Infrastructural Work in Child Welfare: incommensurable politics in the Dutch Child Index

The Dutch Child Index is a nationwide information system (IS) designed to alert professionals about each other’s involvedness with at-risk children, enabling identification of individual at-risk children, improvement of multidisciplinary collaboration and timely interventions. In this paper, we study the infrastructural work and complexities engaged in making the collaborative system of the Child Index function in real life and in care situations. We use the information infrastructure perspective as an analytical lens and describe the infrastructural work that is performed to make the Child Index become part of actual practices. We also identify flexibility, heterogeneity and the connection to existing platforms as difficulties participants have had while performing infra- structural work. The paper makes two main contributions. First, it provides an in-depth empirical analysis of this specific collaborative and preventive infrastructure. Second, based on this empirical analysis, we argue that when developing and understanding infrastructures, it is important to identify limits to the integrative capacity and disciplining power of ISs as result of conflicting infrastructural work due to incommensurable politics. perspective as an analytical lens and describe the infrastructural work that is performed to make the Child Index become part of actual practices. We also identify flexibility, heterogeneity and the connection to existing platforms as difficulties participants have had while performing infrastructural work. The paper makes two main contributions. First, it provides an in-depth empirical analysis of this specific collaborative and preventive infrastructure. Second, based on this empirical analysis, we argue that when developing and understanding infrastructures, it is important to identify limits to the integrative capacity and disciplining power of IS’s as result of conflicting infrastructural work due to incommensurable politics

Modelling data activities in workarounds: a narrative network approach

Workarounds are non-standard processes in organisations to accomplish work-based tasks. They can lead to various data issues, such as data loss, data breach, and data privacy. These data issues are the outcomes of the data activities that constitute a workaround (e.g., store data, transfer data). The problems with workarounds are that they are unique and situational. One way to unpack these data activities is to model them as patterns of action. Thus, this research aims to demonstrate the use of a narrative network to model data activities within workarounds and discuss both the benefits and drawbacks of using this modelling approach. We expect that this research is valuable for researchers to represent, observe, and analyse workaround-centric data activities. It is an essential first step towards revealing the actual cost of workaround-centric data activities. Also, we envisage that this research is useful for managers to establish organisational awareness of workarounds

Friction forces and patient-centredness: Understanding how established logics endure during infrastructure transformation

n this article, we examine three cases of e-health solutions for patients in Norway. For the analysis of the three cases, we focused on friction forces that come into play when different established arrangements need to change to accommodate novelty. We argue that the design of new technologies was shaped by friction related to institutionalised practices, regulatory regimes and entrenched patient roles. These friction forces connect the past with the present, come into action when aiming for novelty and result to the perpetuation of constituents of the past during change processes. Specifically, the e-health solutions under study were strongly influenced by established healthcare provision logics. All three initiatives expanded the healthcare information infrastructure towards the patients with as little disruption to established arrangements as possible.acceptedVersionnivå

Doing Infrastructural Work: The Role of Boundary Objects in Health Information Infrastructure Projects

By their nature information infrastructures require the co-operation of a broad range of diverse stakeholders and interests in order emerge and evolve over-time. Boundary objects provide a means through which those from different social worlds can collaborate without having to reach a consensus in order to do so. In this article we explore the role of such objects, whose infrastructural properties have often been overlooked. We respond to calls to examine the different types of objects used to elicit feedback from potential users and other stakeholders in complex information system projects. Our focus is specifically on health information systems and in particular those involving the implementation of electronic record systems at a national or regional scale. Such projects are notoriously complex and are frequently marked by a diversity of intentions and lack of agreement. When attempted at a national scale at least, they typically fail to meet intended objectives and projects are often abandoned altogether. We suggest that understanding how different types of boundary object—repositories or ideal types—inhibit infrastructural development can assist in understanding these difficulties and point to ways of better supporting the generativity required for the infrastructuralisaton of complex information system

Who is Telecaring Whom? Exploring the total social organisation of care work in an Italian Municipality

Telecare’ refers to the use of digital or information and communication technologies (ICTs) to facilitate health and social care delivery to individuals in their homes. This article explores the phenomenon by foregrounding its interconnections with work activities, paid and unpaid. It draws on research as a part of the design and deployment of a set of telecare innovations for older people in an Italian municipality. The project was conceived at the outset in terms of formal inter- relationships between functions and components of technical systems. Technical setbacks, however, were resolved only by enrolling the active support of groups and individuals (including civil society organisations and older people). By situating a telecare intervention conceptually within the ‘total social organisation of labour’ (TSOL), we provide an analysis that contributes to understanding how a socio-technical infrastructural approach to telecare reveals ways to improve our understanding of how formal and informal care systems interact

Growing an information infrastructure for healthcare based on the development of large-scale Electronic Patient Records

The papers of this thesis are not available in Munin. Paper 1. Silsand, L., Ellingsen, G. (2014). Generification by Translation: Designing Generic Systems in Context of the Local. Available in: Journal of Association for Information Systems, vol. 15(4): 3. Paper 2. Christensen, B., Silsand, L., Wynn, R. and Ellingsen, G. (2014). The biography of participation. In Proceedings of the 13th Participatory Design Conference, 6-10 Oct. Windhoek, Namibia. ACM Digital Library. Paper 3. Silsand, L. and Ellingsen, G. (2016). Complex Decision-Making in Clinical Practice. In: Proceedings of the 19th ACM Conference on Computer-Supported Cooperative Work & Social Computing (CSCW '16). ACM Digital Library. ISBN: 978-1-4503-3592-8. Paper 4: Silsand, L., Ellingsen, G. (2017). Governance of openEHR-based information Infrastructures. (Manuscript). Paper 5. Silsand, L. (2017). The ‘Holy Grail’ of Interoperability of Health Information Systems: Challenges and Implications. Available in: Stigberg S., Karlsen J., Holone H., Linnes C. (eds) Nordic Contributions in IS Research. SCIS 2017. Lecture Notes in Business Information Processing, vol 294. Springer, Cham. This thesis provides empirical insights about socio-technical interdependencies affecting the making and scaling of an Information Infrastructure (II) for healthcare based on the development of large-scale Electronic Patient Records. The Ph.D. study is an interpretive case study, where the empirical data has been collected from 2012 to 2017. In most developed countries, the pressures from politicians and public in general for better IT solutions have grown enormously, not least within Electronic Patient Record (EPR) systems. Considerable attention has been given to the proposition that the exchange of health information is a critical component to reach the triple aim of (1) better patient experiences through quality and satisfaction; (2) better health outcomes of populations; and (3) reduction of per capita cost of health care. A promising strategy for dealing with the challenges of accessibility, efficiency, and effective sharing of clinical information to support the triple aim is an open health-computing platform approach, exemplified by the openEHR approach in the empirical case. An open platform approach for computing EPR systems addresses some vital differences from the traditional proprietary systems. Accordingly, the study has payed attention to the vital difference, and analyze the technology and open platform approach to understand the challenges and implications faced by the empirical process. There are two main messages coming out of this Ph.D. study. First, when choosing an open platform approach to establish a regional or national information infrastructure for healthcare, it is important to define it as a process, not a project. Because limiting the realization of a large-scale open platform based infrastructure to the strict timeline of a project may hamper infrastructure growth. Second, realizing an open platform based information infrastructure requires large structural and organizational changes, addressing the need for integrating policy design with infrastructure design

Supporting dynamic and distributed decision making in acute care environments: Insights from a cognitive ethnography

The way that medical decisions are carried out in hospital environments has undergone radical changes in recent years, in part as a result of the changing landscape of care. To make decisions, physicians are expected to keep abreast of a growing and changing body of medical and patient knowledge, collaborate more with clinical colleagues, and utilize more technologies to inform care than ever before. This dissertation reports on a five month cognitive ethnography in an ICU in Ontario Canada, and utilizes distributed cognition to understand the challenges that physicians face in making decision in modern acute care environments. It also seeks to elucidate the strategies used by ICU physicians to cope with the challenges associated with using information from social, material and technological sources in decision-making. My findings demonstrate how information resources are (1) Objectivist, in that too much attention is paid to supporting the formalized, outcome-centered aspects of medical thinking, without due regard to the processes involved in adapting decisions to their situation; (2) Fragmented, in that, while information resources are often well-designed when considered in isolation, they force physicians to bridge gaps in the logic of access or representation when working between resources; (3) Individualistic, in that information resources are often tailored to support the cognitive needs of individual physicians, leaving the cognitive needs associated with collaboration unsupported, and sometimes undermining them. To compensate for the challenges associated with using objectivist, fragmented and individualistic information resources, physicians employed a number techniques, including relying in paper and other flexible artifacts, interpersonal clinical communications, and engaging in mobility work. This research brings us a step closer to understanding how people, paper, and technologies function together to fulfill the complex and dynamic needs associated with making medical decisions

Repairing routines in enterprise system transformations : a sociomaterial perspective

Today, large implementation projects introducing Enterprise System (ES) technology in organizations are a very common phenomenon, typically driven by the idea that a myriad of benefits can be realized. Yet, after implementation, organizations often face challenging problems due to misalignments between “best practices” embedded in ES technology and existing work practices. For the individual user implementation of new technology thus implies considerable effort in terms of cognitively accomplishing appropriation. This complex process of appropriation was found to result in very strong links between technology and individuals that is described as a sociomaterial entanglement by some scholars. In addition, ES technology implementations do often not ‘simply’ introduce a new technology into an organization, but will likely replace a similarly complex, integrated legacy system. Given the strong link between individuals and technology, established while appropriating the legacy system, replacing old technology will imply the breaking of old associations as much as the building of new ones. Consequently, the point of departure is as much characterized by an achieved sociomaterial entanglement with the old technology as it is by the need to integrate new technology into work practices. It has long been argued that organizational routines are key to understanding changes of work practices in organizations as well as the associated process of organizational learning. While the question how organizational routines emerge and evolve over time is extensively studied, little is known about what happens when routines are disrupted. In addition, the substitution of a legacy system raises the question, how exiting entanglements influence changes in routines triggered by ES technology implementation. Addressing this gap in the literature, this thesis aims to understand how sociomaterial routines are repaired after the implementation of ES technology. To answer this question, a longitudinal interpretive case study of an ES technology implementation project in the retail banking division of a large German bank was conducted. The custom-built legacy system to be replaced by new ES technology due to technical and regulatory requirements had been in place for over thirty years before. Within the retail banking division the study focuses on the credit service unit, which offers back-office services to the bank’s customers and advisors. The case material consists of 57 semi-structured interviews and observation of 38 participants, collected at three different stages during the project (before go-live, immediately after go-live, and 6 month later). Using narrative networks as an analytical device helped capturing the complexity of routine changes related to ES technology implementation and provided the conceptual link between organizational routines and sociomaterial entanglements. Based on a comparison of relevant routines at different points in time during (post-) implementation, five categories of practices individuals (in different positions/at different organizational levels) employed to repair routine performances were identified. Two of the practices aimed directly at adapting routines. But, individuals also developed additional support practices (i.e., work practices, which are performed in addition to, but share common fragments with, the supported routine). Two more repair practices targeted the sociomaterial background based on which routines are established, that is they changed the basis on which those actants are delineated, which are subsequently forming routine fragments. Thus, in line with other studies of post-implementation behavior, the findings show that repairing routines is a collaborative achievement of many, if not all, individuals directly and indirectly affected by the technological change. Yet, the repair practices employed at different levels do not operate independently, but are highly interrelated. Like researchers studying other phenomena using a sociomaterial lens, both physical (e.g., use of printouts) as well as digital (e.g., functionality of new ES technology) materiality were found to be important constituents of problems and repair practice. Furthermore, time was similarly important for repairing routines as both the timing of routine executions as well as the unfolding of repair practices over time had major effects on the final success of recreating routines. The findings also highlight that repair practices are different with respect to their persistence. While those practices employed to handle the situation of change were more likely to disappear again (yet did not necessarily do so), those required for adapting routines and accommodating the new system most likely persist. In conclusion, repairing routines after ES technology implementation does not only involve replacing one routine fragment (related to the old technology) with a new fragment (based on new technology) and appropriately reincorporating this new fragment into an otherwise stable routine. To the contrary, repairing routines implicates far more profound changes to routines, which have to be negotiated both with the social and material environment, and further requires adjusting the sociomaterial background based on which routines are established. In addition, repair practices evolve over time and differ with respect to their persistence. Thus, repairing a routine has a social, material, and temporal dimension, which jointly have to be considered. This doctoral thesis contributes to theory by providing a conceptual account of ES Transformation, which offers an explanation of how a working ES is reestablished by repairing routines after the implementation of ES technology. These findings are also valuable for practitioners as they allow them to better understand and consequently better plan and manage ES Transformations