The transfer of patients from intensive care unit (ICU) to general ward involves risk to patient ... more The transfer of patients from intensive care unit (ICU) to general ward involves risk to patient health. To mitigate this risk the present study investigates the current use of follow-up plans in the handover from ICU to general ward and proposes a novel design of follow-up plans. On the basis of a record audit we find that follow-up plans exist for only 16% of the audited transfers, that these plans are rarely used, and that 25% of the patients with a plan die within 24 hours of their transfer. In a subsequent series of participatory-design workshops with ICU and ward nurses we devised an electronic follow-up plan that consists of an attend-to list rather than a checklist. The attend-to list specifies the issues of concern but leaves the process of attaining them for the general-ward nurses to decide, thereby acknowledging and utilizing their expertise.
Embracing real use in an iterative approach calls for systematic formative evaluation. Effects-dr... more Embracing real use in an iterative approach calls for systematic formative evaluation. Effects-driven IT Development has been suggested as a way of supporting a Participatory Design (PD) process involving implementations that expose mature prototypes to real work practices. This is followed by evaluations of how specified and desired effects are obtained. We present results from a project where high-level political goals ('More Warm Hands'; i.e., clinicians spending more time at the patient bedside) are aligned with the local clinical organization and practice. We demonstrate how to combine quantitative and qualitative methods to address various levels of 'use' from overall politics to actual practice. The project concerns the introduction and use of an electronic whiteboard system to support clinical overview and logistics at emergency departments (EDs). The nurses succeed in getting 'warmer hands' while the physicians have good reasons for not pursuing this aim after all. The study contributes to a growing bulk of literature on how to include PD in the later stages of iterative development.
We present effects-driven IT development as an instrument for pursuing and reinforcing Participat... more We present effects-driven IT development as an instrument for pursuing and reinforcing Participatory Design (PD) when it is applied in commercial information technology (IT) projects. Effects-driven IT development supports the management of a sustained PD process throughout design and organizational implementation. The focus is on the effects to be achieved by users through their adoption and use of a system. The overall idea is to (a) specify the purpose of a system as effects that are both measurable and meaningful to the users, and (b) evaluate the absence or presence of these effects during real use of the system. Effects are formulated in a user-oriented terminology, and they can be evaluated and revised with users in an iterative and incremental systems-development process that involves pilot implementations. In this paper we investigate the design, pilot implementation, and effects assessment of an electronic patient record. Effects concerning, among other things, clinicians' mental workload were specified and measured, but apart from the planned changes associated with these effects the pilot implementation also gave rise to emergent, opportunitybased, and curtailed changes. We discuss our experiences regarding conditions for making the specification of effects and their real-use evaluation central activities in IT projects.
ACM Transactions on Computer-Human Interaction, Jun 13, 2020
We investigate professional greenhouse growers' user experience (UX) when using climatemanagement... more We investigate professional greenhouse growers' user experience (UX) when using climatemanagement systems in their daily work. We build on the literature on UX, in particular UX at work, and extend it to ordinary UX at work. In a ten-day diary study, we collected data with a general UX instrument (AttrakDiff), a domain-specific instrument, and interviews. We find that AttrakDiff is valid at work; its threefactor structure of pragmatic quality, hedonic identification quality, and hedonic stimulation quality is recognizable in the growers' responses. In this paper, UX at work is understood as interactions among technology, tasks, structure, and actors. Our data support the recent proposal for the ordinariness of UX at work. We find that during continued use UX at work is middle-of-the-scale, remains largely constant over time, and varies little across use situations. For example, the largest slope of the four AttrakDiff constructs when regressed over the ten days was as small as 0.04. The findings contrast existing assumptions and findings in UX research, which is mainly about extraordinary and positive experiences. In this way, the present study contributes to UX research by calling attention to the mundane, unremarkable, and ordinary user experiences at work.
This position paper is about socio-technical interventions in pilot implementation contexts. It a... more This position paper is about socio-technical interventions in pilot implementation contexts. It argues that human work interaction design provides massive push towards such interventions. It does so through theorizing the continuous relation-building between empirical work analysis and interaction design activities that creates new local solutions for the stakeholders involved. The question is how hard of soft that this push should be.
Purpose The purpose of this paper is to investigate how four international students at a Danish u... more Purpose The purpose of this paper is to investigate how four international students at a Danish university cope with their study-related and everyday information needs, behaviorally as well as affectively, and how their information seeking blends with their cross-cultural adaptation. Design/methodology/approach Each of the four participants contributed ten diaries and took part in three interviews during the first semester of their stay. Findings International students’ information needs and seeking behavior are shaped by their host university but also by cross-cultural, personal and situational issues. While the cross-cultural issues set international students apart from domestic students, the personal and situational issues create individual differences that call for more individually tailored support. The studied international students lacked information about both study-related and everyday issues. These two types of issues were intertwined and experienced as equally stressful. ...
Digital communication between government and citizens is pivotal to e-government. The Danish egov... more Digital communication between government and citizens is pivotal to e-government. The Danish egovernment initiative Digital Post aims to digitize all communication between government and citizens. We surveyed local government staff about how Digital Post affects the service delivered to citizens. As much as 82% of the 448 respondents considered digital communication with citizens using Digital Post a good idea, yet 47% reported concrete incidents in which they perceived a decrease in service with Digital Post. This result shows the importance of distinguishing between the overall service relationship and the concrete incidents of which the service consists. We discuss interactions between the relationship level and the incident level of Digital Post on the basis of a content analysis of the respondents' incident descriptions.
In workplace contexts the performance of many information tasks is prescribed in procedures. Know... more In workplace contexts the performance of many information tasks is prescribed in procedures. Knowledge of the relationship between workplace procedures and actors' real information behavior is important to understanding information behavior. We explore this relationship by looking at how emergency clinicians' information behavior relates to clinical triage guidelines.
Communications in Computer and Information Science, 2019
Service design is an information intensive activity. This study aims to investigate service desig... more Service design is an information intensive activity. This study aims to investigate service designers' information behavior and understand the roles people and documents play as information sources for service designers. Ten designers were interviewed about their information seeking behavior in one service design project from its start to its completion. The interviewees were asked to describe and reflect upon their choice of information sources and their use of project documentation. Each interview lasted about 1.5 hours. The interviews were transcribed in full and the transcripts were coded with respect to design activities, information sources used, and reflections on information behavior. People served five different roles as information sources and documents served four. Documents became increasingly important sources of information as projects progressed because still more information was recorded in writing. Consistent with previous research, people play an important role because of their easy accessibility and the good quality of the information they provide. In contrast, the forwardlooking role of document creation restricts the backward-looking roles of the resulting documentation. We speculate that the consultancies suffer from poor integration across documents.
We revisit the role of participatory design approaches in the light of the accreditation regime c... more We revisit the role of participatory design approaches in the light of the accreditation regime currently imposed on the Danish healthcare sector. We describe effects-driven IT development as an instrument supporting sustained participatory design. Effects-driven IT development includes specifying, realizing, and measuring the effects from using an information technology. This approach aligns with much of the logic in accreditation but is distinguished by its focus on effects, whereas current accreditation approaches focus on processes. Thereby, effects-driven IT development might support challenging parts of the accreditation process and fit well with clinical evidence-based thinking. We describe and compare effects-driven IT development with accreditation, in terms of the Danish Quality Model which is used throughout the Danish healthcare sector, and we discuss the prospects and challenges of combining these two approaches.
Purpose Social question and answer (social Q&A) sites have become a popular tool for obtaining mu... more Purpose Social question and answer (social Q&A) sites have become a popular tool for obtaining music information. The purpose of this paper is to investigate what users ask about, what experience the questions convey, and how users specify their questions. Design/methodology/approach A total of 3,897 music questions from the social Q&A site Yahoo! Answers were categorized according to their question type, user experience, and question specification. Findings The music questions were diverse with (dis)approval (42 percent), factual (21 percent), and advice (15 percent) questions as the most frequent types. Advice questions were the longest and roughly twice as long as (dis)approval and factual questions. The user experience associated with the questions was most often pragmatic (24 percent) or senso-emotional (12 percent). Pragmatic questions were typically about the user’s own performance of music, while senso-emotional questions were about finding music for listening. Notably, half...
For more than a decade, quality development in the Danish health care sector has been managed wit... more For more than a decade, quality development in the Danish health care sector has been managed with an accreditation system known as the Danish quality model (DQM), shaping the strategy for how to align work organization with technology use. In this article, we introduce a participatory design approach, known as effects-driven information technology development (EDIT), and discuss how this approach may contribute to a new quality-assurance program for the Danish health care sector. Our purpose is to demonstrate how accreditation, which focuses on processes and standards, needs to be supplemented and balanced with participatory approaches that allow for local experimentation and implementation of high-quality outcomes. We describe accreditation and participatory design as two approaches to reconfiguring and aligning work organization and technology; further, we emphasize the differences in each approach’s strategy and application.
Large-scale generic systems are typically adapted to local practice through configuration. This i... more Large-scale generic systems are typically adapted to local practice through configuration. This is especially important in healthcare, which involves a plurality of institutions and users. However, the decision to acquire a generic system in public healthcare is typically founded on regional and national health policy goals, which often are translated into various forms of standardization. As a result, national and regional health policy interests may stand in contrast to interests on the local level. Therefore, we analyze how national and local concerns are weighed against each other in the preparations for implementing large-scale generic systems in healthcare. We explore what role configuration plays and what the prospects are for long-term development. We contribute with insight into how the organizational consequences of generic systems are formed already in the preparation phase and point to how configuration easily results in standardization, thereby basically privileging nat...
The transfer of patients from intensive care unit (ICU) to general ward involves risk to patient ... more The transfer of patients from intensive care unit (ICU) to general ward involves risk to patient health. To mitigate this risk the present study investigates the current use of follow-up plans in the handover from ICU to general ward and proposes a novel design of follow-up plans. On the basis of a record audit we find that follow-up plans exist for only 16% of the audited transfers, that these plans are rarely used, and that 25% of the patients with a plan die within 24 hours of their transfer. In a subsequent series of participatory-design workshops with ICU and ward nurses we devised an electronic follow-up plan that consists of an attend-to list rather than a checklist. The attend-to list specifies the issues of concern but leaves the process of attaining them for the general-ward nurses to decide, thereby acknowledging and utilizing their expertise.
Embracing real use in an iterative approach calls for systematic formative evaluation. Effects-dr... more Embracing real use in an iterative approach calls for systematic formative evaluation. Effects-driven IT Development has been suggested as a way of supporting a Participatory Design (PD) process involving implementations that expose mature prototypes to real work practices. This is followed by evaluations of how specified and desired effects are obtained. We present results from a project where high-level political goals ('More Warm Hands'; i.e., clinicians spending more time at the patient bedside) are aligned with the local clinical organization and practice. We demonstrate how to combine quantitative and qualitative methods to address various levels of 'use' from overall politics to actual practice. The project concerns the introduction and use of an electronic whiteboard system to support clinical overview and logistics at emergency departments (EDs). The nurses succeed in getting 'warmer hands' while the physicians have good reasons for not pursuing this aim after all. The study contributes to a growing bulk of literature on how to include PD in the later stages of iterative development.
We present effects-driven IT development as an instrument for pursuing and reinforcing Participat... more We present effects-driven IT development as an instrument for pursuing and reinforcing Participatory Design (PD) when it is applied in commercial information technology (IT) projects. Effects-driven IT development supports the management of a sustained PD process throughout design and organizational implementation. The focus is on the effects to be achieved by users through their adoption and use of a system. The overall idea is to (a) specify the purpose of a system as effects that are both measurable and meaningful to the users, and (b) evaluate the absence or presence of these effects during real use of the system. Effects are formulated in a user-oriented terminology, and they can be evaluated and revised with users in an iterative and incremental systems-development process that involves pilot implementations. In this paper we investigate the design, pilot implementation, and effects assessment of an electronic patient record. Effects concerning, among other things, clinicians' mental workload were specified and measured, but apart from the planned changes associated with these effects the pilot implementation also gave rise to emergent, opportunitybased, and curtailed changes. We discuss our experiences regarding conditions for making the specification of effects and their real-use evaluation central activities in IT projects.
ACM Transactions on Computer-Human Interaction, Jun 13, 2020
We investigate professional greenhouse growers' user experience (UX) when using climatemanagement... more We investigate professional greenhouse growers' user experience (UX) when using climatemanagement systems in their daily work. We build on the literature on UX, in particular UX at work, and extend it to ordinary UX at work. In a ten-day diary study, we collected data with a general UX instrument (AttrakDiff), a domain-specific instrument, and interviews. We find that AttrakDiff is valid at work; its threefactor structure of pragmatic quality, hedonic identification quality, and hedonic stimulation quality is recognizable in the growers' responses. In this paper, UX at work is understood as interactions among technology, tasks, structure, and actors. Our data support the recent proposal for the ordinariness of UX at work. We find that during continued use UX at work is middle-of-the-scale, remains largely constant over time, and varies little across use situations. For example, the largest slope of the four AttrakDiff constructs when regressed over the ten days was as small as 0.04. The findings contrast existing assumptions and findings in UX research, which is mainly about extraordinary and positive experiences. In this way, the present study contributes to UX research by calling attention to the mundane, unremarkable, and ordinary user experiences at work.
This position paper is about socio-technical interventions in pilot implementation contexts. It a... more This position paper is about socio-technical interventions in pilot implementation contexts. It argues that human work interaction design provides massive push towards such interventions. It does so through theorizing the continuous relation-building between empirical work analysis and interaction design activities that creates new local solutions for the stakeholders involved. The question is how hard of soft that this push should be.
Purpose The purpose of this paper is to investigate how four international students at a Danish u... more Purpose The purpose of this paper is to investigate how four international students at a Danish university cope with their study-related and everyday information needs, behaviorally as well as affectively, and how their information seeking blends with their cross-cultural adaptation. Design/methodology/approach Each of the four participants contributed ten diaries and took part in three interviews during the first semester of their stay. Findings International students’ information needs and seeking behavior are shaped by their host university but also by cross-cultural, personal and situational issues. While the cross-cultural issues set international students apart from domestic students, the personal and situational issues create individual differences that call for more individually tailored support. The studied international students lacked information about both study-related and everyday issues. These two types of issues were intertwined and experienced as equally stressful. ...
Digital communication between government and citizens is pivotal to e-government. The Danish egov... more Digital communication between government and citizens is pivotal to e-government. The Danish egovernment initiative Digital Post aims to digitize all communication between government and citizens. We surveyed local government staff about how Digital Post affects the service delivered to citizens. As much as 82% of the 448 respondents considered digital communication with citizens using Digital Post a good idea, yet 47% reported concrete incidents in which they perceived a decrease in service with Digital Post. This result shows the importance of distinguishing between the overall service relationship and the concrete incidents of which the service consists. We discuss interactions between the relationship level and the incident level of Digital Post on the basis of a content analysis of the respondents' incident descriptions.
In workplace contexts the performance of many information tasks is prescribed in procedures. Know... more In workplace contexts the performance of many information tasks is prescribed in procedures. Knowledge of the relationship between workplace procedures and actors' real information behavior is important to understanding information behavior. We explore this relationship by looking at how emergency clinicians' information behavior relates to clinical triage guidelines.
Communications in Computer and Information Science, 2019
Service design is an information intensive activity. This study aims to investigate service desig... more Service design is an information intensive activity. This study aims to investigate service designers' information behavior and understand the roles people and documents play as information sources for service designers. Ten designers were interviewed about their information seeking behavior in one service design project from its start to its completion. The interviewees were asked to describe and reflect upon their choice of information sources and their use of project documentation. Each interview lasted about 1.5 hours. The interviews were transcribed in full and the transcripts were coded with respect to design activities, information sources used, and reflections on information behavior. People served five different roles as information sources and documents served four. Documents became increasingly important sources of information as projects progressed because still more information was recorded in writing. Consistent with previous research, people play an important role because of their easy accessibility and the good quality of the information they provide. In contrast, the forwardlooking role of document creation restricts the backward-looking roles of the resulting documentation. We speculate that the consultancies suffer from poor integration across documents.
We revisit the role of participatory design approaches in the light of the accreditation regime c... more We revisit the role of participatory design approaches in the light of the accreditation regime currently imposed on the Danish healthcare sector. We describe effects-driven IT development as an instrument supporting sustained participatory design. Effects-driven IT development includes specifying, realizing, and measuring the effects from using an information technology. This approach aligns with much of the logic in accreditation but is distinguished by its focus on effects, whereas current accreditation approaches focus on processes. Thereby, effects-driven IT development might support challenging parts of the accreditation process and fit well with clinical evidence-based thinking. We describe and compare effects-driven IT development with accreditation, in terms of the Danish Quality Model which is used throughout the Danish healthcare sector, and we discuss the prospects and challenges of combining these two approaches.
Purpose Social question and answer (social Q&A) sites have become a popular tool for obtaining mu... more Purpose Social question and answer (social Q&A) sites have become a popular tool for obtaining music information. The purpose of this paper is to investigate what users ask about, what experience the questions convey, and how users specify their questions. Design/methodology/approach A total of 3,897 music questions from the social Q&A site Yahoo! Answers were categorized according to their question type, user experience, and question specification. Findings The music questions were diverse with (dis)approval (42 percent), factual (21 percent), and advice (15 percent) questions as the most frequent types. Advice questions were the longest and roughly twice as long as (dis)approval and factual questions. The user experience associated with the questions was most often pragmatic (24 percent) or senso-emotional (12 percent). Pragmatic questions were typically about the user’s own performance of music, while senso-emotional questions were about finding music for listening. Notably, half...
For more than a decade, quality development in the Danish health care sector has been managed wit... more For more than a decade, quality development in the Danish health care sector has been managed with an accreditation system known as the Danish quality model (DQM), shaping the strategy for how to align work organization with technology use. In this article, we introduce a participatory design approach, known as effects-driven information technology development (EDIT), and discuss how this approach may contribute to a new quality-assurance program for the Danish health care sector. Our purpose is to demonstrate how accreditation, which focuses on processes and standards, needs to be supplemented and balanced with participatory approaches that allow for local experimentation and implementation of high-quality outcomes. We describe accreditation and participatory design as two approaches to reconfiguring and aligning work organization and technology; further, we emphasize the differences in each approach’s strategy and application.
Large-scale generic systems are typically adapted to local practice through configuration. This i... more Large-scale generic systems are typically adapted to local practice through configuration. This is especially important in healthcare, which involves a plurality of institutions and users. However, the decision to acquire a generic system in public healthcare is typically founded on regional and national health policy goals, which often are translated into various forms of standardization. As a result, national and regional health policy interests may stand in contrast to interests on the local level. Therefore, we analyze how national and local concerns are weighed against each other in the preparations for implementing large-scale generic systems in healthcare. We explore what role configuration plays and what the prospects are for long-term development. We contribute with insight into how the organizational consequences of generic systems are formed already in the preparation phase and point to how configuration easily results in standardization, thereby basically privileging nat...
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Papers by Morten Hertzum