The trees that hide in the forest

Sometimes when we make studies on a work environment, e.g., as a preparation for software development, there seems to be a tendency to overlook the smaller things; things that actually have a greater effect on the work situation than we might think at a first glance. There is, of course, never any doubt that big software systems will play a big role in a person’s work over the day. When there are problems with these, this often causes large breaks in the workflow and are (hopefully) sorted out fairly quickly. But there are also many small things; those annoying nuances that might not be causing disasters, but merely make a person frustrated in the long run. These smaller inconveniences are often not detected or considered in the cognitive workspace design.

The idea of a cognitive, ergonomic work context was widely discussed in the 1980’s. (c.f., Hagert, Hansson and Oestreicher, 1987, Wærn 1988) . However, the overall combination of software systems as a work environment seems today to be stressed mostly as an issue of incompatibility, e.g. causing unnecessary copying and processing of data and similar issues. Even if we manage to make the systems compatible and exchanging the data between themselves there are many other environmental factors that will still be affecting the cognitive work context negatively. These factors are sometimes well hidden in the work procedures and may be difficult to assess for software designers, and sometimes they are actually not even software issues but rather involving advanced hardware solutions.

During our previous study visits at a hospital, there were many small things happening that were hardly noticeable, but which at the same time constituted important factors in the work situation. In some cases, these small things were not directly concerned with the software systems used (although it is possible to see some of them as relevant to the overall software systems design), but proper workspace design might actually include these parts in the larger software network.

Just after Easter, in 2018, I was hospitalised for a week with an evil strand of pneumonia. Apart from being sick it also meant an interesting and close view of the nurses’ work context and the tools that they used. Since I was actually a real patient (albeit of an observing kind) I think that the nurses were more relaxed than during the earlier study visit. So, I started to observe several things that happened all around me and in this and some following articles I will go through some of the ideas that fell well into the work context situation.

One thing that was quite apparent, both in the study visits and during my week-long stay at a clinic, was the fragmented workflow for the nurses. Among the ordinary work tasks, there were many local interruptions, from alarms for a certain patients medical condition (mostly false ones, but more about this later), to calls for non-urgent requests from patients for water, tending or other less acute matters. Also, there were incoming medical transports and phone calls which, although part of the work, often tended to interrupt the nurses in their work. This kind of phenomenon is very difficult to catch in a work design study since it more or less requires a longer period of observation in order to properly judge its significance for the work. In this way, we tend to see the forest (of tasks) as a single unit, whereas the nurses instead are working on all the small trees and shrubs (of smaller activities) that actually constitute it.

Another factor that has appeared is that while the design of the main computer systems often is very thoroughly prepared, both in terms of requirements on the software and the hardware, much less effort seems to be spent on the personal software and hardware(!). This means that even if we get very advanced software systems on the ward, the personal equipment often seems to be pretty much left out of the equation. Essentially, this is also very similar to working hard on defining the forest, but lacking the ability to see all the trees making it up.

In my following blogs, I will try to disseminate these issues into a few more concrete examples of this and even make some suggestions for how to proceed and also enhance the situation at a hospital ward with these observations as a base.

Lars Oestreicher,
DISA

(this blogpost is also published on my personal blogpage: moomindad.wordpress.com)

What we see and do not see – Some further notes on the observation studies…

Doing observation studies is not always as easy as it may seem at first glance, and Diane has already written much interesting stuff in her previous posts on the topic. I agree with her meta-observations, and I just thought I should add some of my views on this topic as well. My experiences are from my two days of observations on the children’s hospital, and the ward for children with tumour and blood diseases. Although the doctors and nurses work with very serious issues, I only experienced a very constructive atmosphere during my two days.

Most of the time when we visit the hospital environment we are there to receive treatment or visiting someone who is. We see a lot of things, and in some way they make sense. We see the blinking numbers on the wards, and we see the different screens used by the nurses and doctors. We see the white coats with blue stripes and don’t think more about that. But when we set out to actually study what is going on in this environment we not only have to see but also interpret the observations into scenarios. Even when we want to study a single system, and its effects on the work, it quickly becomes very evident that the workspace is a very entangled mesh of interactions between people and people and between people and machines. Some of these interactions are very short but nevertheless less important, and they are easy to miss if you are not focused. Some interactions are longer and thus also easier to observe. But in some cases, the more long-term interactions are also easy to miss because they are not continuous and thus have to be observed not only in terms of the shorter sequence as a whole (for instance, see example 2 below). 

So, what do we see during an observation visit? Lots of things, but it soon becomes clear that the things we do not (normally) see, are just as important, if not more. Just to give two quick examples:

  1. In the ward, at every workplace there are two screens for logging into applications, such as Cosmic, and other supportive tools. What is not (easily) seen is the parallell information storage that is widely used by the nurses. After almost a day at the ward, I suddenly realised that all the nurses had a small paper notebook, which they consulted now and then. It was kept in the pockets of the coat but was very difficult to observe. When asked about it, the nurse told me that the notebook was used to keep track of the details about each patient. The notebook seems to be an important but almost externally invisible information carrier. 
  2. Another observation that caught my attention, not because it was evident, but rather because it was not, was the role played by the alarm bell. The alarm has two functions, one that is an emergency call and the other, which is just a call for help with toilet visits or similar. Both are noted on the same display, and with similar sounds (still clearly easy to distinguish). However, the reactions to the alarms are completely different. In the second case, one or two nurses go over to the room, as soon as they are finished with their current tasks. In the first case, the work spaces are emptied within a few seconds. All tasks are interrupted, and almost everyone rushes to the room in question. Since they rush in the middle of a task, the software applications need to be extra supportive and help the nurse getting back into what he or she was doing. This is not something that is easily visible but could be of great importance. 

These two examples show in a clear way that observations can be multilayered and need to be both seen and put into the work context. In the case of the notebook, it was also something that was not really thought of by the nurses; it was so integrated into their work that they never gave it any thought. 

This makes on-site observation studies both important and interesting but also difficult at the same time. How to systematically get at these ”invisible” observations is a difficult matter, and from my experiences, I think it requires a long observation time to find many of them.