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,

(this blogpost is also published on my personal blogpage:

Vad kan vi lära av Ladok?

Nya Ladok har nu införts på Lunds universitet. Med denna milstolpe avslutas projektet.  (Grattis till alla inblandade!) Arbetet tar inte slut utan övergår istället i en utvecklingsfas, som hanterar fortsatt utveckling och driftsättning. 

Vi har följt förberedelserna för det lokala införandet vid Uppsala universitet. Under våren 2018 kommer jag att vidga perspektivet för att försöka se vilka lärdomar som kan dras. Min förhoppning är att jag ska hinna intervjua både en del av dem som arbetat i projektet och en del av dem som arbetar med lokala införanden.

Det kan finnas anledning att understryka att jag inte gör någon utvärdering av projektet utan att det handlar om just att fånga upp goda och mindre goda erfarenheter. Det är onekligen ett intressant projekt, när ett så komplext system rullas ut till så många verksamheter. Det faktum att förutsättningarna varierar så mycket gör inte heller att det går att tala om rätt eller fel. Däremot är det väldigt intressant att förstå olika vägval och strategier, både i projektet och i de lokala införandena.

Att lärosätena befinner sig i olika faser ger också en ögonblicksbild av utmaningar i olika skeenden av ett införande.

Den första intervjun ägde rum idag och om allt vill sig väl följs den snart av fler. Alla kommer jag inte att hinna intervjua, inte ens alla projektledare. Därför ska jag komplettera intervjuerna med en mindre enkät eller rundfråga. Men – finns det mer att berätta om arbetet med nya Ladok än vad som ryms i enkäten får du förstås gärna kontakta mig.

Automated Bots – the Mission of Creating Filter Bubbles

Are you aware of that even the smallest actions you do and the likes you give online, can put you into a filter bubble? In our investigation of filter bubbles we use automated bots as our own test subjects. If you don’t know what a filter bubble is, read our first blog post to find out more ( This Wednesday, 14th of March, we are speaking at the Women in Data Science conference in Stockholm about our work.

For the mission of creating filter bubbles we are using a large social media platform as our tool. A user of this platform has access to a flow of information. This flow is individualized for each user based on its actions and behavior on the platform. We are creating 14 unique accounts on this site, extremely similar to one another, with the exception of username, email and IP address. The purpose is to have the individualized flows exactly alike in the beginning. For each of the 14 accounts, we are creating a bot (total of 14 bots). A bot is an automated software, designed to click and use the website just like a human would. In this case, each bot is hitting a like-button for a certain type of information, a certain amount of times per day. This is simulating a real user’s actions on the site. The information that is liked by the bot, is uploaded to a storage on the cloud, that we are using to investigate the behavior, potentially leading up to a filter bubble.

In order to get the data from the individualized flow, we use a crawler. The crawler go through the individualized flow and save the important parts to a file which is then uploaded to the cloud. The data is later used to evaluate the content of the flow to establish whether the user is put in a filter bubble or not. To get a deeper understanding of filter bubbles and whether they can be harmful, we conduct a literature study as well.

Our names are Anna Normark and Rebecca Oskarsson. We are two master students in the IT engineering programme, currently working on our master thesis. Our thesis consists of investigating filter bubbles and their effects, and have the title “Individualizing Without Excluding: Ethical And Technical Challenges”. We are invited to write some blog posts here by our reviewer Åsa Cajander and this is our second part.

Can Digital Forms with Contextual Instructions Improve Medical Certificates for Sick Leave? – A Master Thesis Study

To get paid sick leave in Sweden, one must obtain a medical certificate from a physician and get it approved by the Social Insurance Office (Försäkringskassan). A recent report showcase that 9,7 % of all medical certificate forms are sent back to the issuing physician by Försäkringskassan (2017), needing completion or re-phrasing of the filled in data. The biggest culprit in the form is the field where one should describe how the patient’s condition hinders them from working.

In collaboration with EPJ, Region Uppsala and the company Inera, I will in my master thesis evaluate if a digital version of the form can help mitigate the frequent rejection of forms (due to phrasing). With a number of different prototypes, we will try to uncover if contextual instruction to each form field can help physicians fill in the form in a way that better corresponds with Försäkringskassans expectations.

The project has a great potential not only to ease the burden of an already strained health care system (and their patients), but also in regards of understanding physicians’ needs when it comes to IT. In the best of worlds, the results can help us design better health care systems and ensure a sound health care. It is truly exciting to work on projects that has the potential to impact many patients’ life quality, where an early approved medical certificate can mean the world to many.

Author background

Anton Björsell, Uppsala University. The study is my master thesis project within HCI and is planned to be executed throughout February to May this year. Except my focus on HCI, I also hold a bachelor’s degree in Media and Communication Studies. My favourite kind of research is the one which makes an honest attempt to understand humans and their needs. I am very excited about the project and grateful for having the opportunity to work with a topic that concerns so many people.

A Seminar (in Swedish) on the Implementation of IT in Healthcare

Back in December I was invited to give a seminar in Swedish at the EPJ department of Region Uppsala, the department in charge of many of the health-related IT systems used at the hospitals and primary care facilities in the region. My seminar was on the the current state of research in relation to how to implement IT in healthcare. Out of all the perspectives one can use to approach this area of challenges for healthcare, I devoted most of the seminar to presenting barriers and enablers to change management projects as well as IT development projects, and discussing these with the participants. The seminar was recorded and is now available on YouTube, if you find the topic interesting (and are comfortable with the Swedish language).

The HTO group, and more generally the HCI group at the Department of Information Technology, Uppsala University, have an ongoing collaboration with the EPJ department at the region, and there will be more seminars on a variety of topics given by us during the spring.

Final Seminar Related to PhD Thesis about Inertia and Deployment of IT systems

Thomas Lind will defend his PhD thesis the 15th of September 2017. This week we had a seminar where the work was discussed with an external reviewer, José Abdelnur Nocera.

José Abdelnour Nocera and Thomas Lind

The thesis is about the deployment of IT systems. Thomas Lind’s PhD thesis has several contributions:

  1. The development of a theory for understanding deployment: Inertia.
  2. Deeper understanding of deployment of IT from a sociotechnical perspective.
  3. The evaluation of the method “Vision seminars” as a method to use when deploying IT systems.

During the seminar Thomas Lind first presented his work, and this was followed by a discussion with José Abdelnour Nocera. The discussion concerned both the six papers that are included in the thesis as well as the introductory text for the papers.

In the evening we had a nice dinner at Basilico.

The HTO group thanks José Abdelnour Nocera for a very valuable discussion. Now we are looking forward to the final defense of the PhD thesis. 🙂

La la Ladok

Our research group has a long tradition of doing action research. Action
Research has been defined as having dual aims, research as well as involvement. The latter implies things happening, action, change–a bit like agile development if you wish. At the same time, this is relative to scale. In a small project, things are happening fast and various actions by practitioner and researcher alike have direct consequences. In large projects, this is not always so. In retrospect it will be easier to see the change and trace a trajectory. In real time, especially in the periphery of a large project, it can be hard to experience any action.

One of ongoing action research projects we are following the local preparations for a major new system implementation. Deadlines have been pushed forward on numerous occasions–by years.

The system in question is the nationwide Swedish Student Information System (SIS) – better known by the name Ladok. The system holds all student records for students in Swedish higher education and is critical from a legal perspective but it is also the backbone for most other student related ICT as it is used to generate directory information that is used by learning management systems (LMS), campus cards etc. The system is long overdue for an upgrade and a completely new version is just in its early phase of implementation. This is a 50 million Euro project with an estimated user base of 400 000 students and 50 000 staff in higher education.

We have been following the local preparations at one university, rather than the development as such. The collaboration has included activities such as:

  • coaching,
  • seminars,
  • participation in information efforts and
  • surveys.

The major effort though, were the vision seminars that were conducted with students and staff (users that is) in order to establish high level goals. Thus, our focus has been on local preparations for a huge change in work processes that the new system will require.

While the constraints and uncertainties can be at times frustrating this is also the reality behind many large system implementations. In the next few posts we will further discuss some of our experiences from the project – so far.