What does it take to replace an old functioning information system with a new one A case study

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What does it take to replace an old functioning
information system with a new one? A case study

• Hans Kyhlbäck and Berthel Sutter
• Blekinge Institute of Technology, SWEDEN
• IT in Health Care, Second International
  Conference
• 13-14 September 2004 Portland, Oregon, USA

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Author presentation
Berthel Sutter School of Mangament Blekinge
Institute of Technology Sweden
Hans Kyhlbäck School of Engineering Blekinge
Institute of Technology Sweden
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Paper manufacturing shop floor workers (1970s)
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Sheet metal, hydraulic press machine operator
(1980s)
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Sheet metal manufact., maintenance dept. (80s)
The author in the 80s
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What does it take to replace an old functioning
information system with a new one?

• Our first claim
• An old-fashioned information system within
  health care work will not success-fully be
  replaced by a new one,
• - unless the new is better as a whole,
• - that is, better supports work practices of
  a range of occupational and professional workers.

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Our second claim

• The dilemmas system designers almost always will
  face when designing information system for the
  public sector is based on
• - a contradiction between central, high level
  interest and a local level work-practice
  perspective.

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Work practice of municipal nurses

• Our study reveals that work practice of the
  municipal nurses is characterized by three
  distinctive features
• - high mobility,
• - the need for face-to-face interaction in
  different locations,
• - a great variety of artefact usage

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The bag on wheels and the cup board at a
residents home
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Materials and methods

• The investigation of municipal wound care was
  accomplished by ethnographic work
• - in taking notes, shooting digital photos,
  collecting material artefacts in use and making
  audio recorded interviews.
• Our methodology, Developmental Work Research
  (DWR), might open up for a needed paradigm shift
  to involve practitioners in work-oriented design
  of computer artefacts.

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Principles of Developmental Work Research (DWR)
summarized

• First, a collective activity system can be
  taken as the unit of analysis, giving context and
  meaning to seemingly random individual events.
• Second, the activity system and its components
  can be understood historically.
• Third, inner contradictions of the activity
  system can be analyzed as the source of
  disruption, innovation, change, and development
  of that system, including its individual
  participants.
• Yrjö Engeström. 1993.

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Wound treatment has significantly changed

• Today, a wound is systematically diagnosed and a
  more advanced treatment is provided.
• There is a need of a unified documentation.
  Today we have a number of home-made case books
• and the introduction of digital photos on
  wounds, coincide as the motive for our case, a
  process of redesign of the old socio-technical
  wound care system and transforming it into a more
  advanced and unified tool.

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Paper form page 1(3)Today in use at Ronneby
Elder Care
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PD session, paper forms from today practice put
on the table (photo March 2003)
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HELARComputer prototype, include digital photos
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Contradiction between the old and a new way in
municipal elder care

• We encounter an upcoming contradiction between
  the old and a new way to document work that
  requires an extended set of skills to perform.
• To make a feasible switch, it seems as it will
  be needed, at one time, to exchange most of the
  paper document work with an all-embracing
  computer system.

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To be seated like an office white-collar worker

• A contradiction between a mind set that
  permeates software development and essential
  qualities of nurses work practice is revealed.
• Some of the observed difficulties are about
  recognition and making connections between
  different devices on a simple level of
  artefact-artefact interaction. To do those things
  right, the nurse has to be seated like an office
  white-collar worker.

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One size do not fit all

• If sitting by the desk top computer all day long
  is the reality for computer system developers,
  one small size on the scale of widgets, buttons
  etc. is appropriate,
• - if being on the go and on the move as the
  nurses are - a second larger size is required.

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Essential characteristics of the nurse
occupational work (1)
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Essential characteristics of the nurse
occupational work (2)
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What it takes to replace an old IS with a new one
in municipal care

• Possible computer solutions supporting more
  complex and advanced activity systems, as for
  example municipal wound care, require
• - to take the practitioners seriously,
• - to deal with power relations and
• - to develop more fine tuned measures on needed
  scale and size properties of interface
  constructions.

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Implications of the DWR approach

• - Our method points in the direction of exploring
  observed tensions and contradictions as resources
  for design of new solutions let it be either
  redesign of practice or creation of new
  technology.
• - The DWR approach implies research in the field,
  in close contact with practitioners at work. This
  is true for the gathering of key artefacts in
  use, but also when it comes to development of
  computer system.
• - The methodology invites us to do participatory
  design and participatory evaluation of the new
  artefact.

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What does it take to replace an old functioning
information system with a new one? A case study

• End of presentation
• Address for correspondence
• Hans Kyhlbäck
• Blekinge Institute of Technology
• SE- 372 25 Ronneby, Sweden
• E-mail Hans.Kyhlback_at_bth.se