-realisation of technology and ‘design in use’. The aim is to build a new understanding between IT professionals and users which is grounded upon what happens as the latter grapple with the problems of applying IT, appropriating its functionalities and affordances into their work practices and relations.

Methods: Following a discussion of participatory design and ethnomethodology, a novel method called co-realisation, which aims to provide a synthesis of the preceding methods, is suggested as an alternative. Through a discussion of findings from a case study of IT systems design and development in healthcare we show how the co-realisation approach might provide work-affording systems and how user-designer relations might be reformulated. We suggest that work-affording systems can be developed through the deployment of an engaged facilitator who works with the users to unpack the work site-specific potentialities of technology.

Results: The case study shows how risk of non-adoption might be minimised through the development of partnerships, and how the presence of the facilitator in the workplace capitalises on the mundane work undertaken therein and how the facilitator might work with the users to develop artefacts that support this work as opposed to reconfiguring it.

Conclusions: The case study illustrates co-realisation in action and how it might be seen to reconfigure relations between users and designers in a way that appears productive. Co-realisation can help address the widely observed problem of IT systems failures in healthcare.

Trusting the Record

Objectives: This paper aims to contribute to a longstanding interest in documents and paperwork in healthcare work through an examination of everyday work with patient records in a clinic.

Methods: An ethnographic study of record keeping practices in a deliberate self harm clinic was conducted to consider the role that document work plays in the development of trust in the routine social interactions of a working division of labor.

Results and conclusions: Issues of trust are seen to play central roles within the complexities of organizational working and some consequent implications for the deployment and use of electronic medical record systems are considered.

The electronic medical record and everyday medical work

The deployment of the electronic medical record (EMR) is widely seen by healthcare policy makers and service managers as a key step in the achievement of more efficient and integrated healthcare services. However, our studies of medical work practices reveal important discrepancies between the presumptions of EMR and the ways in which healthcare professionals actually use and communicate information. These lead us to conclude it may be some time before technologies like the EMR can deliver promised benefits, and will do so only if they are allowed to evolve via user-led design and development processes.

Improving ‘knife to skin time’: process modelling and new technology in medical work

As healthcare becomes information intensive technology increasingly plays an important role in managing patient care; information gathering and dissemination; and co-ordinating work. One approach to ensuring resources, staff and systems are allocated and used efficiently is process modelling. This paper presents some findings from the Dependability Interdisciplinary Research Collaboration (DIRC) project, on ‘process modelling’ as an aspect of managerial activity and the work involved in both creating and implementing process maps or models. Our ethnographic investigations document some of the problems in developing process maps of medical activity as part of a desire to ‘improve knife to skin time’. We suggest that process maps are not systematic, rational, scientific deductions of the most efficient process. Process maps are locally sensible versions of best practice, and problems may arise where such locally sensible versions are exported throughout an organization to other settings where other relevances may apply.

Working IT out in medical practice: IT systems design and development as co-realisation

OBJECTIVES

The paper explores possibilities for situating IT design and development work within the context of use so as to support the co-realisation of technology and 'design in use'. The aim is to build a new understanding between IT professionals and users which is grounded upon what happens as the latter grapple with the problems of applying IT, appropriating its functionalities and affordances into their work practices and relations.

METHODS

Following a discussion of participatory design and ethnomethodology, a novel method called co-realisation, which aims to provide a synthesis of the preceding methods, is suggested as an alternative. Through a discussion of findings from a case study of IT systems design and development in healthcare we show how the co-realisation approach might provide work-affording systems and how user-designer relations might be reformulated. We suggest that work-affording systems can be developed through the deployment of an engaged facilitator who works with the users to unpack the work site-specific potentialities of technology.

RESULTS

The case study shows how risk of non-adoption might be minimised through the development of partnerships, and how the presence of the facilitator in the workplace capitalises on the mundane work undertaken therein and how the facilitator might work with the users to develop artefacts that support this work as opposed to reconfiguring it.

CONCLUSIONS

The case study illustrates co-realisation in action and how it might be seen to reconfigure relations between users and designers in a way that appears productive. Co-realisation can help address the widely observed problem of IT systems failures in healthcare.

Trusting the record

OBJECTIVES

This paper aims to contribute to a longstanding interest in documents and paperwork in healthcare work through an examination of everyday work with patient records in a clinic.

METHODS

An ethnographic study of record keeping practices in a deliberate self harm clinic was conducted to consider the role that document work plays in the development of trust in the routine social interactions of a working division of labor.

RESULTS AND CONCLUSIONS

Issues of trust are seen to play central roles within the complexities of organizational working and some consequent implications for the deployment and use of electronic medical record systems are considered.