Studying technology use as social practice: the untapped potential of ethnography

Information and communications technologies (ICTs) in healthcare are often introduced with expectations of higher-quality, more efficient, and safer care. Many fail to meet these expectations. We argue here that the well-documented failures of ICTs in healthcare are partly attributable to the philosophical foundations of much health informatics research. Positivistic assumptions underpinning the design, implementation and evaluation of ICTs (in particular the notion that technology X has an impact which can be measured and reproduced in new settings), and the deterministic experimental and quasi-experimental study designs which follow from these assumptions, have inherent limitations when ICTs are part of complex social practices involving multiple human actors. We suggest that while experimental and quasi-experimental studies have an important place in health informatics research overall, ethnography is the preferred methodological approach for studying ICTs introduced into complex social systems. But for ethnographic approaches to be accepted and used to their full potential, many in the health informatics community will need to revisit their philosophical assumptions about what counts as research rigor

Ethnographic study of ICT-supported collaborative work routines in general practice

<p>Abstract</p> <p>Background</p> <p>Health informatics research has traditionally been dominated by experimental and quasi-experimental designs. An emerging area of study in organisational sociology is routinisation (how collaborative work practices become business-as-usual). There is growing interest in the use of ethnography and other in-depth qualitative approaches to explore how collaborative work routines are enacted and develop over time, and how electronic patient records (EPRs) are used to support collaborative work practices within organisations.</p> <p>Methods/design</p> <p>Following Feldman and Pentland, we will use 'the organisational routine' as our unit of analysis. In a sample of four UK general practices, we will collect narratives, ethnographic observations, multi-modal (video and screen capture) data, documents and other artefacts, and analyse these to map and compare the different understandings and enactments of three common routines (repeat prescribing, coding and summarising, and chronic disease surveillance) which span clinical and administrative spaces and which, though 'mundane', have an important bearing on quality and safety of care. In a detailed qualitative analysis informed by sociological theory, we aim to generate insights about how complex collaborative work is achieved through the process of routinisation in healthcare organisations.</p> <p>Discussion</p> <p>Our study offers the potential not only to identify potential quality failures (poor performance, errors, failures of coordination) in collaborative work routines but also to reveal the hidden work and workarounds by front-line staff which bridge the model-reality gap in EPR technologies and via which "automated" safety features have an impact in practice.</p

Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method

Background: The extensive and rapidly expanding research literature on electronic patient records (EPRs) presents challenges to systematic reviewers. This literature is heterogeneous and at times conflicting, not least because it covers multiple research traditions with different underlying philosophical assumptions and methodological approaches. Aim: To map, interpret and critique the range of concepts, theories, methods and empirical findings on EPRs, with a particular emphasis on the implementation and use of EPR systems. Method: Using the meta-narrative method of systematic review, and applying search strategies that took us beyond the Medline-indexed literature, we identified over 500 full-text sources. We used ‘conflicting’ findings to address higher-order questions about how the EPR and its implementation were differently conceptualised and studied by different communities of researchers. Main findings: Our final synthesis included 24 previous systematic reviews and 94 additional primary studies, most of the latter from outside the biomedical literature. A number of tensions were evident, particularly in relation to: [1] the EPR (‘container’ or ‘itinerary’); [2] the EPR user (‘information-processer’ or ‘member of socio-technical network’); [3] organizational context (‘the setting within which the EPR is implemented’ or ‘the EPR-in-use’); [4] clinical work (‘decision-making’ or ‘situated practice’); [5] the process of change (‘the logic of determinism’ or ‘the logic of opposition’); [6] implementation success (‘objectively defined’ or ‘socially negotiated’); and [7] complexity and scale (‘the bigger the better’ or ‘small is beautiful’). Findings suggest that integration of EPRs will always require human work to re-contextualize knowledge for different uses; that whilst secondary work (audit, research, billing) may be made more efficient by the EPR, primary clinical work may be made less efficient; that paper, far from being technologically obsolete, currently offers greater ecological flexibility than most forms of electronic record; and that smaller systems may sometimes be more efficient and effective than larger ones. Conclusions: The tensions and paradoxes revealed in this study extend and challenge previous reviews and suggest that the evidence base for some EPR programs is more limited than is often assumed. We offer this paper as a preliminary contribution to a much-needed debate on this evidence and its implications, and suggest avenues for new research

Memory objects in project environments: Storing, retrieving and adapting learning in project-based firms

This paper investigates the role of objects holding representations of knowledge in the transfer of learning across projects. On the basis of an in-depth case study, this paper shows that the way in which relatively simple artifacts, such as Excel workbooks, represent knowledge enables them to act as boundary objects across occupations and as memory devices across projects. It is the temporal capacity of these boundary objects that makes them points of juncture in a widely distributed memory system, enabling project-based firms to balance preservation and adaptation of knowledge. The mechanisms for the preservation of learning are not missing from project environments, rather they are less visible and less direct than in other settings, and therefore less docile in the face of managerial action

Understanding SLA through peer interactions in a Chinese classroom: A sociocultural perspective

Second language learning and development is a complex process that is situated in sociocultural settings. Classrooms provide such daily life settings in which language acquisition occurs via social interactions among peers and the instructor as well as other mediated means. The purpose of this research study was to examine the roles of peer interaction in a Chinese as a foreign language (CFL) classroom and how different types of peer interaction affect learners\u27 second language development in a classroom setting, and what roles peer interactions played in such a setting. Based on the sociocultural theory, the study explored the opportunities for learning that occurred during peer interactive work. Data included personal history interviews, language reflection journals, audio and video recordings of CFL learners in pair or group work, and Oral Proficiency Interviews (OPIs). The participants were seven students from different cultural backgrounds in an intermediate Chinese as a foreign language classroom. Findings indicated that peer interactions played an important role in the Chinese classroom. Mutual assistance in various forms provided various learning opportunities, in which not only the more capable peers assisted less capable peers, but also the reverse situation occurred in different tasks. The study also revealed the changeable nature of peer roles in their interactive routines, in which learners\u27 perspectives and orientation could be changed during peer collaboration process, sometimes dispite of the learners\u27 original goals. However, although task design may affect the degree of a learner\u27s participation, both motivated and less motivated learners benefited from the participation of peer learning activities in which an unmotivated learner might feel impelled to engage in a shared activity. The findings of this study support the sociocultural view of SLA and point to the benefits of assisted performance in L2 peer interaction. These findings also help broaden the understanding of the role peer interaction plays in a second/foreign language classroom. In addition, the results have both theoretical implications as well as practical implications in second language learning and instruction in the classroom

An analysis of two tug propulsion systems in the Port Elizabeth harbour

The shipping industry is reliant on port authorities for the facilitation of safe entry and departure of ships at the ports. This role can not be fulfilled without the assistance of harbour tugs which are run by the marine operations section of the Transnet National Ports Authority. The tugs have to be safe and efficient in the process of pulling and pushing ships around the harbour. Harbour tugs are expensive to acquire and to maintain. The marine operations business has to make appropriate choices of tug propulsion design in order to realise the benefits of the tugs acquired by the ports authority. This can be achieved by analysing the current tugs that the operations are using, which will then serve as valuable information when the time for asset replacement is due. The researcher chose to use the two tug propulsion designs currently used by the Port Elizabeth harbour tugs as a basis for this analysis. The analysis links the three factors of maintenance management, equipment efficiency and equipment safety, to the minimisation of operational costs as perceived by the tug personnel, the pilots and the marine managers. This study seeks to verify the link between these factors and the perceived minimisation of operational costs. Available literature was reviewed and data was collected using a suitably designed questionnaire for this research. This research paper has led to recommendations that should inform the tug acquisition decisions and raise the awareness of the marine employees to relate the factors set out above to minimise operational costs

An analysis of two tug propulsion systems in the Port Elizabeth harbour

The shipping industry is reliant on port authorities for the facilitation of safe entry and departure of ships at the ports. This role can not be fulfilled without the assistance of harbour tugs which are run by the marine operations section of the Transnet National Ports Authority. The tugs have to be safe and efficient in the process of pulling and pushing ships around the harbour. Harbour tugs are expensive to acquire and to maintain. The marine operations business has to make appropriate choices of tug propulsion design in order to realise the benefits of the tugs acquired by the ports authority. This can be achieved by analysing the current tugs that the operations are using, which will then serve as valuable information when the time for asset replacement is due. The researcher chose to use the two tug propulsion designs currently used by the Port Elizabeth harbour tugs as a basis for this analysis. The analysis links the three factors of maintenance management, equipment efficiency and equipment safety, to the minimisation of operational costs as perceived by the tug personnel, the pilots and the marine managers. This study seeks to verify the link between these factors and the perceived minimisation of operational costs. Available literature was reviewed and data was collected using a suitably designed questionnaire for this research. This research paper has led to recommendations that should inform the tug acquisition decisions and raise the awareness of the marine employees to relate the factors set out above to minimise operational costs