IT and Nurses’ Daily Work: An Invisible Burden – a Licentiate Seminar by Diane Golay

Last week Diane Golay defended her licentiate degree thesis with an opponent. A licentiate degree seminar is very similar to a PhD defense in Sweden and you have an invited external opponent to discuss the research done.

After an introduction to the proceedings of the licentiate seminar by Åsa Cajander, the main supervisor, Diane Golay provides an excellent overview of her work towards her PhD so far in the DISA project, studying the effects of digitalization on the work environment of nurses. The licentiate thesis is based on three research papers:

    1. Golay, D., Löscher, I., Lind, T. (Submitted): The Impact of Information and Communication Technology on Work, Workers, and the Psychosocial Work Context: Research Trends from 2000-2017.
    2. Golay, D. (2018): Analyzing Work-Related Technology Use From a UX Perspective: The HolisticUX Method. NordiCHI’18. The paper is found here.
    3. Golay, D. (Submitted): More Work, Same Hours: Invisible HIT-Induced Tasks in Nurses’ Everyday Work.

In her work Diane Golay concludes that nurses daily work life with healthcare information technology has clear benefits, such as more efficient ways or working. But healthcare information technology also results in “unexpected, unintended adverse consequences”. According to her research typical issues include “loss in efficiency, extra effort to carry out routine tasks, and the creation of new, HIT-induced work activities”. Diane Golay also concludes that health technology leads to new kinds of work that are invisible in the sense that, for example, these new activities are not recognized by management as work nor something taken into account when introducing more HIT.

The Abstract for the Licentiate Thesis: 

Information and Communication Technology (ICT) has been an increasingly pervasive component of most workplaces throughout the past half century. In healthcare, the turn to the digital has resulted into the broad implementation of Healthcare Information Technology (HIT). The impacts of ICT on work life have been investigated predominantly through surveys, although some researchers have advocated for the use of a qualitative, experience-based approach. Meanwhile, the existing body of research on the impacts of HIT on clinicians has painted a mixed picture of digitalization. Despite some clear benefits, HIT has indeed been found to have unexpected, unintended adverse consequences for hospital staff. Typical issues include loss in efficiency, extra effort to carry out routine tasks, and the creation of new, HIT-induced work activities. Simultaneously, research outside of the healthcare domain has shown that ICT could require extra effort from some users in order for the sociotechnical system to function properly – extra work often invisible to developers. Based on observation, interview and focus group data collected at a large Swedish hospital, this thesis set out to investigate the impact of HIT on hospital nurses from an experience based perspective, resulting in four main contributions. First, a method supporting experience-based data analysis, the HolisticUX method, is introduced. Second, 13 forms of HIT-induced additional tasks in nurses’ workload are identified, five of which are not acknowledged in previous research. Third, task avoidance is identified as a consequence of nurses’ increased workload, negatively affecting patient safety, care quality and nurses’ professional satisfaction. Finally, four factors are argued to contribute to a suggested invisibility of the HIT-induced time burden in nurses’ work life to management and developers: 1) lack of a holistic perspective, 2) the hidden cost of a single click, 3) the invisibility of nursing work, and 4) visible data, invisible work.

After Diane Golay’s great presentation of her work, Lina Nilsson invites Diane Golay to a discussion about her research so far as well as her plans for the future.

The discussion, touching on all parts of the thesis and diving into the particulars of the three papers, is mainly centered on how to improve on the work even more and interesting venues and possibilities for this in the remaining studies towards Diane’s PhD thesis. The overall impression of the discussion is of Lina being impressed with the work done so far, and Diane being very grateful for the discussion about the future and the additional input and tips moving forward. The discussion also touched upon subjects such as reliability and validity in this type of research, cultural differences between research areas studying IT in health care such as sociology and computer science, and much else. Throughout, Diane had no problems defending and motivating her choices and proved well aware of the limitations and risks involved in her research. Her research so far has already provided us with interesting contributions to the knowledge in our field, and we are looking forward to her future studies! 

By the end of the day we celebrated the Licentiate degree being awarded to Diane Golay with a set of delicious cakes.

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