Digital Work Environment – Health, Technology & Organisation (HTO)

Digitaliseringen och arbetsmiljön

Idag var det officiellt boksläpp för Digitaliseringen och arbetsmiljön, en bok som professor emeritus Bengt Sandblad författat tillsammans med sina kollegor. Medförfattare är Jan Gulliksen, Ann Lantz, Åke Walldius och Carl Åborg – alla kända namn inom just digitalisering och arbetsmiljö.

Bokens redaktör Jens Fredholm passade på att ställa lite frågor till författarna. Bengt Sandblad slog fast att de flesta problem är onödiga idag, kunskap finns om hur de ska lösas. Åke Walldius fyllde i med att verktygen ska stödja, inte störa men att samverkan mellan alla parter är viktigt. Ann Lantz pekade på ständiga förbättringar som en viktig strategi. Carl Åborg underströk att vi måste sträva mot ett hållbart arbetsliv, det är inte hållbart om en ökande mental belastning ska göra att människor blir sjukskrivna. Jan Guliksen avrundade med att peka på att läget ändå är annorlunda idag, ledningen brukar vilja ta ett ansvar och det finns många fantastiska digitala verktyg vi använder utan problem.

På en fråga från publiken hur man nu ska komma till rätta med alla dessa problem var svaret givet: läs boken.

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

On Digitalisation and Fragmentation of Time

Diane Golay and Åsa Cajander did a presentation on Fragmentation of Time and Digitalisation for the Uppsala University Academic Senate this fall. This blog post captures some of what we said in the presentation. Enjoy!

Digitalisation of work sometimes has the unintended side effect that it fragments our time. Fragmentation commonly refers to the separation of activities into many discrete pieces. It is usually calculated based on two different aspects: the length of continuous work episodes, and the number of interruptions. In those terms, fragmented work is characterized by short work tasks and frequent interruptions, as opposed to a work rhythm made of few but long work episodes with no or few interruptions.

Several studies have pointed to the increasing fragmentation of our work. For instance, a 2009 study found that people switched tasks about every 12 minutes. Two years later, another study found that a modern worker’s day comprised an average of 88 work episodes, most of which (90%) lasted for 10 minutes or less. The found average duration for those work episodes was of just under three minutes.

Work fragmentation is related to a perceived increase in work pace and work intensity. It is also detrimental to the actual work taking place. The causes of fragmentation can be both external, such as a phone call or a computer that stops working, or internal, i.e. self-initiated, such as looking up an information on the web while working on a report.

External interruptions have a particularly negative effect on work. A context switch requires cognitive overhead, and context- switching is related to time costs. Concrete negative consequences of external interruptions include errors, stress, work delay, difficulty resuming the interrupted task, and increased user frustration. Interruptions are however not always negative: inquiries, breaks, and adjustments can facilitate the primary task by providing valuable information or creating an environment that encourages increased productivity. Context plays a significant role in determining whether interruptions are considered to be beneficial or detrimental. In general, interruptions that occur outside of one’s current working sphere context are disruptive as they lead one to (sometimes radically) shift their thinking. In contrast, interruptions that concern one’s current working sphere are considered helpful.

However, it should be noted that fragmentation is also a natural part of our work. Work tasks are to a small or high degree woven together and fragmented in complex patterns. Workers seldom work with one task at the time. Interruptions are a to some extent also a natural part of our work. Breaks are for example crucial for collaboration and learning.

So we should not aim for a fully continuous workflow, but might want to try and reduce external and internal interruptions that are not related to the task(s) at hand. Finding an amount of fragmentation that works for us will enable us to boost our work performance, reduce our cognitive workload, and simply make us feel better at and about our work.

***

[1] Jin, J., & Dabbish, L. A. (2009). Self-interruption on the computer. Proceedings of the 27th International Conference on Human Factors in Computing Systems – CHI 09, 1799. https://doi.org/10.1145/1518701.1518979

[2] Wajcman, J., & Rose, E. (2011). Constant connectivity: Rethinking interruptions at work. Organization Studies, 32(7), 941–961. https://doi.org/10.1177/0170840611410829

Philips Future Health Index 2018 released

Last July, I was approached by someone from the Philips team in London that works on the Future Health Index program. Previously they launched the first part of the 2018 Future Health Index, which is the indicator of the value delivered by 16 national health systems from around the world. For the second part, they wanted to produce some tangible guidelines on how things can improve and drive change within the industry.

In order to develop these guidelines, they interviewed 12 key opinion leaders (KOLs) across the Netherlands, US, UK, Australia, Germany, China, Sweden and Estonia – and I was one of them.

The Interview Questions

The interviewer was so kind to send me the transcript of my interview, otherwise I probably would not have remember them. I really enjoyed talking to him, which is not surprising given that people’s experiences with and attitude toward eHealth services is my PhD topic.

We started with my PhD research and I gave a background on the Swedish patient portal through which Swedish citizens can access their electronic health records online. We talked about the initial reaction from healthcare professionals and the conflict between the project and the local medical association (you can read about it in this article), how patients receive it, and what I think about this situation compared to, for example, Germany. Research within the DOME consortium indicates that the initial concerns of physicians might not have become reality and that many patients value direct access to their records, increased their understanding of their medical issues as well as their sense of control. In relation to that, I was asked whether the lesson would be to impose the intended change even if it is against heavy criticism of particular stakeholders. This really is a tricky question, especially in a context like healthcare in which a power-imbalance between clinician and patient still exists. I think, if real change is supposed to happen, sometimes consensus is impossible if the people who are supposed to change are against it. But at the end of the day, all stakeholders (like patients, family, physicians, therapists, nurses, management, insurance etc.) are (or should be) “in the same boat” so to speak and work together.

One of my favorite quotes on this is from Greenhalgh et al. (2012) who called for more effective inter-stakeholder dialogue in relation to telehealth and telecare:

The different interest groups described in this paper are likely to continue to exist in an uncomfortable truce with one another, competing for dominance as they gain more or less public appeal, professional credibility, political power, resource and so on.

and with reference to Checkland & Holwell (1998) they add:

While consensus is not a realistic or even desirable goal, surfacing such things as assumptions and values, and inviting debate on their significance through intersectoral and interdisciplinary dialogue will help achieve what systems thinkers have called ‘accom- modation’ (acknowledgement of, and adaptation towards, other perspectives and practices).

Future Health Index: Key Recommendations

I recommend to read the full report, which you can download here: Part 1, Part 2. According to the Future Health Index research, ‘universal’ electronic health records plays an important role in the future, for example regarding integration of and more effective use of data. They identified five key concrete recommendations to overcome challenges and drive integrated care:

Get regulation right.Clearly defined polices and robust data privacy and security standards at the national level build confidence in all parts of the healthcare continuum and help healthcare institutions develop their own data codes of practice, as well as encouraging healthcare professionals and the general population to collect, share and analyze data with greater confidence.
Modernize education.Healthcare professionals won’t demand EHRs and AI tools at work if they don’t learn to rely on them during medical training. Increasing healthcare professionals’ adoption of these tools must start with their integration into medical school curriculums.
End top-down implementation.Healthcare professionals are unlikely to adopt new tools when they’re presented as a ‘fait accompli’ by technologists. Creating EHRs and AI solutions in collaboration with both healthcare professionals and the general population will have a significant impact on successful integration.
Prove and explain value.Both healthcare professionals and patients need to be able to easily understand how data collection and analytics tools make a difference. Constantly measuring and communicating outcomes will create a body of evidence that will help bridge the understanding gap.
Harmonize data standards.Companies, healthcare professionals and governments in each market must work together to reach a greater degree of consensus on data formats and protocols.

Parts of this post originally appeared in a slightly different form on the my personal blog.

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)

The Effects of Digitalization on the Nurses Work Environment DISA: The Coolest Project @ Uppsala University?

We think that we have a very cool project. We are truly a multidisciplinary team working on digitalization and the effects on the nurses work environment. We also have a very good reference group, and our collaboration with Region Uppsala in the project is fantastic.

When we saw that there was a competition about the coolest project at Uppsala University we nominated ourselves!

They will announce the winners of the competition in a couple of weeks at a faculty pub event. We´ll be there to celebrate with the winners, or perhaps we are the winners?

Paper: Medical Records Online for Patients and Effects on the Work Environment of Nurses

We have one paper from the DISA project accepted for Medical Informatics Europe 2018. The paper is written by Åsa Cajander, Jonas Moll, Sara Englund and Anastasia Hansman and will be presented at the conference in Gothenburg 24-26 of April 2018. The paper is based on Sara Englund and Anastasia Hansmans study with interviews of nurses in primary care.

Below is the abstract of the paper:

In 2012 Patients Accessible Electronic Health Records (PAEHR) was introduced in Region Uppsala, Sweden. When PAEHR was introduced heath care professionals were very concerned especially in relation to potential negative effects on their work environment. However, few studies exist that investigate in what way work environments have been affected, and no studies have focused on the nurses’ working in primary care. Hence, the purpose of this study was to fill this gap through seven interviews with primary care nurses that were transcribed and thematically analysed.

The study shows that the nurses’ experiences an altered contact as patients accessing PAEHR came prepared to meetings with more informed questions. They also experienced that the service had increased their work load and that it creates uncertainty for nurses who do not know when to inform the patient about test results etc. Finally, some implications are discussed in relation to the patients’ role in shared decision making.

How to Prevent bad IT

Badly implemented IT is a costly affair. According to reports from Unionen (a Swedish union), there are tens of millions of Euro to be saved, in Sweden alone. Many problems are also well known and there are ways to address them. Yet knowledge about both problems and solutions is limited. One actor trying to spread best practices is the Swedish health promoting agency Prevent (jointly owned and managed by the employer and employee organisations).

Prevent recently teamed up with a number of Swedish researchers in this field, including our own professor Bengt Sandblad to develop a solution to this. The solution (also mentioned in an earlier blog post here) is an online guide covering a number of stages and aspects relating to ICT requirements, development and implementation.

The guide was featured in local newspaper Uppsala Nya Tidning (here and here) and the coverage indicates that there is an increasing awareness and understanding of the issues.

You can find the guide from Prevent here: www.prevent.se/it/

“The digital development has changed the core of working life” according to professor Bengt Sandblad

Our work environment is more and more digitalized. Many of us use a large number of IT systems in our work every day. Dysfunctional computer system becomes a work environment problem.

Professor Bengt Sandblad from the HTO group has done a report for the work environment authority in Sweden, He is also working on a book and he is also working on a book on the digital work environment. The book will appear around Christmas.

This week Bengt Sandblad is interviewed in Universen and some of the key ideas in the article are:

The potential benefits of IT systems is often lost due to usability problems.
The digital development will not to slow down. On the contrary: it will move faster and faster.
Often IT systems are not adapted to the needs of people, or the organization.
Information overload is a crucial problem.
We need to design systems that are made for human cognition.
We have a tendency to build systems based on what computers are good at. Not what people are good at.
There is a risk that work is what is left when the computers have done what they aren’t good at doing.

For more information read the full article 🙂

Finally: Joy at Work

Summer is over and Joy at Work is finally here. Well, at least that is the slogan for the Nordic Ergonomic Society’s yearly conference – NES 2017. This year it is three days of keynotes and presentation sessions in Lund, Sweden, at the Ingvar Kamprad Design Centre. As human-computer interaction ows some of its heritage to ergonomics, there are more than a few interesting presentations from our perspective. I notice that there are some presentations relating to eHealth which seem highly relevant to our DISA project, for instance.

On the whole, the conference sessions cover a lot of themes relating to ergonomics, its hard to identify any specific trends. On the contrary, I think the conference width is a good reminder of how complex working life actually is. Perhaps the inclusion of a special session for presentations relating to flexible workplaces is the strongest indicator of a hot new topics.

Monday ended with a tour of the lab facilities of the host, the division of Ergonomics and Aerosol Technology. This was a really pleasant surprise as the five stations in different labs revealed five very engaged researchers and some at times very hands on experiences of various equipment. I think a couple of the presenters could almost have persuaded me to change career. Science at its best.

Then there is also one presentation by myself on Tuesday afternoon, where I will discuss some of our experiences relating to the assessment of the Digital Work Environment in the wild. In a way, this presentation is just a teaser, as I will write more on this issue the coming months. For the very same reason I do hope I will get some input from the audience.