Documents and work

1. Documents and work Carsten Østerlund

2. Documents are Everywhere

3. Example: Document in Healthcare • Developing and Implementing healthcare IT • A long history • http://www.youtube.com/watch?v=t-aiKlIc6uk

4. Documents in Healthcare • Conundrum: • Despite five decades of work the healthcare sector has not been able to implement large scale medical information systems • State of affairs: • Many incompatible information systems coexist in current healthcare environment • Question: • How do doctors and nurses use medical documents?

5. Repeated History Taking Sophie & Mother Primary Care Clinic Emergency Room Hospital Ward Nurse Secretary Clinical Assistant Primary Care Doctor Triage Nurse Registration ER Nurse Resident ER Attending Doctor Night-Float In-Patient Nurse Medical Student Intern Senior Resident Attending Doctor

6. Multiple Documents Sophie & Mother Nurse Secretary Clinical Assistant Primary Care Doctor Triage Nurse Registration ER Nurse Resident ER Attending Doctor Night-Float In-Patient Nurse Medical Student Intern, Marc Senior Resident Attending Doctor Document

7. History of Document Research • Prior to the advent of the computer and IS field • Post advent of the information technology • Reemerging focus on Documents and Work

8. Prior to the Computer & IS field • Need for improved access to the records of scholarship • Debates: • Graphic materials of scholarship vs. documents of all sorts in all field of human activity • Documents as: graphic materials vs. any material basis for knowledge. • Example: Is a gazelle a document? (Suzanne Briet)

9. Post the Computer & IS field • 1930s introduction of microfilm by Eastman Kodak and later IBMs punch-cards • Predictions that these new media would change science and supplant the conventional book • Shift in focus from document as object to information as object • Detach the content of documents from their form (material instantiation) and context • Focus on the manipulation of information

10. Reemerging Focus on Documents & Work • Documents in work settings • Documents as part of infrastructures • Emphasis on mutability and mobility of documents • A concern for the materiality of documents

11. Documents & Work • Key point: Do not focus on documents as a discrete topic but as something that enter into and coordinate people’s doings • Documents are people’s doings • Dealing with documents constitute an important part of most people’s daily work practices • Yet, documenting work is often not regarded as ‘real’ work • It is invisible, hidden, articulation, black-boxed work • Examples: • Service Technicians & Copiers • Scientists work • Police work • Architecture • Medicine • Etc.

12. Multiple Documents Sophie & Mother Nurse Secretary Clinical Assistant Primary Care Doctor Triage Nurse Registration ER Nurse Resident ER Attending Doctor Night-Float In-Patient Nurse Medical Student Intern, Marc Senior Resident Attending Doctor Document

13. Case - continued • Marc, the Intern • Doctor in first year of residency • HOSO: • House Officer Sign-Out

14. HOSO

15. HOSO as Flexible Map Space Sophie Space Patient Hospital ward

16. HOSO as Itinerary Time Sophie Sophie Space Space Things to do

17. Coordination Through the Use of Maps and Itineraries Time Sophie Sophie Space Things to do Marc’s Moves

18. Case: Intern & Senior Resident • Intern: Marc (1st year resident) • Senior Resident: Elisabeth (4th year resident) • Work closely together and share practices • Keep separate on-line records of patients: • Similar factual information • Use same genre elements • What distinguishes their documenting practices? • Why not one system?

19. Senior Note I

20. Senior Note II

21. HOSO

22. Documents’ Double Accountability • Account of something • Account (model) of practice • Allow overseeing practices to ensure they meet standards • Accounting for something • Account (model) for practice • Allow people to coordinate practices

23. Documents and Audience Documents interact with their audience by acting as prescriptive devices Documents denote their use by telling the reader how they, the documents are to be applied and the proper context of their use People can recognize a document's prescriptions only if they are familiar with the document genre and context People’s background knowledge enables them to understand how to use the document Documents: Prescriptive Devices Audience: Carriers of Background Knowledge

24. Documents & Knowledge Sharing Explicit Documents Narrower Broader Broader Narrower Background Knowledge

25. Dynamic Relationship between document and audience Documents: Prescriptive Devices Audience: Carriers of Background Knowledge Dynamic Relationship • Dynamic relationship between documents as prescriptive devices and users as carriers of background knowledge • How much background knowledge do the users bring and how much does the documents prescribe?

26. Documents as Portable Places • Pronouns, demonstratives and other deictics or shifters relate utterances to their speaker, addressees, referents, places, and times (Linguistic anthropologist, Hanks) • Play a key part in our interpretation of our communication • Example I: “Down there!” • Example II: “We keep the orthopedic patients down at the end of the hallway by the elevator – to radiology.”

27. Documents as Portable Places • Two types of relationship, between • the interacting parties • the interacting parties and their referent (i.e., the patient)

28. Senior Note I: Interacting Parties No Speaker or Address Contemporaries to this document Spatial Field Temporal Field

29. HOSO: Interacting Parties Contemporaries to this document No Speaker or Address Spatial Field Temporal Field

30. Interacting Parties • Addressivity and Participants • No explicit address or signatures • Communal documents • Group of care participants and contemporaries • Spatial Field • Important places • Temporal Field • Temporal structure for work day

31. Senior Note I: Referent All patients as the referent

32. Senior Note II: Referent Spatial References Individual patient as the referent Participants without enduring relationships Temporal References

33. HOSO: Referent Participants without enduring relationships Spatial References Temporal References

34. Referent – Patients’ Histories • Two levels of relationships between interacting parties and referents: • Groups of patients • Individual patients • Participants • Spatial references in patient histories • Temporal references in patient histories

35. HOSO & Senior Note: Differences • HOSO: • Here-and-now communication in a small group following the same rhythm in the same place. • Emphasizes task at hand. • Senior Notes: • Larger group not working shoulder to shoulder. • Senior Residents do not share same degree of symmetric access to each other and patients (referent).

36. Documents’ Double Accountability • Account of something • Account (model) of practice • Allow overseeing practices to ensure they meet standards • Accounting for something • Account (model) for practice • Allow people to coordinate practices