| Increasing sensitivity towards everyday work practice in system design | ||
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As a fieldworker I needed to learn to construct my understanding of the phenomena or activity at hand by maintaining a careful epistemological discipline in the double role of participant and observer in fieldwork. Becoming a participant observer provides the necessary methodological possibilities in regard to the epistemological shift of studying practices as it allows simultaneously for an insider (emic) as well as an outsider (etic) location for the researcher (see e.g. Jordan 1996a, Forsythe 1999).
I learned to participate in the life of the work community to grasp the social organisation of activities and events and at the same time maintain mental distance to be able to understand what is not usually made explicit by the members of the community. My vantage point ranged according to the adopted participatory role, i.e. the degree of participation, observation and interviewing. Accordingly, the situated views from somewhere in which I engaged provided perspectives both from a participant’s inside standpoint and from the outside.
In the experimental teleradiology project the field was entered to study the emerging teleradiology work practice. My initial impression of teleradiology as some sort of expert work was superficial, based on what I had gathered from the radiologists with whom the study had been negotiated. As my understanding about everyday teleradiology work grew to comprise radiologists’ and support staff’s work in both locations as well as directly and indirectly system-use related preparatory tasks, I realised that I should study and make visible all work that went into the everyday working of the teleradiology service to make it available and accountable for the system redesign.
By participating in the everyday practices of the experimental teleradiology system trial period I gained an in-depth understanding of the real-world social processes involved in the emergent teleradiology work practice. The teleradiology staff took pains to adjust and accommodate the service and system use situations as part of their daily routines. They were constantly, especially in the beginning of the trial phase, engaged in efforts to learn to use the system and to solve the problematic situations, often by trial and error. At the same time they were conscious about completing their customary duties. For instance, the radiology nurse in Kuusamo would try to solve the manifold and time-consuming problems with transferring images to OUH and also see the patient case through the teleradiology consultation trajectory to make sure that the report was timely delivered to the tending clinician.
As a fieldworker I also participated in these processes, observed and was involved in the actual instances of problem solving and local innovation. I realised that the teleradiology service could not have been established as a running operation without the personnel developing their work , i.e. forming a new way of collaboration between two radiology units by learning new skills and accommodating the new tasks as a part of the daily routines.
As an observer – not carrying out the daily duties and simultaneously coping to learn to use the system - I was able to maintain a certain distance to the everyday teleradiology work practice. The distance allowed me to see, identify and problematise certain aspects of work as they appeared as part of the unfolding activities. In analysing and reflecting the observations and interpretations in fieldnotes tentative formulations of the everyday events and activities in the field were delineated. I learned that analysis of work practice is a continuous and iterative process of observing and reflecting in action. The fieldworker reformulates her understanding of work practice until it is no longer challenged by the events in the field (the so-called ‘surprise index’, Jordan 1996a, p. 36).
Due to my background in system design and a growing understanding of radiology work I had a privileged outside perspective for assessing the system as part of everyday work practice. My eye was especially on the actual instances of system use, i.e. how usable the system was for everyday clinical work, and how the system provided for the communication and collaboration between the two work communities which it brought to work together.
As a fieldworker I had access to all teleradiology related work, for instance, both radiology communities and all involved occupations, which gave me a possibility to learn comprehensively about the practitioners’ views. I found out that the participant categories did not form a single coherent emic entity but rather represented situated, partial views (sensu Haraway 1988) of the teleradiology system and the emergent work practice. These views were based on the practitioners’ occupational and organisational standpoints, fields of expertise, their form of participation in the teleradiology project and situated points of view from within the actual teleradiology work practice.
For instance, the members of the design team who had little to do with the daily running of the system were just aware of the most prominent problems with the system but did not know about the various problematic practicalities. The practitioners who worked with the system formed their partial and situated views about the system and its use based on what they experienced in their occupationally and geographically segregated tasks, i.e. what part of the teleradiology work practice was visible to them. For example, secretaries in OUH liked the system as its work processing capabilities were superior in comparison to the mainframe system that they regularly used for typing out dictations, radiologists in OUH got increasingly dissatisfied with how the system displayed images for interpretation hampering their work, and in Kuusamo the everyday use of the system was experienced as so time consuming that the radiology nurses were replaced by primary care assistants in scanning images, sending requests and receiving reports.
As a fieldworker I learned about the partial and situated views of practitioners. I intentionally elicited and analysed them and continued to systematically compare their inside and my outside views. Thus, I constructed a fieldworker’s insider-outsider understanding of the everyday teleradiology work practice. Though the fieldworker view was also situated and partial it was distinctively different from the practitioners’ views. First of all, it was analytic in the sense that it was formed with a certain distance to the everyday experience of practitioners. It did not just replicate practitioners’ views but provided for insight into the invisible aspects of which insiders are often unaware or unable to articulate, e.g. local and tacit knowledge as well as lived experience.
Secondly, it provided for a systematic overview of the teleradiology work practice. As a fieldworker I synthesized the various situated partial emic views by making comparisons allowed by both the necessary access and analytic distance to them. In the teleradiology experiment it would have been difficult for those involved in the everyday work to gain an overall understanding of it, as the practitioners were so immersed in their own aspect. Also, the distributed nature of work made gaining an understanding of the entire teleradiology process more difficult, the practitioners were not aware of what was happening at the other end of the teleradiology link. Third, fieldworker understanding is definitely not an insider view. Not only does it measure up in the medical knowledge and historical understanding of the staff, it also lacks the lived experience of the practitioners.