| Increasing sensitivity towards everyday work practice in system design | ||
|---|---|---|
| Prev | Chapter 4. Towards work practice based participatory system design | Next |
The construction of my fieldworker’s understanding for teleradiology system redesign started by investigating the wealth of data and materials collected during fieldwork[1], i.e. viewing and reviewing videotaped instances of actual system use and the related stimulated recall interviews, and reading and rereading interview materials, such as participants’ experiences of the trial use phase followed by detailed analyses of videotaped system use situations focussing on the unfolding activities[2]. The following sections describe the analytic work that went into constructing the understanding that would enable appreciative intervention.
In identifying endogenous change in the work activities it was important to retain a participant observer’s immersion in the actual work practice. Due to this intimate proximity together with the participant interventionist’s special interest on change, I was able to discern endogenous transformations in work as the teleradiology personnel took pains to accommodate the system so that they could productively work with it. For instance, the teleradiologists had to learn to do ‘monitor interpretation’ (see Table 4, Picture C, on page 61). Though the change may not be as great as in learning completely new ‘semiotic systems’ as in relation to the introduction of new imaging modalities (cf. Barley 1988b), the new mediating technology, however, required the radiologists to adapt their accustomed interpretation process, as the system, for example, reduced the size of image display, provided new possibilities for image manipulation in the form of image processing functions and imposed certain sequential orders of activities for particular parts of the image interpretation process (see e.g. Karasti 2000, publication IV, pp. 11-13 and 17-20).
The practitioners hardly remarked upon their development work. It was such a taken-for-granted aspect of breaking in a new system that the evolving advancement went on as an integral part of everyday work in conjunction with carrying out the customary duties. The practitioners were not in a profitable position to reflect on the informal development and local innovations which became part of the work practice as they were contrived because they were so immersed in carrying out their actual work. As a participant interventionist having access to both inside and outside perspectives, I could understand and articulate the incremental transition and endogenous change taking place.
In taking distance from being immersed in the practitioners’ perspectives it was important to focus on the technological mediation of work activities for the purposes of system redesign. I engaged in exploring the existing and potential space of technological change by assessing how usable the system was in the everyday clinical practice and considering what design issues should be dealt with in its redesign. To continue with the example of a teleradiologist’s image interpretation, I addressed such issues as the initial display of images on a radiologist’s computer screen in the beginning of an interpretation session and the use of image processing functions intertwined as part of the unfolding activities. I examined instances of a radiologist’s actual work with a special focus on the usefulness of these system features and outlined tentative formulations of how they could be improved to better account for the actual work practice. In conceiving the questions for assessment and preliminary answers for enhanced sensitivity I resorted to my understanding and experience of radiology work gathered as a fieldworker and my background in system design to generate the issues from within actual unfolding work practice. In taking distance to analyse and reflect, a participant interventionist has the advantage of being able to combine a focus on technological mediation of work activities with an appreciative understanding of work practice.
Juxtaposing[3] the differently mediated ways of working had first emerged in the stimulated recall interviews where the teleradiologist started to compare image interpretation in the two environments. Following the example, I have frequently juxtaposed the teleradiology activities with corresponding film-based practice in analysing the actual instances of teleradiology system use. For instance, I juxtaposed the two environments to learn how the radiologists organised their activities in the interpretation sessions. In traditional practice radiologists are accustomed to interpreting images as sequentially ordered cases in series. The alternator supports this with its magazine for light panels that are used for the temporary storage of mounted films. The radiologists read the request of the next patient to determine the problem formulation while the light panels are changed between the cases. As the new pair of light panels appears, they take a quick overall glance at the films and then proceed to a more detailed interpretation process and dictation of a report.
In the teleradiology environment, in turn, the radiologists would have to wait while the images appeared on the screen one by one in a blown-out-size and were then reduced to fit the pre-set frames before they could read the request. Though the radiologists were able to glance at all images as they were sequentially displayed, they lacked the specific problem formulation given in the request to perform an initial interpretation. During the diagnostic interpretation and dictation the radiologists engaged in continuous image articulation work as they organised images on screen and used the image processing features for image manipulation (discussed also in a workshop, see Karasti 2000, publication IV, pp. 12-13).
The juxtaposition of two work practices with different technology mediation allowed me as a participant interventionist to discern the differences of and similarities between the environments and ways of working. Furthermore, the film-based practice provided a tried and proven vantage point for the assessment of the teleradiology system in use.
In the double role of a participant interventionist I was continually reminded to appreciate work practice as I had learned during fieldwork (see sections 3.1 and 3.3, particularly 3.1.3) and to explicitly assess the system-in-use-situations.
The problems with the experimental system in which I was interested as a designer became observable in many ways as they were experienced and confronted in system use, such as in work-arounds, extra work, hesitancy in actual situations of system use, avoiding certain procedures with the system, having to struggle with the system to get something done. At times, even if the work activities seemed to be unfolding without problems, difficulties could be discerned on a closer examination. In these occasions it required an intimate understanding of work practice to be able to discern the problem, for instance, by being able to identify what was essential in the activity from the practitioner’s point of view or by juxtaposing the emergent teleradiology practice with the accustomed film-based way of working to elicit the tacit aspects of work.
An example of such a covert but also persistent inconvenience relates to the simultaneous comparison of images during interpretation which is a taken-for-granted aspect of image interpretation in the alternator environment with several films mounted on large light panels (see also Karasti 2000, publication IV, pp. 11-13 and Karasti 2001, publication V, pp. 26-28). In a traditional environment the radiologist moves about in front of the alternator as an embodied part of interpretation to reach an optimal body positioning in relation to the films to be compared. Such simultaneous juxtaposing of images was not possible in the teleradiology environment with digital images on a computer monitor due to the smaller screen real estate.
There was an awareness of the issue of image display being reduced in size amongst the radiologists already from the beginning of the project. However, it was only the radiologists who actually used the system in clinical diagnostics who had to face the problem in practice and it was not easily discernible. At first, the radiologists took pains to accommodate the system and adjust their ways of working rather than evaluating the system critically. Simultaneously to coping with learning to use the system and adjusting their ways of interpreting images to the digital environment, the teleradiologists also tried to cope with the need to do simultaneous image comparison. They adapted appropriate work-arounds for each individual occasion to compensate for the deficiency in the system and to be able to compare images, e.g. by reducing the size of two images so that they can be simultaneously viewed on the monitor, by trying to memorise one image and then proceed to the one to be compared, or by repeatedly and quickly alternating between the images. The radiologists’ ingenious, seemingly fluent ways for coping with the system and the flexible reorganisations of work activities to circumvent the predicaments made it more difficult to the fieldworker to realise the problem in its whole extent.
I gained an analytic and systematic understanding of each of the teleradiology practitioner perspectives in turn through similar activities as explained above in relation to a radiologist’s image interpretation. These situated and partial points of view were then synthesized into more overall accounts and assessments of the teleradiology system and work practice.
For instance, an understanding of the dispersion of image articulation work, i.e. work that corresponds to ‘hanging images’ of film-based practice carried out in current practice by film developers in OUH, was gathered through combining the perspectives of two teleradiology practitioners and scrutinizing the system’s capabilities of image display (see also Karasti 1997a, publication I, pp. 7-8). The teleradiology system introduced entirely new tasks and working procedures to roentgen nurses in Kuusamo. As the system was experienced as time consuming, the teleradiology tasks were delegated to primary care assistants, who collectively took responsibility for running the system but lacked the radiology expertise necessary in scanning films and transferring images. This resulted in problems with image layout and organisation on the monitors in the other end which increasingly annoyed the teleradiologists as they had to move, turn and rotate images on the screen in the beginning and during the process of interpretation. In film-based work practice radiologists are used to having all image-related articulation work carried out prior to the interpretation sessions so that they can concentrate on the interpretive diagnostics. The work of ‘hanging images’ in film-based practice was dispersed into four aspects of the teleradiology system work: 1) the scanning of films and transmission of images in Kuusamo, 2) the image display system laying out the images on the teleradiologist’s screen, 3) the radiologist arranging the images on the computer screen at the beginning of a session in order to obtain an overall view of the case, and 4) continuous image handling by the radiologist during the interpretation process. Such integrated understandings of teleradiology work and related problematics were accessible only to the participant interventionist as the practitioners were too immersed in their situated perspectives.
In constructing my understanding for the teleradiology system redesign I shifted between the perspectives of a participant and an interventionist which obviously would not have been possible without the understanding of actual work practice gained previously as a participant observer. Turning into a participant interventionist introduced and intertwined an explicit technology focus and change thinking into the fieldworker role. It required an explicit articulation and making visible of the ongoing transition in the work communities and a definite interest in exploring the technological change from within the actual work practice. As I realised that the perspectives provided for complementary observations, both valuable in gathering a holistic understanding and informed assessment of technology use in work for system redesign, I became interested in using these insights in developing a tool for design practice and in exploring the possibilities of communicating this understanding to others to be used as a starting point for evaluating and redesigning the teleradiology system.
In ethnographic traditions researchers are not accustomed to taking their findings back to the subject communities for comment and critique (see e.g. Hastrup 1995). Such an activity has been considered merely as a form of research validation, namely ‘respondent validation’ (see e.g. Silverman 1993, pp. 156-158) and it has been questioned because “those studied are not in a good position to reflect on their own behaviours and would most likely simply offer post hoc rationalisations of justifications for their behaviours if asked to participate in analysis” (critique summarised in Blomberg et al. 1993, p. 140). On the other hand, the reflection and cautiousness pursued by ethnographers in relation to representing the ‘other’ in the written ethnographies increased my understanding of the complexity and subtlety of the related issues that have only recently started being discussed in relation to representations of work within system design (e.g. Suchman 1995b).
| [1] | The materials included: observations in the field and related field notes, video recordings of the actual instances of work practice, audio or video recordings of the stimulated recall interviews, interview materials, copies of the requests and reports of patient cases, other documents gathered during fieldwork, and video recordings, transcripts and analyses of the earlier phase where film-based work was studied. |
| [2] | In other phases I have organised possibilities for collaborative analyses of radiology work, especially of collaborative film-based image interpretation sessions. Here in relation to teleradiology work, however, I suspected that co-analysis of unfolding teleradiology system use situations observable only through slight changes on a computer screen would have been too arduous for outsiders that lacked knowledge of the system and its interfaces. |
| [3] | I am grateful to Marjorie and Charles Goodwin for first drawing my attention to juxtaposition in Goodwin (1994a), Goodwin (1994b), Goodwin & Goodwin (1997). The notion has become important for my work. |