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Artefactual Multiplicity: A Study of Emergency-Department Whiteboards
Abstract and Figures
Whiteboards are highly important to the work in emergency departments (EDs). As a collaborative technology ED whiteboards
are usually placed in the dynamic centre of the ED, and all ED staff will approach the whiteboard regularly to organize their
individual yet interdependent work. Currently, digital whiteboards are replacing the ordinary dry-erase whiteboards in EDs,
which bring the design and use of whiteboards in ED to our attention. Previous studies have applied the theoretical lenses
of common information spaces, coordination, and awareness to the investigation of whiteboard use and design. Based on an ethnographic
study of the work practices involving two differently designed ED whiteboards, we found these concepts insufficient to explain
one essential characteristic of these heterogeneous artefacts. In this paper, we suggest an additional theoretical concept
describing this characteristic of heterogeneous artefacts; namely artefactual multiplicity. Artefactual multiplicity identifies not only the multiple functions of heterogeneous artefacts but also the intricate relations between these multiple functionalities.
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... CSCW researchers have studied the connection between artefacts as a web of coordinative artefacts [3] or as artefactual multiplicity comprising the multiple functionalities of heterogeneous artefacts and relations between embedded functionalities [14]. The characteristic of all these examples is that the multiple artefacts or the artefactecologies are somewhat ixed and taken for granted, and studied as is. ...
Designing new technologies to support synchronous interaction across distance has for many years focused on creating symmetry for participation between geographically distributed actors. Symmetry in synchronous interaction has, to some extent, been achieved technologically (while multiple social, historical, political, and hierarchical concerns continue to exist) and proven empirically in the increased use of remote-work technologies that were used during the pandemic. However, synchronous interaction in hybrid work is achieved differently, since the asymmetry produced by some participants being collocated while others geographically distributed introduces increased complexities for such interactions. Focusing on this challenge, we ask: To what extent can symmetry in cooperative work engagements be achieved in hybrid work contexts? We explore this question by interrogating multiple different empirical examples of synchronous hybrid interaction collected across different organizations, activities, and events. We found that the effort required to accomplish hybrid work includes additional articulation work necessary for bounding multiple intertwined artefacts across sites, devices, and applications. Further, the multiple artefacts setup across sites, combined with asymmetric collocation across participants, produce incongruence in technological frames of reference for each participant. All participants in hybrid work have only partial access to the hybrid setup, and no single person has access to the complete setup. The incongruence in technological frames produces insurmountable gaps in collaboration, causing all hybrid work situations to be characterized fundamentally by asymmetric relationships. We argue that symmetry in hybrid synchronous interaction is impossible to attain in attempts to solve this problem through design. Instead, we propose that designers of cooperative technologies for hybrid work shift towards developing artefact-ecologies supporting hybrid work, focusing on asymmetry as a necessary feature. Fundamentally, the design strategy should explore novel ways of taking advantage of the multiple different artefact-ecologies which serve as the foundation for the hybrid collaboration. Instead of striving for symmetry, we propose to feature asymmetric conditions in future technology designs for hybrid interaction.
... A differentiated incremental approach of design participants examining design problems is demonstrated through the object-driven dynamics, as the cultivation of the installed base, even on a smaller scale, is distributed and embedded in multiple work practices and contexts of use. Furthermore, as work practices have been shown to be challenging to understand and account for in design (Bjørn and Hertzum 2011), our study provides a detailed description of how the framing of intermediary objects emerge from healthcare professionals' exploration and how these objects are dynamic in their way of mediating contextual contingencies. Second, we conceptualise different mechanisms that make objects generative in infrastructure design. ...
This study explores the generative role of objects in design work. While the CSCW literature includes a range of contributions on infrastructure design and ways of accounting for diverse existing systems, practices and perspectives in design, the focus has typically been on the point of use, rather than the earlier stages of design processes. However, as more worker groups become involved in design there is a need to understand the microdynamics of collaborative design in this phase and the interplay between problem framing and exploration. We examined how the design of an information system in the health sector evolved through the instantiation and exploration of intermediary objects that become generative in the design process. The data comprised observations over 2 years from design meetings with a team of health professionals and software developers mandated to develop a system for the registration and sharing of patient information across primary care units. The analysis showed how intermediary objects formed focal points from which infrastructure design problems were framed and collectively explored. These processes required considerable negotiation and exploration within and between the interdependencies that become relevant in the design process. We identified how intermediary objects take different representational forms and become generative in two ways: By producing new or transformed objects, and by revealing layers of complexity inherent in the design problem. We discussed implications of the analysis as regards aspects of the infrastructure design that can be handled in the design team versus aspects that should be delegated to local adaptation.
... Literature on the socio-material practices of hospital hygiene has explored how infection control is enacted via the organizing movements of bodies, medical materials, and mundane objects Brown et al., 2020;Fox, 1997;Heath et al., 2018;Hooker et al., 2020;Mesman, 2009Mesman, , 2012. Others have used the concept of "mobility" (Bardram and Bossen, 2005;Luff and Heath, 1998) to attend to the spatiality of collaborative work in hospital care, such as through routines and resource distribution (Bjørn and Hertzum, 2011;Mesman, 2012;Vernooij et al., 2022). Mobility has also been examined in terms of patient movements in relation with space, including through bodily capacities for movement, engagement with the environment, and experiences of interpersonal proximity and distance (Andrews et al., 2013;Milligan, 2000;Wiles, 2003). ...
This paper explores the boundary-making practices enacted by the hospital. Taking a hospital in Sydney, Australia, as our case, we investigate how the hospital holds together as a care environment through the coordinating movements of many materials, spaces, bodies, technologies, and affects. Drawing on interviews with hospital healthcare workers involved in care, research, and management related to COVID-19, we examine the multiplying effects of these movements to trace the ways in which the hospital is (re)made in relation with pandemic assemblages. We accentuate the material affordances of care environments and how care is adapted through the reshaping of the spaces and flows of the hospital. Through this, we highlight how care providers can work with the fluidity of the hospital, including through reorganizing routines and spaces of care, engaging with communication technologies to enact care at many scales, and remaking mundane materials as medical objects in the evolving care environment.
... A domain where very significant CSCW research has been conducted over the years is healthcare. In-depth studies mainly in hospital settings in Europe and in the USA have shed light on the coordinative complexity of healthcare work, demonstrating the important role of time (Reddy et al. 2006), place (Bardram and Bossen 2005), documents (Heath and Luff 1996;Schneider and Wagner 1992), and how they are interrelated (Bjørn and Hertzum 2011;Østerlund 2008). These practices and their complexity are often not taken into account in the design of healthcare information systems (Hartswood et al. 2003). ...
Computer-Supported Cooperative Work (CSCW) is an interdisciplinary research area concerned with developing computing technologies that facilitate, mediate, or regulate interaction between people engaged in cooperative work or similar kinds of sustained social activities. CSCW is a heterogeneous enterprise, addressing a motley of computational technologies and assimilating contributions from a host of scientific disciplines. What unites CSCW research is a shared concern with the fundamental problem of incorporating models of coordinative practices in computational artifacts and to do so in such a way that actors are able to deal with contingencies and are supported in that by the functionalities of the computational artifacts. Reflecting this shared concern, CSCW research is also united in a symmetrical commitment to ground design efforts in studies of actual work practices and to orient studies of actual work practices towards informing the development of collaborative technologies. As a field CSCW focuses on a variety of domains where complex cooperative practices occur. Due to the heterogeneity of the field and of such domains, a range of approaches and frameworks are applied to CSCW research. A notably established approach that has shaped substantial part of CSCW scholarship and had influence beyond the discipline are in-depth ethnographic studies of actual practices in their naturally occurring settings. In this regard CSCW has been influential in championing a hybrid approach to the study of computing systems encompassing concerns for understanding and for designing.
Hypotension during perioperative care, if undetected or uncontrolled, can lead to serious clinical complications. Predictive machine learning models, based on routinely collected EHR data, offer potential for early warning of hypotension to enable proactive clinical intervention. However, while research has demonstrated the feasibility of such machine learning models, little effort is made to ground their formulation and development in socio-technical context of perioperative care work. To address this, we present a study of collaborative work practices of clinical teams during and after surgery with specific emphasis on the organisation of hypotension management. The findings highlight where predictive insights could be usefully deployed to reconfigure care and facilitate more proactive management of hypotension. We further explore how the socio-technical insights help define key parameters of machine learning prediction tasks to align with the demands of collaborative clinical practice. We discuss more general implications for the design of predictive machine learning in hospital care.
In Participatory Design (PD), the design of a cooperative digital solution should involve all stakeholders in the co-design. When one stakeholder’s position is weaker due to socio-cultural structures or differences in knowledge or abilities, PD methods should help designers balance the power in the design process at both the macro and micro levels. We present a PD method that addresses the power relations arising during the design process and draws on theories about participation and power in the design and organisation of change processes. We contribute to Computer Supported Cooperative Work (CSCW) by using the PD method to design computer support for cooperation on cognitive rehabilitation between people with Mild Acquired Brain Injuries (MACI) and their healthcare professionals, where strengthening the cooperation is considered an element of patient empowerment. This method is presented as a contribution to the intersection between PD and CSCW. The discussion of power in PD contributes to the discussion of cooperation in CSCW. We found that EquiP supported the creation of choices, and hence the ‘power to’ influence the design. This method can contribute to a power ‘equilibrium’ and a positive-sum power relation in PD sessions involving all stakeholders.
How can we make data science systems more actionable? This dissertation explores this question by placing end-users and their data practices, rather than data scientists and their technical work of building models and algorithms, at the center of data science systems. Inspired by phenomenological views of technical systems from CSCW, HCI, and STS, I use ethnographic and other qualitative methods to understand how participants from four studies worked with data across three settings: craft brewers producing beers, people with visual impairments engaging with image descriptions of their photos on their smartphones, and repair workers repairing broken artifacts. I analyze implications for making data science systems actionable by framing the participants as potential end-users of these systems. My findings emphasize that actionability in data science systems concerns not just predictions made on mostly given datasets. Actionability in my settings arose from the ongoing work of making data relevant to artifacts and phenomena that end-users engaged with in their practices and settings. I show how this ongoing work of making data relevant was challenging. The properties of artifacts and phenomena were inherently multiple and their relevance was contingent on end-users’ situations. I describe end-users’ data practices as processes of “registering” (making intelligible) a contingent yet coherent set of properties to turn multiple, uncertain artifacts and phenomena into actionable versions. My dissertation makes several contributions to emerging research on actionability and data science in CSCW, HCI, and STS literature. First, based on my findings, I theorize an approach to data science systems that imagines actionability as driven not so much by data scientists generating predictions, or even by putting humans in the loop, but by placing end-users at the center. Second, my end-user approach to data science systems informs the technical work of data science by proposing requirements for models and algorithms to be accountable not just in their predictions but to end-users’ practices and settings. Third, my dissertation integrates into data science research foundational phenomenological views from CSCW that focus on how technological systems can account for and support end-users in their domains of practice, rather than the other way around.
Despite technical advances over the past few years in the area of systems support for cooperative work there is still relatively little understanding of the organisation of collaborative activity in real world, technologically supported, work environments. Indeed, it has been suggested that the failure of various technological applications may derive from their relative insensitivity to ordinary work practice and situated conduct. In this paper we discuss the possibility of utilising recent developments within sociology, in particular the naturalistic analysis of organisational conduct and social interaction, as a basis for the design and development of tools and technologies to support collaborative work. Focussing on the Line Control Rooms in London Underground, a complex multimedia environment in transition, we begin to explicate the tacit work practices and procedures whereby personnel systematically communicate information to each other and coordinate a disparate collection of tasks and activities. The design implications of these empirical observations, both for Line Control Room and technologies to support cooperative work, are briefly discussed.
Most computing serves as a resource or tool to support other work: performing complex analyses for engineering projects, preparing documents, or sending electronic mail using office automation equipment, etc. To improve the character, quality, and ease of computing work, we must understand how automated systems actually are integrated into the work they support. How do people actually adapt to computing as a resource? How do they deal with the unreliability in hardware, software, or operations; data inaccuracy; system changes; poor documentation; inappropriate designs; etc.; which are present in almost every computing milieu, even where computing is widely used and considered highly successful? This paper presents some results of a detailed empirical study of routine computer use in several organizations. We present a theoretical account of computing work and use it to explain a number of observed phenomena, such as:
How people knowingly use “false” data to obtain desired analytical results by tricking their systems.
How organizations come to rely upon complex, critical computer systems despite significant, recurrent, known errors and inaccurate data.
How people work around inadequate computing systems by using manual or duplicate systems, rather than changing their systems via maintenance or enhancement.
In addition, the framework for analyzing computing and routine work presented here proves useful for representing and reasoning about activity in multiactor systems in general, and in understanding how better to integrate organizations of people and computers in which work is coordinated.
The topic of Computer Supported Cooperative Work (CSCW) has attracted much attention in the last few years. While the field is obviously still in the process of development, there is a marked ambiguity about the exact focus of the field. This lack of focus may hinder its further development and lead to its dissipation. In this paper we set out an approach to CSCW as a field of research which we believe provides a coherent conceptual framework for this area, suggesting that it should be concerned with thesupport requirements of cooperative work arrangements. This provides a more principled, comprehensive, and, in our opinion, more useful conception of the field than that provided by the conception of CSCW as being focused on computer support for groups. We then investigate the consequences of taking this alternative conception seriously, in terms of research directions for the field. As an indication of the fruits of this approach, we discuss the concept of ‘articulation work’ and its relevance to CSCW. This raises a host of interesting problems that are marginalized in the work on small group support but critical to the success of CSCW systems ‘in the large’, i. e., that are designed to meet current work requirements in the everyday world.
At a very early stage in the course of CSCW, it became evident that categories such as ‘conversation’ or ‘workflow’ were quite
insufficient for characterizing and understanding the ways in which cooperative work is coordinated and integrated. It quickly
became obvious that cooperating actors somehow, while doing their individual bits, take heed of the context of their joint
effort. More specifically, the early harvest of ethnographic field studies in CSCW (e.g., Harper et al., 1989a, b; Heath and
Luff, 1991a) indicated that cooperating actors align and integrate their activities with those of their colleagues in a seemingly
‘seamless’ manner, that is, without interrupting each other, for instance by asking, suggesting, requesting, ordering, reminding,
etc. others of this or that.
The paper draws its inspiration from the provocation which Merton offered sociology both to engage with empirical data and to perform analyses adequate to guide intervention beyond the particular case. Whilst contemporary STS is very different both in its models of theory and its forms of methodology, this paper suggests Merton's concerns with engagement and adequacy provide a useful way to interrogate current approaches. Specifically, the paper explores some recent anthropological conceptions of ethnographic fieldwork that have provided potent models for the study of scientific and technological cultures. These multi-sited approaches have also provided the opportunity to develop new notions of intervention and explore alternative ways of making contributions to development of theory and practice. In the process of pursuing the goals of engagement and adequacy notions of ethnography have however become stretched. This sense of detachment from methodological canons accentuates the need for methodological debate and skill-sharing in STS.
The prevalence of chronic disease along with the technologies to develop these diseases, have altered the organizational structure of health care. Through documented case studies, the authors demonstrate how health workers confront these issues, guiding the reader through various work sites, the interactions of staff members with each other and with patients, and the overall patient treatment and response. Focusing on the concept of illness trajectory, this book vividly illustrates the complex, contingent nature of modern medical work.
This article examines HIV-positive patients' experiences of treatments within a context characterized by the multiplicity of opinions expressed both by specialists and the public domain (media in particular). It is based upon a survey of 63 patients encountered in a Paris hospital. The authors demonstrate the contrasts between these patients In terms of two main dimensions: the degree of the patients' proximity to specialist knowledge, and the level of homogeneousness that the patients attribute to medical know-how. At the point where these two dimensions meet, the article distinguishes between three forms of patient attitude towards treatment; in other words, three ways of simultaneously positioning oneself with regard to the media, associations, doctors and family circles/entourage: resorting to exteriority; self-integration into biomedical institutions; arranging heterogeneous actors. It analyses the transformations relating to the main experience profiles highlighted by sociological studies of other pathologies.
This paper focuses on time management as a cooperative task. Based on an analysis of the cultural complexity of scheduling surgical operations in a large clinic, possibilities of using information technology are explored. A computer system can be used to facilitate and change the negotiation of resource deployment in complex organizations by a) providing an integrated view of time management problems and decision-making within a complex organization, and b) by improving coordination. The paper discusses some design options for such a system which combines negotiation support with an auromatic sheduling device and critically examines the rationale for an organization to accept and implement such a system.