Abstract
This chapter addresses a problem that is often experienced when ICT systems are being implemented in a work practice. Posed as a question, it might be formulated like this: What does it take to replace an old functioning information system with a new one? Findings are grounded on a long-term case study at a community elder care. This chapter used the Development Work Research (DWR) approach that is an interventionist methodology comprising ethnography as well as design experiment. During the case study, a new digital case book for the community wound care was developed. However, as it turned out, the nurses´ established practice favored the old-fashioned mobile information system. First conclusion of this chapter is that an old-fashioned information system within health care work will not successfully be replaced by a new one, unless the new is better “as a whole”, that is, better supports work practices of a range of occupational and professional workers. Second conclusion is that when designing information system for the public sector, system designers will almost always face dilemmas based on a contradiction between central, high level interest and local level work-practice perspectives. The third conclusion is that in order to succeed in the design of new information and communication system, the distinctive features of the work activities in question have to be delineated by ethnographic studies, and taken into consideration in the design process.
TopThe long term case study that forms the empirical ground for our argumentation in this chapter was conducted in a small municipality in the south of Sweden. There community elder care is given to about 400 people living in eleven special accommodation units where they receive help with everyday things, like getting dressed, taking medicine, and some having their wounds cared for. A number of assistant nurses, nurses, managers and other personnel work and provide round-the-clock service.
Although the treatment of wound is only one of many things the nurses have to take care of, this sub-activity of their work has been the point of departure of our R&D project. Its first concrete aim was to design a digital case book to be used as a tool by the nurses in their wound care practice.
Key Terms in this Chapter
Shop floor work: In the context of health care, shop floor work is work practice directly related to the patients´ wounds or other health problems. It is front line work, in contrast to office work or management work.
Case book: Less formal document created and used for the main purpose to support a particular practice (in our case it is wound care). It shall not be confused with the formal medical or other kind of record required by legislation.
Participatory design (PD): Joint design involving design specialists plus practitioners such as graphic, metal and other shop floor workers. The rational is to take advantage of the “content” knowledge of the practitioners, to preserve skills and to promote a democratic development of working life.
Shop floor work: In the context of health care, shop floor work is work practice directly related to the patients´ wounds or other health problems. It is front line work, in contrast to office work or management work.
Developmental work research (DWR): A kind of interventionist or action research guided by cultural-historical activity theory. Researchers and practitioners jointly investigate the work practice, analyze the empirical data and do design for change of the actual work practice.
Case book: Less formal document created and used for the main purpose to support a particular practice (in our case it is wound care). It shall not be confused with the formal medical or other kind of record required by legislation.
Participatory design (PD): Joint design involving design specialists plus practitioners such as graphic, metal and other shop floor workers. The rational is to take advantage of the “content” knowledge of the practitioners, to preserve skills and to promote a democratic development of working life.
Community elder care: In Sweden the local government provides help and service to elderly. On criteria of national legislation and the individual´s actual needs, an agreed set of provisions are given by municipal employees. Usually once or several times each day at the elderly´s home.
Clusters of artefacts: In work practices most often several artefacts, or clusters of artefacts, are used in ways determined by the practitioners´ discretion.
Ethnographic investigation: Observation in practice of those people who actually carry out any activity that is of interest. Ethnographic techniques involve the use of video or audio recording devices and/ or taking field notes. The collected material is the empirical data used for producing research reports.
Artefacts: Man made things, that is things that are culturally and socially produced/brought about (in contrast to natural things).
Developmental work research (DWR): A kind of interventionist or action research guided by cultural-historical activity theory. Researchers and practitioners jointly investigate the work practice, analyze the empirical data and do design for change of the actual work practice.
Cultural-historical activity theory (CHAT): Founded by Vygotsky, Luria, and Leontiev, and built on the assumption that an activity is artefact-mediated and object-oriented.
Clusters of artefacts: In work practices most often several artefacts, or clusters of artefacts, are used in ways determined by the practitioners´ discretion.
Cultural-historical activity theory (CHAT): Founded by Vygotsky, Luria, and Leontiev, and built on the assumption that an activity is artefact-mediated and object-oriented.
Community elder care: In Sweden the local government provides help and service to elderly. On criteria of national legislation and the individual´s actual needs, an agreed set of provisions are given by municipal employees. Usually once or several times each day at the elderly´s home.
Artefacts: Man made things, that is things that are culturally and socially produced/brought about (in contrast to natural things).
Ethnographic investigation: Observation in practice of those people who actually carry out any activity that is of interest. Ethnographic techniques involve the use of video or audio recording devices and/ or taking field notes. The collected material is the empirical data used for producing research reports.