In this paper, we describe a practice that is common across multiple heterogeneous contexts but enacted differently depending on the unique constellation of resources and demands present in each local context. Using the case of informal... more
In this paper, we describe a practice that is common across multiple heterogeneous contexts but enacted differently depending on the unique constellation of resources and demands present in each local context. Using the case of informal documentation practices in two departments of a single hospital, Emergency and Labor & Delivery, we describe how clinicians in each department develop contextualized informal documentation practices after deployment of a new EMR system. We describe three underlying functions of informal documentation that are inherent to the practice of medical personnel: "memory work," abstraction work," and "future work." We then find that the newly deployed EMR technology does not support these kinds of work. We argue that hospital documentation work systems should be designed with an eye to such universal work practices, while keeping in mind that the effectiveness of informal documentation practices is rooted in its adaptive and flexible deployment in heterogeneous work settings.
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Electronic Medical Records promise to simultaneously enhance coordination and provide transparency and accountability in work process. As such, EMR are purported to benefit both hospitals and patients. In this paper we use grounded... more
Electronic Medical Records promise to simultaneously enhance coordination and provide transparency and accountability in work process. As such, EMR are purported to benefit both hospitals and patients. In this paper we use grounded empirical data to explore how this promise plays out in the everyday tasks of healthcare providers. Building on the small body of CSCW literature that suggests that the accounting functions of EMR are impinging on the ability of medical personnel to coordinate work, we draw on the theoretical lens of new institutionalism to outline how certain institutional logics around safety and accountability are shaping the experience of EMR systems in situ. We suggest that the institutional logics that currently characterize U.S. healthcare are embedded in the EMR design itself, structuring how institutional values such as " safety " are achieved and evaluated. Using over one year of ethnographic research in an obstetrical unit, we find that the institutional logics of " safety " embedded in the EMR create negative organizational outcomes, effectively undermining coordination and necessitating inaccurate accounts of work. We provide design implications to address these issues in the current institutional environment and envision how systems might be designed to promote alternate logics of safety that are social, dynamic, and cast humans as expert agents in the system.
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This panel will explore algorithmic authority as it manifests and plays out across multiple domains. Algorithmic authority refers to the power of algorithms to manage human action and influence what information is accessible to users.... more
This panel will explore algorithmic authority as it manifests and plays out across multiple domains. Algorithmic authority refers to the power of algorithms to manage human action and influence what information is accessible to users. Algorithms increasingly have the ability to affect everyday life, work practices, and economic systems through automated decision-making and interpretation of " big data ". Cases of algorithmic authority include algorithmically curating news and social media feeds, evaluating job performance, matching dates, and hiring and firing employees. This panel will bring together researchers of quantified self, healthcare, digital labor, social media, and the sharing economy to deepen the emerging discourses on the ethics, politics, and economics of algorithmic authority in multiple domains.
In households that rely on biomass for a large percentage of their energy needs, adoption of improved biomass stoves can result in significant reduction of indoor air pollutants and emissions of greenhouse gasses with concurrent health... more
In households that rely on biomass for a large percentage of their energy needs, adoption of improved biomass stoves can result in significant reduction of indoor air pollutants and emissions of greenhouse gasses with concurrent health co-benefits. To maximize the effectiveness of the stove dissemination process, promoters should choose target populations that are both likely to adopt the new technology and to influence the opinions of other potential adopters within a social group. In the current study a longitudinal analysis of adoption patterns and intensity of use of a Patsari improved biomass cookstove was conducted in 259 randomly selected households of a community intervention study in rural communities of Michoacan, Mexico. Health promoters classified households into one of several stove user groups during a series of monthly follow up interviews after Patsari installation, based on physical traces of use and household self-reporting by questionnaire. Multinomial logistic regression was used develop a model of household and community characteristics associated with early adoption of the Patsari, leading to the development of bi-level model for targeting improved stove dissemination efforts. Factors including community of residence, number of adults in household, suffering from irritated eyes, using wood scraps for fuel, and cooking with certain types of traditional fogons were associated with early adoption of Patsari cookstoves. Maximum saturation of the Patsari in the study population was reached four months after installation; after this point, stove use decreased until eight months but remained relatively steady with 55% of the sample using the Patsari regularly from month eight onwards. Results highlight the importance of utilizing effective targeting strategies to maximize NGO resources and increase the robustness of the diffusion process, resulting in more stoves in actual use. Additionally, results point to the importance of evaluating the success of an improved stove program in terms of stove use over time, rather than the total number of stoves disseminated.
Data reuse – long a key focus of information studies and CSCW research on eScience – is increasingly a major issue in organizations attempting to leverage data gathered using information systems for accountability functions such as... more
Data reuse – long a key focus of information studies and CSCW research on eScience – is increasingly a major issue in organizations attempting to leverage data gathered using information systems for accountability functions such as performance measurements. Carrying out organizational analytics and performance measurements for accountability typically rests on the ability to successfully reuse existing, procurable data. We present results from an ethnographic study of the practices of recording birth certificate data and related attempts to assess and improve birth certificate data in response to a new re-use of birth certificate data for measurements introduced to hold hospitals accountable for the quality of the care they are delivering. Drawing on literature on data reuse and information infrastructure, we describe the situated work that must take place in order for birth certificate data to be reused for accountability purposes, and the organizational capacity building that must take place to facilitate the reuse of birth certificate data for measurement oriented to organizational improvement and accountability.
Diverse domains including education, healthcare, and business are attempting to harness IT and data science to govern individual and organizational performance. Largely centered on performance measurement, data-driven accountability tools... more
Diverse domains including education, healthcare, and business are attempting to harness IT and data science to govern individual and organizational performance. Largely centered on performance measurement, data-driven accountability tools are used to engineer work processes according to best practices and transfer policy to practice through tying quantitative outcomes to consequential valuation schemes. In this early work, we present preliminary insights from a multi-sited ethnography of ongoing development of infrastructure for data science being developed for purposes of organizational accountability in the healthcare. The aim is to describe key concerns in the design of 'infrastructure for accountability' (consisting of the array IT, organizations, organizational relationships, standards, and roles being developed to undergird performance measurement). Some initial considerations for design of infrastructure for accountability include dual functions of the data, communication hierarchy, emergent seams, and bridging installed bases and communities of practice. This research has implications for researchers, designers, and managers of infrastructure for accountability, as well contributing ethnographic empirical insights into social and organizational implications of creating the data-driven world.
Contemporary decisions about the management of populations, public services, security, and the environment are increasingly made through knowledge gleaned from 'big data' and its attendant infrastructures and algorithms. Though often... more
Contemporary decisions about the management of populations, public services, security, and the environment are increasingly made through knowledge gleaned from 'big data' and its attendant infrastructures and algorithms. Though often described as 'raw,' this data is produced by techniques of measurement that are imbued with judgments and values that dictate what is counted and what is not, what is considered the best unit of measurement, and how different things are grouped together and " made " into a measureable entity. In this paper, we analyze these politics of measurement and how they relate to action through two case studies involving high stake public health measurements where experts intentionally leverage measurement to change definitions of harm and health. That is, they use measurement for activism. The case studies offer a framework for thinking about of how the politics of measurement are present in user interfaces. It is usually assumed that the human element has been scrubbed from the database and that significant political and subjective interventions come from the analysis or use of data after the fact. Instead, we argue that human-computer interactions start before the data reaches the computer because various measurement interfaces are the invisible premise of data and databases, and these measurements are political.
CSCW has long been concerned with how work is coordinated. A rich body of literature examines the mechanisms underlying cooperative work and the articulation of discrete tasks into meaningful sequences of action. However, there is less... more
CSCW has long been concerned with how work is coordinated. A rich body of literature examines the mechanisms underlying cooperative work and the articulation of discrete tasks into meaningful sequences of action. However, there is less treatment of how workers balance multiple streams of work at once. In hospitals, the introduction of Health Information Technologies coupled with increased requirements for documentation means that workers must simultaneously care for and integrate two work trajectories: that related to the patient and that related to the medical record. Using data from an ethnographic study of labor & delivery nurses in a mid-size hospital, I describe the situated, embodied, and effortful work of coordinating multiple streams of action into a single coherent performance of work, a process I refer to as choreography, and present a number of choreography practices. I then describe implications of this perspective for CSCW.
Healthcare organizations and providers are being held accountable for the care they give and for their processes of improving care safety and quality to an unprecedented degree. In countries around the world, there is a pressing need to... more
Healthcare organizations and providers are being held accountable for the care they give and for their processes of improving care safety and quality to an unprecedented degree. In countries around the world, there is a pressing need to develop infrastructure for accountability of healthcare to support performance measurement and reporting activities. Yet, little research exists on the design, development, management, or governance of infrastructure for accountability in healthcare, nor on practices of data sharing and reuse that are central to healthcare performance measurement. This paper draws on literature on data sharing and cyberinfrastructure for eScience to identify key concepts from research on supporting collaborative scienctific practice to inform research on practices and infrastructure for healthcare accountability.
Keywords: Ethnography < Qualitative Orientation < Research Methods, Organizational communication and information systems (General) < Organizational Communication and Information Systems < Topic Areas, Organizational effectiveness <... more
Keywords: Ethnography < Qualitative Orientation < Research Methods, Organizational communication and information systems (General) < Organizational Communication and Information Systems < Topic Areas, Organizational effectiveness < Organization and Management Theory < Topic Areas, Coordination < Group/team processes < Organizational Behavior < Topic Areas Abstract: Ongoing coordination is the backbone of work process and organizational effectiveness. Coordinating requires that interdependent specialists achieve integrating conditions for coordination—including understanding who is accountable for carrying out a given task, how a sequence of action should proceed, and how one's work fits into the whole on an ongoing basis. Navigating the inevitable disconnect between formal logics of action and the specifics of the local context and situation at hand is a hallmark of effective coordinating. Nevertheless, as work systems designed to direct action with a heavy hand are increasingly implemented in organizations, the disconnect between formal delineations and situated practice is transformed with large negative consequences for organizations. Through 16 months of empirical research using ethnographic methods surrounding implementation of an Electronic Health Records (EHR) system in a hospital obstetric unit, we find that the EHR rendered what was once a productive disconnect between formal logics and situated practice into an unproductive disconnect. Further, this shift engendered a new form of ongoing coordinating. What was once 'artful coordinating' – in which clinicians across occupations drew upon on formal logics, local context and situated contingencies as resources to action and, in so doing, created conditions of predictability and informal accountability – became 'contorted coordinating,' characterized by working around formal logics of the EHR while struggling to meet the demands of local context and situated contingencies and, in so doing, undermining predictability.