Healthcare Information Giving Services

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Healthcare Information Giving Services

• Technologies and Everyday Practicalities
• K. Clarke, J. Rooksby, and M. Rouncefield
• (Lancaster University)
• R. Procter and R. S. Slack
• (University of Edinburgh)

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Studies

• Based on studies of work practice in two
  settings
• Scottish Poisons Information Bureau
• Mental Health Helpline

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Background Beautiful Logic

• Policy drivers healthcare needs computer-based
  systems
• Perception of resulting positive impacts on
  trust, reliability and effectiveness
• Beautiful logic (Gregory) the system has a
  beautiful logic but users cannot see how to use
  it in practice

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What This Misses

• The actual lived work of people doing the job
  the common sense, banal, everyday work of the
  organisation
• E.g. advising is not just reading what is on the
  screen
• How to get at this?

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What We Do

• Ethnomethodological ethnography learning in
  detail what members know and use
• Co-realisation long term engagement with users
  moving into what would be maintenance phase of
  traditional developments

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What It Adds

• Detailed analyses of work practice
• Identifies the achievement of e.g. advice-giving
  not just following logic of database
• Its only through membership and long term
  engagement that we can design work affording
  systems and see what systems weve designed
  afford

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What It Adds

• Show how information is used what resources,
  when and how
• Extracts in the paper provide some design
  relevant examples
• Flexibility of design
• Worldliness of training

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Doing Information Work

• The poisons information and mental health advice
  lines have different user constituencies with
  very similar needs
• Need is for relevant and relevanced information
  in and for this particular case or call
• Communication across boundaries also issue here

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Doing Information Work (SPIB)

• Scottish Poisons Information Bureau (SPIB)
  TOXBASE (www database) and information officers
  to handle calls from healthcare professionals

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Doing Information Work (SPIB)

• Looking at transcripts between information
  officer (IO) and caller
• Collaborative character of calls IO and caller
  work to do advising.
• Calls not routine routine is achievement of IOs
  recipient designing, relevancing and repairing in
  real time. Contrast to ordering by system in e.g.
  calls to banks

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Doing Information Work (SPIB)

• Improvisational choreography information not
  just there but has to be made to come to hand.
  E.g. snake bites
• Accounting for search narrating what has been
  done suggesting other sources
• Offering candidate accounts IOs alert callers to
  potential issues. E.g. isopropyl alcohol

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Doing Information Work (MHH)

• Mental Health Helpline (MHH) Volunteer
  telephone-based advice for persons with issues
  related to mental health.

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Doing Information Work (MHH)

• Doing the organisations work (Watson)
• MHH provides listening service
• Advice based on formulation or emergent
  perception of callers troubles displayed
  during calls course
• Work of finding out what the advisable problem
  actually is

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Doing Information Work (MHH)

• Duality of service information and listening
  mutually elaborative
• Some calls advice sought, others listening how
  to make the listening aspect of the work
  accountable and what implications would
  computer-based service have here?

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Some Interim Findings

• Not simply reading whats on screen more to
  work but might not be visible from design/to
  design
• Practical usage of classification schemes
• Potential tension between practical
  classification and imposed standards. Workarounds
  
• Flexibility

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Some Interim Findings

• Sociality of the work
• Centrality of intermediaries
• Narration of search
• Offering candidate advice based on unfolding
  relevances in call

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Conclusions

• Calls are best described as ongoing and
  developing sequences of action, actions that get
  formed up into organizational events Whalen,
  1995
• Advising as a situated activity system
  (Goffman)

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Conclusions

• Getting the beautiful logic to work requires
  attention to the actual work this is where the
  beautiful logic is, where the action is
• By looking at situations such as advice giving in
  this way produce work affording systems

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Acknowledgements

• The authors wish to thank the personnel of SPIB
  and the Mental Health Helpline for their patience
  and agreement to be observed/recorded
• The study on which the paper is based is funded
  by the EPSRC, grant number GR/86683/01