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.

Seminar with Lina Nilsson on “Social Challenges when Implementing eHealth in Healthcare – Organisational Experiences from Research and Development Projects”

Lina Nilsson’s does research on implementation of eHealth. She is a senior lecturer at the Linneaus University and works in health informatics. She has a background in sociology with leadership and management.

Lina did her PhD project in Applied Health Technology (up until 2014), on using IT to improve communication between patients and healthcare staff. In her thesis, she identified social challenges when implementing Information systems in a Swedish healthcare organization: power, alienation, professional identity and encounters are aspects that may influence the implementation process.

Today, she is engaged in education but also research and development projects with focus on eHealth at Linnæus University.  

During her talk she discussed the professional identity of being a good nurse that is not the same thing as being good at IT systems. That working with IT was not seen as a part of the core professional nursing profession, and that previous bad experiences of implementations affect future ones.

Suspicions based on previous experiences of implementations, attitudes along the lines of “it didn’t go that well last time, why should we trust this one to be any better?” are challenging for an implementation project in health care. eHealth can provide tools that are appreciated by health care professionals, but also affect their work in ways that they do not. For example by affecting traditional power structures between professions.

Today Lina Nilsson has focused her research on nursing. One thing that she has found is that ICT implementations solve certain problems related to work, but that it also introduces new problems. She is also working in a project, ePATH, directed at supporting patients and empowering patients in care at home. In another project, she is involved in researching how small and medium sized enterprises can compete more fairly with larger actors on the market for providing HIT to health care organisations.

Uppsala SciFest 2019

This is the second time visiting the Uppsala SciFest 2019, and it was an intense first day. School class after school class visited the booth in which I demonstrated the use of EEG-equipment as a simple Brain-Computer interface. The challenge is to focus your attention on one of two small circles on the screen in such a way that it starts to move. This is difficult since we are not used to using our brains in this way.

Full concentration, focusing on moving things on the screen, just by thinking hard.

However, after training for a couple of minutes, many of the visitors actually managed to make the desired circle move more than the circle not focused on. The problem is that it is not possible to describe how you do this since the learning is made in the brain, rather than as a conscious activity. This was a continuous source of slightly embarrassed comments: “I don’t know how I do it, but it just happens…!“. And that is a very good observation. This skill is actually very much like keeping the balance on a bicycle, you know when you get it right, but no one can tell you how to do it.

All in all, the first day at SciFest was a success, so I will just keep my fingers crossed that the rest of the SciFest will continue just as well, including on Saturday, when it is open to the public.

What could a digitalized primary healthcare look like in 2030? IT in Society Class of 2018 presenting at Vitalis

This years’ IT in Society Class got the task from Region Uppsala to look into primary care. Students in this class come from Uppsala University and the highly prestigious Rose-Hulman Institute of Technology. Anne Peters, Mats Daniels and Åsa Cajander are teachers in Uppsala, and Cary Laxer is the teacher in Indiana.

By the end of the semester they submitted an abstract to the peer-reviewed industry conference VITALIS – and they were accepted! The Vitalis conference is the leading eHealth conferences in the Nordic countries with more than 5000 participants who now have the opportunity to meet our students. See you at Vitalis!

Below is the abstract: 

What could a digitalized primary healthcare look like in 2030? This was the question addressed by a group of around 25 computer science students from Uppsala University and Rose-Hulman Institute of Technology in the US. To examine this question, they collaborated with healthcare professionals in Region Uppsala. In their semester long project, they researched the current primary healthcare system in order to find digitally related improvements that can impact how healthcare could look like in 2030. The research conducted is human-centered and seeks to define modernization methods that would improve the working situation for the medical professionals, as well as the patients’ experience. To grasp the current workflow in Region Uppsala we conducted a holistic overview from two perspectives: the patient perspective and the healthcare professional’s perspective. We found that the current primary care system has areas of improvement in the fields of User experience and Graphical User interfaces for computer systems that patients and staff members use. We also found that digitized self-assessment and triage is an area that can reduce the workload of the staff and enhance the patient experience.

Our research has also highlighted the need to find new digital tools and adapt the existing digital solutions to provide a better working environment for workers in primary care. This would imply moving away from “pen and papper” analog systems towards a more digitally integrated, cohesive system.

The suggestions that we provide in this presentation are based on sound scientific studies previously conducted and on extensive field interviews with more than 20 involved specialists and data gathering on the current system. We have also conducted two surveys in order to understand how patients feel in regards to the current primary care system and participated in observations to see how primary care professionals operate on a daily basis.

Some of the solutions we propose are:

– the smart, easy to use design of graphical interfaces that also adapt and learn the user’s behaviour to provide ease of access

– adding more real time alternatives to get in touch with medical professionals such as live chat messaging

– using wearable devices to monitor frequent patients’ clinical measurements

– modernizing the analog areas of the current system with the help of new technologies.

Looking forward into the future, we have ideas of how a future system could look like in 2030. The areas of improvement are relying on the continuous development of artificial intelligence and machine learning, all integrated to reiterate our objective: an efficient, human-centered primary care. We hope that these improvements would lead to a better medical system and change society for the better.

Three Key Note Speakers at the Next SuniWeb Conference

Join the HTO research group at the next SuniWeb Conference in Uppsala the 29 and 30th of April 2019! Three people from our research group will be keynote speakers.

All three researchers will be presenting on the 29th of April. First Diane Golay and Åsa Cajander will be talking in the morning about the latest research in the area of digitalisation and the work environment. This includes really interesting results from Diane Golay’s licentiate thesis related to invisible work and IT (from the DISA project). They will also touch upon fragmentation of time, changes in work tasks and the problems related to always being online.

Lars Oestreicher will be talking as the final keynote of the conference. His topic will be “How do you create communication systems for people with severe disabilities?”. In his talk, he will talk about web applications and non-excluding design.  In this way of doing design you focus on how to isolate the excluding factors already in the design process. He will also talk about his exciting research on young people with disabilities and music as a concrete example of to focus on abilities instead of disabilities.

A social event in celebration of our new financial system

At Uppsala University, the administrative system Raindance has been updated to a new version. The HTO-group is doing collaborative work in relation to this project (the EASY project). Last Thursday afternoon, the project celebrated that the implementation phase in now complete, by inviting the users to a network meeting. Approximately 100 users came to the meeting. From the HTO-group, Gunilla and Thomas went.

The afternoon started with information regarding the process as a whole: from the procurement phase until today. Edrun Eriksson (Head of the Ledger Office unit at the Financial Administration and Procurement Division) reminded the users of what expectations and hopes they had forwarded themselves, early on in the process. She gave us some illustrative examples. Furthermore, she had made a printout of the complete list, which was put up on the wall, so that all participants could read them later on during the afternoon. She also presented a summary of all sub groups and sub projects that have been active in the process. They were quite many! For meetings, she had just marked the amount with a question mark – being a bit over conscious regarding the great number of hours put into the project!

Edrun also took the opportunity to express a big “Thank you!” to all the people that have contributed with energy, experience, and time! It is nice for everyone to be reminded about the great effort that has been put into the project, and to hear of everything that is already achieved. Furthermore, the audience was asked a couple of questions with the aid of Menti.com and participants’ cell phones. The first question was “In what area are you presently in biggest need of support?” By choosing from given alternatives, the answers showed up in a pie chart. The other question was regarding ideas for future improvements, which was a free text question; so that the participants could write whatever answers they wanted.

The presentation then continued with a section where we (Gunilla and Thomas) got the chance to present ourselves to the audience. We, of course, have not met so many of all the users previously. We talked in general about IT artifacts, and of how people in an organization often experience them at times of changes. IT artifacts holds not only the technological dimension, but also a social dimension. It is OK to feel lost sometimes, and one needs to hear someone tell you this. 🙂 We ended our section by talking more specifically about the survey we are preparing to distribute to the users. The purpose of the survey is to evaluate some issues that can – hopefully! – be described as successes, and to point out some specific areas where users would like to see further improvements.

After us, we all got some information regarding the closing of the year 2018, presented by Hanna Mörtberg (newly appointed University Director of Finance at the University Management and Management Council). She showed us some comparative numbers from the years 2010 until today. The university is growing at an amazing speed and has now reached over a 7 billion turnaround!

Spirits were quite high when the presentations were over and we started on some nice snacks with a glass of bubbling refreshments. Anyone had the opportunity to write down whatever ideas they wanted to share about the project, on a writing wall that was positioned at the back of the room. Still, I believe people mostly wanted to chat with friends, have some good food, and just relax after a great job done! Overall, the afternoon was a well-spent time to mark the end of the implementation phase. Now, the system will continue to change over time, as any IT system would. It is a never-ending story.

Lecture on Digitalization and our Work Environment

 

System development work is difficult, and many IT systems do not work satisfactorily despite intensive technology development. My research is about improving the situation and understanding what the problems are. I am working on developing improved working methods in the organizations and projects that develop and introduce IT. The focus here is user-centered methods, gender, sociotechnical perspective and agile development. I have also researched the skills that the people in the projects need to master to be able to work with the development of complex systems that support people in a good way.

If you are curious about my research – listen to the 12 min long lecture in Swedish

 

NordiCHI’18 – Key Note by Carly Gloge on Moonshot thinking at Google X and Pippi Longstocking Reflections

This week several members of the HTO group attended the NordiCHI 2018 conference in Olso, with the theme “revisiting the life cycle”. Here are some highlights from the first key note that we attended. In this key note Carly Gloge presented some work at company X which is Google’s “moonshot factory”. Their idea is to start with the really big problems first, and trying to solve them with innovation and technology. Some examples of innovations are self driving cars, here presented as reinventing the car driver.

This key note was really also addressing diversity as a success factor for the Moonshot factory, as well as being brave. Google X has really focused on diversity, and Carly Gloge says that this is one of the reasons why Google X has been so successful. A veryinteresting thing that came up related to this in the discussions section was the fact that Google is sued by Caucasian men that feel that they don’t have equal opportunities as other people at Google. They have ended up being accused of discrimination towards Caucasian men!

“If I would have known then what I know now, I would really have focused on diversity on my team in my previous jobs”.

Carly Gloge also presented their finding that psychological safety is at the core of successful teams. This finding is based on a Google investigation on successful teams where they ended up understanding that psychological safety was the only way to create a successful team, and not combining Type A personalities or “alpha males”.

They also very much focus on the growth mindset as a way of thinking, which means that you can always learn new things and that it is not innate to be an expert in something. This mindset is also mentioned as the “YET” mindset – I don’t know this yet and some in our HTO group has done some research on this mindset in computer science. This made us think of one of the famous quotes from Pippi Longstocking:

“I have never tried that before, so I think I should definitely be able to do that.”

― Astrid Lindgren, Pippi Longstocking

Carly Gloge tells us that the importance of diversity is also gaining traction in the asset management community, with large actors such as the US company Blackrock identifying diversity as a success factor that they include when creating their investment strategies.

Google has acquired a lot of companies, small and large, and Carly Gloge’s team is one composed of several such acquisitions. As with any acquisition this has its challenges, especially for a company aiming for radical solutions to the world’s problems. As Carly puts it, they frequently need to ask themselves “are we [our group/team] just a solution looking for a problem, or what are the problems we really would like to tackle?”

A suitable quote from Carly to start off this conference:
“If you obsess over your users, you can’t go wrong”

Inauguration of Åsa Cajander as New Full Professor

Åsa Cajander will be installed as one of around 20 new full professors at Uppsala University on the 16th of November 2018 between 15-17. There will be plenty of other people from the department at the same inauguration as we seem to be very successful this year in promoting full professors.

The inauguration ceremony has its roots in the medieval university, and is really one of the university’s grand ceremonies. During the week before the inauguration all the new professors will do lectures presenting their work. These lectures are recorded and can be found online for the curious reader.

Doktorspromotionen jan 2018 Foto. Mikael Wallerstedt

Uppsala University also has a very grand Conferment Cermony. The Conferment Ceremony and the Inauguration of Professors are the ceremonies which exist att all Swedish universities and research university colleges. While the Conferment Ceremony is connected to the individual faculties, each with its own promotor, the Inauguration is common to the whole university.