4.4. Learning from an actual instance of tool use
In relation to the teleradiology project two workshops were organised after the trial period with the experimental system in clinical use before moving on to product design. Each of the workshops lasted for about two hours. There were ten participants in the first workshop the theme of which was the radiologists’ image interpretation work, and twelve in the second one in which the topics were the new way of collaboration between the two radiology units and the distributed supportive work.
After the workshops were conducted the analytic lens was turned around[1] as it is my contention that the concrete design activities should become an object of rigorous study just as any other work. Analyses were carried out to provide an understanding of what actually took place in the workshops. Though such scrutiny has not been common in the field of system design, notable exceptions are Blomberg & Trigg (2000), Newman (1998), Bødker & Grønbæk (1996), Mogensen & Trigg (1992) and Trigg et al. (1991). The following summarises the interplay of views in the unfolding process of participants co-constructing shared understandings of work practice and design issues (see Karasti 2000, publication IV), and puts forward four elements that in particular contributed to sensitizing system design towards actual work practice in one of the workshops (see Karasti 2001, publication V).
4.4.1. The interplay of views in the co-construction of shared understandings
Collaborative activities started with and were grounded on viewing and analysing the activities and events of actual work represented in the video collage. Throughout the workshop the participants were reminded of and could go back to the concrete cases and particular instances of situated technologically mediated everyday work. Gradually the discussions became increasingly grounded on actual work practice and system use, and new appreciations of what is important to attend to in design were gained. (see Karasti 2000, publication IV, pp. 7-21.) Both the video collage and practitioner participation enhanced the concentration of collaborative activities around work practice (Karasti 2001, publication V, pp. 21-23). The viewing of videotaped instances of work activities invited for multivoiced interpretations and the practitioners recounted their lived experiences evoked by the video clips (see Karasti 2000, publication IV, pp. 21-28).
The analysis of unfolding activities revealed the everyday practice differently from the customary idealised views of practitioners about their work. The ideal views implicitly include but also intricately conceal from active articulation plenty of invisible and taken-for-granted aspects of work which, however, are essential for the everyday smooth running of work. As such aspects of work, previously so obvious to the practitioners to be unremarkable, became visible, the participants questioned them by juxtaposing them with their new observations. (ibid., p. 23.) Similarly, some of the initial views on teleradiology based on general expectations and potentials of digital imaging became challenged and reconsidered as the realisation of initial design concepts became evaluated through the analysis of actual teleradiology system use situations (ibid., pp. 23-24). In these analyses the participants were able to identify essential aspects of work that need to be preserved regardless of the technological mediation and environment, e.g. image comparison in interpretation and the possibility to follow the progress of a patient along the patient examination trajectory (ibid., pp. 25-26).
Starting with the analysis of traditional work allowed the participants to form a shared platform of understandings about film-based practice and to base the subsequent analysis and evaluation of the emergent work practice on them (ibid., pp. 26-27). The co-construction of work practice based design issues, e.g. improvements to the experimental system, images envisioned of the future teleradiology system and work practice and technology induced enhancements to the future system that arose from the potentials of digital imaging, was grounded on a close and continuous connection between actual work practice and system design issues (ibid., p. 27). The emergent and evolving criteria for evaluating the experimental system and considering the legitimacy of the design issues was intimately informed by and weighted in the light of the existing ways of working as well as practitioners’ work practice experience and professional expertise (ibid., pp. 27-28).
4.4.2. Four elements contributing to the gravitation on work practice
The analyses further revealed a set of interaction patterns that contributed to the gravitation of collaborative activities towards actual work practice. The following sections elaborate on four of these elements illustrated by an excerpt of activities in a workshop on radiologists’ image interpretation (see also Karasti 2001, publication V, pp. 21-25 and 34-36). The participants have collaboratively viewed a sequence of video collage where radiologist A is engaged in interpreting thorax films on light panels (depicted in Table 6, pictures A and B). The tape is paused, H asks a question (Table 6, Line 1) and A answers (Lines 2-6).
An instance of image interpretation presented in a sequence of video collage and discussed in a workshop.
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| Pictures A and B. In the video sequence of episode 2B radiologist A reaches out from the left to the right in front of the autoalternator light panels. | ||
| Co-viewing sequence 2B | ||
| 1 | H: So here you move all the way from one end to another, or what are you doing there? | |
| 2 | A: I think it’s necessary to reach out to get a view at right angles at both of the films. You cannot look at the | |
| 3 | film, or at the monitor from the side. In a way, you look perpendicularly, and when you are | |
| 4 | comparing two images, you search a position in the middle of them to be able to see them in about the | |
| 5 | same size. It has to be the reason for moving like this, I suppose. I’ve never really thought there is so | |
| 6 | much body work involved in image interpretation, but so it seems to be ... | |
| Co-viewing continues with sequence 2C | ||
4.4.2.1. The double presence of work practice
The workshop setting provided for the presence of work practice in two ways, i.e. through the video collage representing instances of actual work practice and through the active participation of practitioners. In the excerpt the video collage depicts radiologist A, absorbed in reading films, changing his position in front of the alternator (Table 6, pictures A and B). In responding to H’s pointer about the observable performance (Line 1) radiologist A recalled his presence in the instance as he elaborated on his image interpretation activities (Lines 2-6).
The video collage offered the participants a chance to observe work practice almost in situ, as the work was actually performed in the workplace. The idea of making the work visible ‘as it is’ provided for both the smooth, taken-for-granted routines as well as the problematic situations encountered in work. The video collage presented for analysis what the practitioners find relevant in the course of accomplishing their ordinary work. The otherwise hard to grasp moment-by-moment temporal organisation of unfolding activities was subjected to an analysis. The detail of video as medium afforded for the intrinsic nature of everyday technologically mediated interactions, and the intertwined use of different materials and technologies became accessible for scrutiny.
In viewing and analysing the video collage the practitioners verbalised their interpretations and evocations of the work by describing, expounding and characterising activities and events. Through their explications the there and then of the video collage also became the here and now of the workshop. They recounted circumstantial information that cannot be seen on the tape. They brought in the vocabulary of radiology work practice, the everyday practicalities and common practices, and the categories from within the work practice. In all these explications the practitioners drew on their professional expertise and lived experiences of film-based work. (Karasti 2001, publication V, pp. 21-23.)
4.4.2.2. Rendering work practice both familiar and strange
The preceding section described how the video collage rendered the work practice familiar so that practitioners’ experiences and recollections were evoked. The video collage worked also in a different way by rendering the work as something extraordinary to the practitioners. In the above excerpt radiologist A noted, as if surprised, that he “never really thought” that there was so much body work involved in the search for optimal spatial relations with the films spread over the large area of light panels during image interpretation (lines 5-6).
The very ordinariness of work activities which makes them invisible, as if seen but unnoticed when immersed in everyday work, was broken and they became somehow extraordinary when depicted in the video collage. Through detachment from the everyday routines the workshop setting allowed the practitioners a rare vantage point of an outsider perspective, significantly different from having to cope to get the job done. It gave the practitioners a chance to see their work with the eyes of ‘the other’ and to became more reflective about their own work.
In the propitious conditions of the workshop the ambivalence of strangeness and familiarity provided by the video collage grew into a dialogue, a two-way relation for exploration. Iteration between the familiar and the strange gave room for the practitioners to engage in a more analytic stance towards their work, to reflect from a distance and to analyse as if an outsider. (Karasti 2001, publication V, pp. 23-24.)
4.4.2.3. Juxtaposing existing and new ways of working
The video collage made visible, concrete and as if tangible the two co-existing differently technologically mediated ways of working, by starting with the film-based practice and then proceeding to the teleradiology environment. In the excerpt 2B of an early phase of the workshop where image interpretation in film-based environment was analysed radiologist A, reminded of his recent experiences with monitor interpretation, juxtaposed traditional and teleradiology image interpretation environments to point out a similarity in the practices (line 3). The traditional work practice represented the lived experience of all practitioners who have learned their trade in the film-based environment. In the workshop the participants had a chance to familiarise themselves with the emergent way of working by seeing the teleradiology personnel working on the experimental system and hearing about their experiences.
By staying close to the technologically mediated work activities in the two environments the practitioners started relating the experiences of traditional work with teleradiology work, though the latter drastically differed from the familiar film-based work practice. And by juxtaposing the two distinct work practices they were able to discern a variety of ways in which transformations took place in practitioners’ work (see e.g. Karasti 2000, publication IV, pp. 11-13). These understandings of changes with the experimental teleradiology system to everyday work paved the way for envisioning further transformations. Images of the future context were constructed as the practitioners became able to expand their thinking to the foreign digital imaging-based forms of working. (Karasti 2001, publication V, pp. 34-36.)
4.4.2.4. From particular activities to meanings of work
The practitioners were in a central position to elaborate on the videotaped activities in the workshop. Their situated positions within the everyday clinical work practice in combination with the newly gained outsider perspective in the workshop allowed them to iterate between the particular work activities on the video collage and their lived experience of work practice. They were able to relate the situated, particular instances of videotaped work activities to their experiences of what is common in everyday work practice rather than producing mere descriptions of the specific activity. For instance, in addition to describing the particular activity observable on the video (lines 2-4), radiologist A unravelled its meaning from the point of view of everyday image interpretation, i.e. the radiologists need to find a position in middle of the films to be able to read them at a perpendicular angle in more or less the same size (lines 4-5).
The situated particularities in the observable performance on the videotape evoked the practitioners to characterise the issues and concerns germane to the actual work practice that they found relevant in the unfolding course of accomplishing the work. They articulated what was important with concern to their specific experience of everyday work practice. Meanings of work practice were formulated as the practitioners understand and can explicate the intelligibility of particular, observable work activities in the video collage. (Karasti 2001, publication V, pp. 24-25.)