Requirements of time management tools for outpatient physiotherapy practice

The effects of electronic appointment booking systems on the time management activities of health professionals have received little attention to date. We report on time management practices in three outpatient physiotherapy departments with different paper and electronic systems. The study has identified a set of time management activities and associated social behaviours common to physiotherapy departments. The convenience, flexibility and expressive nature of paper diary systems is of significant value to users, whilst the clarity and superior database functionality of electronic systems are valued by staff using this medium. The study highlights several potential barriers to the effective deployment of electronic booking systems in physiotherapy departments, including poor resource and training provision, concerns regarding restrictive diary control measures, the continued reliance on burdensome duplication procedures and the need to coordinate multiple information artefacts, which need to be addressed if such technology is to be successfully designed and deployed. Copyright © 2005 SAGE Publications (London, Thousand Oaks, CA and New Delhi)

Understanding “influence”: An exploratory study of academics’ process of knowledge construction through iterative and interactive information seeking

The motivation for this study is to better understand the searching and sensemaking processes undertaken to solve exploratory tasks for which people lack pre-existing frames. To investigate people’s strategies for that type of task, we focused on “influence” tasks because, although they appear to be unfamiliar, they arise in much academic discourse, at least tacitly. This qualitative study reports the process undertaken by academics of different levels of seniority to complete exploratory search tasks that involved identifying influential members of their academic community and “rising stars, ” and to identify similar roles in an unfamiliar academic community. 11 think-aloud sessions followed by semi-structured interviews were conducted to investigate the role of specific and general domain expertise in the process of information seeking and knowledge construction. Academics defined and completed the task through an iterative and interactive process of seeking and sensemaking, during which they constructed an understanding of their communities and determined qualities of “being influential”. Elements of the Data/Frame Theory of Sensemaking (Klein et al., 2007) were used as sensitising theoretical constructs. The study shows that both external and internal knowledge resources are essential to define a starting point or frame, make and support decisions, and experience satisfaction. Ill-defined or non-existent initial frames may cause unsubstantial or arbitrary decisions, and feelings of uncertainty and lack of confidence

Understanding safety-critical interactions with a home medical device through Distributed Cognition

As healthcare shifts from the hospital to the home, it is becoming increasingly important to understand how patients interact with home medical devices, to inform the safe and patient-friendly design of these devices. Distributed Cognition (DCog) has been a useful theoretical framework for understanding situated interactions in the healthcare domain. However, it has not previously been applied to study interactions with home medical devices. In this study, DCog was applied to understand renal patients’ interactions with Home Hemodialysis Technology (HHT), as an example of a home medical device. Data was gathered through ethnographic observations and interviews with 19 renal patients and interviews with seven professionals. Data was analyzed through the principles summarized in the Distributed Cognition for Teamwork methodology. In this paper we focus on the analysis of system activities, information flows, social structures, physical layouts, and artefacts. By explicitly considering different ways in which cognitive processes are distributed, the DCog approach helped to understand patients’ interaction strategies, and pointed to design opportunities that could improve patients’ experiences of using HHT. The findings highlight the need to design HHT taking into consideration likely scenarios of use in the home and of the broader home context. A setting such as home hemodialysis has the characteristics of a complex and safety-critical socio-technical system, and a DCog approach effectively helps to understand how safety is achieved or compromised in such a system

Scoping analytical usability evaluation methods: A case study

Analytical usability evaluation methods (UEMs) can complement empirical evaluation of systems: for example, they can often be used earlier in design and can provide accounts of why users might experience difficulties, as well as what those difficulties are. However, their properties and value are only partially understood. One way to improve our understanding is by detailed comparisons using a single interface or system as a target for evaluation, but we need to look deeper than simple problem counts: we need to consider what kinds of accounts each UEM offers, and why. Here, we report on a detailed comparison of eight analytical UEMs. These eight methods were applied to it robotic arm interface, and the findings were systematically compared against video data of the arm ill use. The usability issues that were identified could be grouped into five categories: system design, user misconceptions, conceptual fit between user and system, physical issues, and contextual ones. Other possible categories such as User experience did not emerge in this particular study. With the exception of Heuristic Evaluation, which supported a range of insights, each analytical method was found to focus attention on just one or two categories of issues. Two of the three "home-grown" methods (Evaluating Multimodal Usability and Concept-based Analysis of Surface and Structural Misfits) were found to occupy particular niches in the space, whereas the third (Programmable User Modeling) did not. This approach has identified commonalities and contrasts between methods and provided accounts of why a particular method yielded the insights it did. Rather than considering measures such as problem count or thoroughness, this approach has yielded insights into the scope of each method

Safer healthcare at home: Detecting, correcting and learning from incidents involving infusion devices

OBJECTIVE: Complex medical devices such as infusion pumps are increasingly being used in patients’ homes with little known about the impact on patient safety. Our aim was to better understand the risks to patient safety in this situation and how these risks might be minimised, by reference to incident reports. DESIGN: We identified 606 records of incidents associated with infusion devices that had occurred in a private home and were reported to the UK National Reporting and Learning Service (2005–2015 inclusive). We used thematic analysis to identify key themes. RESULTS: In this paper we focus on two emergent themes: detecting and diagnosing incidents; and locating the patient, lay caregivers and their family in incident reports. The majority of incidents were attributed to device malfunction, and resulted in the patient being under-dosed. Delays in recognising and responding to problems were identified, alongside challenges in identifying the cause. We propose a process model for fault diagnosis and correction. Patients and caregivers did not feature strongly in reports; we highlight how the device is in the home but of the care system, and propose an agent model to describe this; we also identify ways of mitigating this disjoint. CONCLUSION: Devices need to be appropriately tailored to the setting in which they are employed, and within a system of care that ensures they are used optimally and safely. Suggested features to improve patient safety include devices that can provide better feedback to identify problems and support resolution, alongside greater monitoring and technical support by care providers for both patients and frontline professionals. The proposed process and agent models provide a structure for reviewing safety and learning from incidents in home health care

Patient empowerment: designing technology that supports people’s coping strategies

Background: Self-management technologies, such as patient-controlled electronic health records (PCEHRs), have the potential to help people manage and cope with disease. Objectives: This study set out to investigate patient families’ lived experiences of working with a PCEHR. Method: We conducted a semi-structured qualitative field study with patient families and clinicians at a children’s hospital in the UK that uses a PCEHR. All families were managing the health of a child with a serious chronic condition, who was typically under the care of multiple clinicians. As data gathering and analysis progressed, it became clear that while much of the literature assumes that patients are willing and waiting to take more responsibility for and control over their health management (for example, with PCEHRs), only a minority of participants in our study responded in this way. Their experiences with the PCEHR were diverse and strongly shaped by their coping styles. Theory on coping identifies a continuum of coping styles, from approach- to avoidance-oriented, and proposes that patients’ information needs depend on their style. Results: Based on themes that emerged from the data analysis, and informed by prior research on coping styles, we identified three groups of patient families and an outlier, distinguished by their coping style and their PCEHR use. We refer to the outlier as controlling (approach-oriented, highly motivated to use PCEHR), and the three groups as collaborating (approach-oriented, motivated to use PCEHR), cooperating (avoidance-oriented, less motivated to use PCEHR) and avoiding (very avoidance-oriented, not motivated to use PCEHR). Conclusions: The PCEHR met the needs of controller and collaborators better than the needs of co-operators and avoiders. We draw on Self-Determination Theory (SDT) to propose ways in which PCEHR design might better meet the needs of avoidance-oriented users. Further, we high-light the need for families to also relinquish control at times, and propose ways in which PCEHR design might support a better distribution of control, based on effective training, ease of use, com-prehensibility of data security mechanisms, timely information provision (recognising people’s dif-ferent needs), personalisation of use, and easy engagement with clinicians through the PCEHR

Semi-structured qualitative studies

HCI addresses problems of interaction design: delivering novel designs, evaluating existing designs, and understanding user needs for future designs. Qualitative methods have an essential role to play in this enterprise, particularly in understanding user needs and behaviours and evaluating situated use of technology. There are, however, a huge number of qualitative methods, often minor variants of each other, and it can seem difficult to choose (or design) an appropriate method for a particular study. The focus of this chapter is on semi-structured qualitative studies, which occupy a space between ethnography and surveys, typically involving observations, interviews and similar methods for data gathering, and methods for analysis based on systematic coding of data. This chapter is pragmatic, focusing on principles for designing, conducting and reporting on a qualitative study and conversely, as a reader, assessing a study. The starting premise is that all studies have a purpose, and that methods need to address the purpose, taking into account practical considerations. The chapter closes with a checklist of questions to consider when designing and reporting studies

Concealing or Revealing Mobile Medical Devices? Designing for Onstage and Offstage Presentation

Adults with Type 1 Diabetes have choices regarding the technology they use to self-manage their chronic condition. They can use glucose meters, insulin pumps, smartphone apps, and other technologies to support their everyday care. However, little is known about how their social lives might influence what they adopt or how they use technologies. A multi-method study was conducted to examine contextual factors that influence their technology use. While individual differences play a large role in everyday use, social factors were also found to influence use. For example, people can hide their devices in uncertain social situations or show them off to achieve a purpose. We frame these social behaviours using Goffman's theatre metaphor of onstage and offstage behaviour, and discuss how this kind of analysis can inform the design of future mobile medical devices for self-management of chronic conditions

Safer Interactive Medical Device Design: Insights from the CHI+MED Project

Interactive medical devices such as infusion pumps, monitors and diagnostic devices help save lives. However, they are also safety critical in that they may fail in use and patient harm or death ensue. It is not just that the software and hardware should meet their specification. The design should help ensure users do not make mistakes. Safety factors become more important as medical devices become mobile and are used by patients as part of their everyday life rather than by trained professionals in well-defined hospital environments. Regulators are increasingly taking home-use seriously as a result of device recalls due to devices that have caused patient harm. We give insights from the research on the CHI+MED project (www.chi-med.ac.uk). It has focussed on understanding how the design of interactive medical devices can support safety. CHI+MED also developed practical tools and guidance that we review

Understanding Infusion Administration in the ICU through Distributed Cognition

To understand how healthcare technologies are used in practice and evaluate them, researchers have argued for adopting the theoretical framework of Distributed Cognition (DC). This paper describes the methods and results of a study in which a DC methodology, Distributed Cognition for Teamwork (DiCoT), was applied to study the use of infusion pumps by nurses in an Intensive Care Unit (ICU). Data was gathered through ethnographic observations and interviews. Data analysis consisted of constructing the representational models of DiCoT, focusing on information flows, physical layouts, social structures and artefacts. The findings show that there is significant distribution of cognition in the ICU: socially, among nurses; physically, through the material environment; and through technological artefacts. The DiCoT methodology facilitated the identification of potential improvements that could increase the safety and efficiency of nurses’ interactions with infusion technology