How to separate the trees from the forest – The workplace as a Swiss army knife

Continuing on the “forests and trees” metaphor from a previous post we will now see what happens when you try to separate the trees from each other. So, let us start with one single tree (or task). One tree does not make a forest, but it can very easily be distinguished as a tree of a certain kind. A Pine tree has long needles; A fir tree has short needles. And a tree without needles is a leafy tree (unless it is a Gingko tree, but that is another story).  However, once there are more trees in a lump, the categorisation becomes more difficult. 

Transferred to the issue of work and tasks: As long as we are only doing one single task or having one single role, it is also quite simple to see and study it, and also (at least to some extent) to understand how it works, and what the consequences are. This is not to say that this kind of work is simple or uncomplicated, a heart transplant is a complicated task, even though it is a single task and well specified at that. We may also still make design mistakes on this single task design, but these kinds of mistakes are mostly confined to the task environment we work in at the moment. 

In a way, as long as we have many instances of the same type of single tasks that we can handle more or less sequentially, we are still proceeding through something, which in the forest metaphor is like a well-managed orchard with the same kind of trees planted spaciously and in neat rows. We can still handle the situation with the same kind of specialised tools, and the tools may also have an easier way to communicate with each other, e.g., using the same terminology, the same data formats etc. since they are designed for the same task.

Now, when we consider the work situation for nurses at a hospital ward explicitly, their situation is completely different. Their work more or less constitutes the very definition of “fragmented work tasks”. First, there is planned fragmentation, where the person has to change tasks or responsibilities according to a schedule. Second, there are interrupting tasks in terms of alarms, visiting relatives, telephone calls and other randomly occurring events that also cause a fragmented work situation. There is a related blog post by Åsa Cajander “On Digitalisation and Fragmentation of Time” about this phenomenon.  

The interruptions that occur over a work day can have at least two major effects on the nurse. He or she has to switch context for the work, which in itself is a stressing action for the brain. In the case of sudden intruding tasks, there is also the problem of mentally going back to the interrupted task and continue from where it was discontinued, sometimes after many hours. This situation becomes almost, again in the forest analogy, like looking at a primeval forest or a rainforest. There are trees everywhere and of every kind, and they are all interconnected in some ways. You need both stamina and focus in order to find your way through the forest/work. 

This becomes even more problematic when we look at the computer support for work tasks in any workplace. The general computer system is in many cases designed in the same way as a Swiss Army knife. We use the same technical framework for all the tasks that should be performed, using a keyboard, a mouse (or a mousepad) and a screen for the stationary tasks, and mobile apps, in the best case redesigned for the smaller screens of mobile devices, for the tasks that are done on the run. Journal entries, medication dosage calculations, and many planning tasks are therefore performed in the same limited cognitive space, and there is no real support for the switching between those tasks, nor for the fragmentation of the ongoing work. 

In some cases, like writing down the notes for the daily ward round, the information is even taken down as hand-written jots on a paper form and has to be transferred manually into the journal later. 

A Swiss army knife is not really perfect in any of its functions (even the knife blade leaves a lot to be desired), it still works, and someone who is not a carpenter, mechanic or plumber might even think it is a good and practical tool. But for any professional, if asked, they would definitely prefer to use a specialized tool. Apart from being more efficient, specialized tools also pose a lower risk of accidents and slips. In the same way, non-specialized computer tools may, even though they can perform the desired tasks, still not be the best choice in a complex work situation.

When we design new computer systems for organizations like hospital wards, schools, etc. they are often positioned around one task at a time. We study one tree at a time in the forest. Even though we are much better off than at the beginning of the PC era, when we could only run one program at a time, we are still running several parallel processes that interconnect badly, if at all. 

During the study visit at Akademiska in Uppsala last year (the university hospital in Uppsala), I found ten different systems used in one of the wards, all running on the “same computer”. This amounts to having ten tools on the Swiss army knife. Of course, the individual programs are in some way specialized. We don’t use spreadsheets for everything. Each separate task has applications or programs that are explicitly designed for its purpose but not for the whole entangled web of work tasks. Furthermore, the interaction design is often completely different in the different systems, which means that the user has to switch from interaction style to interaction style, and from command structure to command structure.

One example to indicate what I mean: the notes that are made for each patient during the ward rounds are almost always written by hand at the ward where  I visited. However, after the ward round they have to be entered manually into the system, which has the double effect that it might be a slow process, taking valuable time from the nurses, and that there is also a high risk of misreading numbers and hastily jotted down notes.

The paper notes are not integrated into the computer system. While we note this, we might realize that we could need a more automated solution (which may still need proof-reading and checking). In this new solution, it would be possible for the doctor on duty to write, still by hand, on a tablet that may offer character recognition. This would reduce the tiring process of transcribing the text, making it much easier and also leave more time for other, more important tasks. 

Now, this is, in my opinion, where one of the problems with the systems in the hospital resides. We are so focused on the design of the single system, that we forget all the small details that could make the whole work situation simpler and more manageable.  Add to that that we also forget to look at the small details that should incorporate such things as:

  • specially designed portable devices, that are designed for a single task, such as taking notes for the information rounds. 
  • the development of distinct, but consistent interfaces to all the subsystems.
  • ncorporating support for the interruptions that occur during a day. Why not a “what did I do last”- kind of function? 

The conclusion of this observation is that we need to look at a work situation from a holistic and a reductionistic perspective simultaneously when we are planning and designing the digitised work place, resulting in a well planned and easily manageable rain forest of work tasks.

The Year 2018 in Review

In retrospect, 2018 was a great year for our research group. So, as we move on to 2019, here are some of the hilights for this year.

The year began with Thomas Lind doing one of his first –but definitely not last– presentations as a PhD, on the topic of IT implementations in health care.

Just after that, the new course on Complex IT Systems in Large Organizations started, with Diane Golay as one of the teachers. In the field of education there were of course also a number of interesting master thesis (such as this, this, this and this).

The second quarter saw Åsa Cajander earn the title excellent teacher but more importantly she also became full professor. You can still view her inauguration speech here (in Swedish). As if that was not enough Bengt Sandblad’s new book on the digital work environment was published – and our colleague Rebecca had her half time seminar.

During the summer Shweta Premanandan visited us once again and she got to experience the Swedish midsummer festivities. Minna Salminen Karlsson escaped the same festivities and instead joined the OAP workshop in the Netherlands.

Of course there were a number of other conferences and events attended by members of the HTO group (here or there). Gunilla Myreteg enjoyed a workshop arranged by Birgitta Wallgren at EPJ (the department for Electronic Patient Records). The HTO group also was responsible for a workshop at Uppsala Health Summit on the topic of Using Data for Better Cancer Treatments.

Much of the research efforts were related to the DISA project. Among many other things Ida Löscher reflected on the use of Work Domain Analysis and Lars Oestreicher shared some observations on cognitive workspace design.

We celebrated Jonas Moll as he concluded his PostDoc in Uppsala, two years and quite a few presentations and papers later. The year finally ended in high spirits when Christiane defended her thesis and became Dr Grünloh.

So, what do we have in store for 2019? More courses, more papers and more conferences of course. Perhaps we could also land a grant or two, to fill the gaps of those who have moved on to new positions. But we will no doubt continue to collaborate with our HTO alumni, in academia you can check out—but you can never leave.

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.

 

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)

Nomination of Lars Oestreicher to Uppsala University’s Equal Opportunities Award 2018

Lars Oestreicher was recently nominated to the Equal Opportunites 2018 award by the departments’ equal opportunities group. Congratulations! 

The nomination text : 

Lars Oestreicher works as a teacher and researcher in the field of Accessibility and Design for everyone in Human Computer Interaction. The Design for All area resides on a very clear equal opportunities basis, and contains both knowledge of people’s differences, as a value base that strongly emphasizes inclusion and the problem of stigmatization of people with disabilities in society as well as their vulnerability.

Lars Oestreicher has developed a pioneering course for students in the Design for All area, and has also written a new textbook on the subject as there is no suitable course literature to find to teach these questions. In the course of the course, Lars works very consciously to learn an inclusive mindset, where he, among other things, has moments where the students themselves can experience how to live with a disability.

Lars Oestreicher has also participated as a specialist in accessibility issues in a reference group for the development of the MegaMind exhibition at the Stockholm Technical Museum, and is conducting a VINNOVA-funded project together with Årsta specialist, which aims to allow children with severe cognitive and physical impairments to create music independently.

Lars Oestreicher is the university’s most competent researcher and teacher in this field, and his work and dedication goes far beyond what is expected of a teacher as he has an inclusive perspective in mind. Through his work, he has included equal opportunities issues as part of our education programs for students in computer science. We believe that this deserves to be noted and therefore wishes to nominate Lars to the University’s Equal Opportunities Award.

Would you like to do your Master Thesis with the HTO Group?

We are always interested in working together with master students that are interested in our area of expertise. Have a look at our research projects presented in this blog, or read about them in the project page. Looks interesting?  Then contact us to know more.

We are especially interested in students who would like to look into Scrum and how to incorporate users, digital work environment studies, eHealth and studies related to medical records online.

Would you like to read more blogs similar to this one?

Can’t wait for the next HTO blog post? Would you like to read more blogs similar to this one? There are a few more blogs connected to the HTO group. Maybe you did already find them; otherwise I will introduce them here:

Åsa Cajander – A blog on IT@work, HCI, Computer Science Education and Gender Equality in Academia

Åsa Cajander is an associate professor of human-computer interaction at Uppsala University, and the research leader of the HTO group. Åsa is also the coordinator of the DOME consortium that does research on the deployment of medical records online in Sweden, and she is the gender equality officer at the Department of Information Technology.

Her blog is frequently updated with a mix of shorter and longer posts about the latest news for the HTO group, the DOME consortium or any other part of Åsas work! Åsa writes that “In short this blog contains everything I am interested in at work!” and she describe her research area like this:

“I do research mainly from a socio-technical perspective in the following areas:

IT and work. Digitalisation has great potential to improve work and to increase work engagement. However, to develop and deploy ICT in organisations is difficult and often users think that the ICT is too complex and has major flaws.

Computer Science Education. I also do research on learning and didactics, and is part of the Uppsala Computing Education Research Group (UpCERG)”

 

You can also follow Åsa on Twitter as @AsaC and @DOMEprojekt

 

 

 


Jonas Moll – An academic blog

Jonas Moll is a postdoctoral researcher in human-computer interaction at Uppsala University, and his background is in computer science. Here you can read interesting reflections and detail descriptions on what is going on within the research projects or other things Jonas participates in. This is how Jonas describes his research area and his blog:

“My main research areas are computer mediated communication and collaboration in multimodal environments. A special interest lies in how haptic feedback can affect the communication and collaboration in collaborative virtual environments.

I am also one of the researchers within the DOME (Deployment of Online Medical records and E-health services) consortium, where I focus on how patients’ access to their medical records online affect the communication between patients and physicians.

I am also conducting pedagogical development studies related to the use of social media within the scope of higher education courses.

In this blog I will publish posts about my academic activities and interests, with special emphasis on multimodal interaction, eHealth and social media in higher education. I do this not only to show what I am currently working on, but also to force myself to reflect on and discuss what I am doing.”

 

You can also follow Jonas on Twitter as @Jonas_Moll

 

 

 


Diane Golay – PhD student in Human-Computer Interaction

Diane Golay is a PhD student within Human-Computer Interaction (HCI) at Uppsala University, and in this relatively new blog you can follow her refelections about subjects related to HCI and being a PhD student. She writes that “In this blog, I share my reflections, discoveries and tips related to my experience as a newbie in academia” and she describes her research area like this:

“My main research area is the use of ICT in the workplace. I am especially interested in investigating how ICT can be designed in order to fit workers’ needs and characteristics as well as how the use of ICT affects employee’s well-being, working conditions and professional identity. Within the framework of the DISA project, I currently focus on investigating how digitalization in healthcare affects nurses’ work environment.

A further research interest of mine is human-computer interaction (HCI) didactics. In my experience as a teaching assistant within that specific field, I was able to witness how difficult it is to make HCI’s core message come across, especially in regard with often sceptical computer science students. However, I believe it is essential for future software engineers to incorporate HCI methods and findings into their practice in order for better, more usable systems to be brought onto the market. Throughout my PhD studies, I thus hope to be able to take a closer look at how HCI-related skills can be taught to programming-oriented students.”

 

You can also follow Diane on Twitter as @DianeGolay

 

 

 


Christiane Grünloh – My Blog on Research, HCI, eHealth, and Academic Life

Christiane is a PhD student at TH Köln University of Applied Sciences (Germany) and KTH Royal Institute of Technology in Stockholm (Sweden). In her blog, she writes about her research in Human-Computer Interaction, eHealth services, teaching, and academic life in general.

I like to think of this blog as a tool and place for reflection, and as an opportunity to share things I learned that might be valuable for others as well.

You can also follow Christiane on Twitter as @c_gruenloh

 

 

 

 


The @htogroup also exist on Twitter, as well as these other HTO group members:

Doctoral defense in Vienna

A time for celebration!

Last Tuesday, Åsa Cajander and I attended the defense of Jean Hallewell Haslwanter’s excellent doctoral thesis. Her work digs into the issues development teams encounter when designing sensor-based monitoring systems aimed at older people, and she uses the problems she identifies to formulate recommendations for both development teams and funding agencies. As such, it is a very relevant read for anybody directly or indirectly working with design and software development projects, even if those are based on other types of technologies.

The defense took place in central Vienna, at the Institute for design and assessment of technology of the Technische Universität Wien (TU Wien). Åsa was one of the thesis’ two examiners, along with Klaus Miesenberger (Johannes Kepler University Linz). Interestingly, the defense proceedings were a bit different from the routines I have seen so far in Sweden. The event was quite short (about 1 ½ hour against the 2 ½ – 3 hours I was accustomed to), and no opponent had been called in. Instead, Jean presented her work during the first 45 minutes – she did a really great job, giving a very concise but clear and to-the-point overview of her research – after which the members of the examination committee and Jean’s supervisor, Geraldine Fitzpatrick, proceeded to ask her some questions. Finally, following the committee’s deliberation session, Jean went back into the room alone to get the notice of the successful outcome of the defense, while this generally takes place in public in Sweden.

The lovely post-defense celebration led to very fruitful exchanges of ideas (at least from my perspective, since I received some very good research tips from Toni Michel!), and I was very happy I had made the trip to Vienna – in spite of the cumulated 4 ½ hours of flight it required! It was a real pleasure to meet Jean and her colleagues, and I very much enjoyed the experience!

HTO are Organizing a Workshop @ Uppsala Health Summit 2018

Uppsala Health Summit is “a recurring international policy arena for dialogue on challenges for health and healthcare, and how we can overcome them”.  In 2018 the theme for the summit is cancer, and the HTO group has been asked to organize a workshop in the area of using existing data for diagnosis and treatment of cancer. We see this as a great opportunity to address this important issue and take it one step further towards a solution.

People who are personally invited are welcome to join this health summit. The project manager on the summit, Madelein Neil, personally invites decision makers, opinion formers and experts.

The HTO group are currently working on setting up the ideas for our workshop. We have had a few discussions and so far, we are thinking of re-using the concept of critical incidents that Christiane Grünloh presented at the INTERACT conference this year. The abstract of this paper is:

Demands for technological solutions to address the variety of problems in healthcare have increased. The design of eHealth is challenging due to e.g. the complexity of the domain and the multitude of stakeholders involved. We describe a workshop method based on Critical Incidents that can be used to reflect on, and critically analyze, different experiences and practices in healthcare. We propose the workshop format, which was used during a conference and found very helpful by the participants to identify possible implications for eHealth design, that can be applied in future projects. This new format shows promise to evaluate eHealth designs, to learn from patients’ real stories and case studies through retrospective meta-analyses, and to inform design through joint reflection of understandings about users’ needs and issues for designers.

On Nailing and Thomas Lind’s PhD Dissertation

Three weeks ago Thomas Lind nailed his PhD thesis onto the log of a birch tree at the department. Nailing the printed thesis is the first step towards getting it accepted and earning a Doctor of Philosophy degree at Uppsala University. The nailing is also done electronically, and in this Digital world that might be more official than the actual book.  The idea with nailing a thesis is to make it openly available for anyone interested to read and review. It is seen as a step to ensure quality, and a PhD thesis needs to be nailed three weeks before the actual defense.

Yesterday three weeks had passed and we had invited a committee consisting of three well-known researchers within HCI to evaluate Thomas Lind’s work. The committee consisted of

A PhD dissertation starts off by the opponent giving a summary of the thesis placing it in the context of the research area. Professor Netta Iivari from University of Oulu did a splendid job in presenting Thomas Lind’s work.

After this presentation, the opponent has a discussion with the PhD student around the work done. Usually the discussion includes explaining concepts, the Methods used and paths taken. This discussion is followed by questions from the committee and from the audience. When the committee and audience has asked all their questions it is time for the grading committee to have a meeting to discuss the quality of the work.

Thomas has addressed a very pressing issue when implementing new IT in organisations and explores the concept of inertia in sociotechnical systems. His thesis is a contribution to understanding Systems development and change. The presentation and discussion during the dissertation was really interesting, and I especially appreciated the discussion around research communities, and what research community we want to impress.

All people involved did a very good job, and Thomas Lind not only nailed the thesis three weeks ago – he also nailed the dissertation discussion!