Intelligences

The Secret Life of Medical Records: A Study of Medical Records and the People Who Manage Them

NATHANIEL MARTIN and PATRICIA WALL A study of the practices surrounding paper medical records captured key aspects of the work necessary to support this crucial element of health care. It uncovered work that was invisible to the nurses and physicians who use the records. This invisible work comprises tasks necessary to find and deliver the records as well as those necessary to ensure that the records are accurate and up to date. This study was undertaken because medical records are undergoing a transition from paper to digital systems, which will impact the practices of users of these systems at all levels, including clerical and medical staff. This is an area of particular interest to our organization as we look to provide technologies and services that enable seamless integration of paper and digital worlds. New technologies and practices will need to be developed to accomplish what is now being done invisibly....

The Invisible Work of Being a Patient and Implications for Health Care: “[The Doctor Is] My Business Partner in the Most Important Business in My Life, Staying Alive”

KENTON T. UNRUH and WANDA PRATT In a distributed system of care, patients shuffle among many clinicians and spend the majority of their time away from the treatment center. Although we see the results of patients’ work (e.g., medication taken, arrived at appointment) we do not see the work itself. By failing to see this work, industry overlooks issues with vital implications for their business. To lift the veil of invisibility from patients’ work, we conducted a longitudinal field study to uncover the invisible work breast cancer patients do to obtain information, bridge inter-institutional care, manage dependencies and resolve inconsistent recommendations. In this paper we provide detailed examples of this work and explore the impact on patients and health-care operations; identify patterns of work with implications for patient-centered research and design; and propose common information spaces to improve patients’ work through designs that highlight dependencies, preserve state information, link recommendations to justifications,...

Now You See It and Now You Don’t: Consequences of Veiling Relational Work

LISA KREEGER and ELIZABETH HOLLOWAY This paper offers findings from a study of relationship formation in Information Technology (I.T.) outsourcing services and explores the conditions in which relational practices are veiled by the work designs, tools, business lingo, and even media representations of Information Technology outsourcing services. Veiling describes the way the language and focus of these elements have taken over and permeated organizations to levels where the aspects of relational work are obscured. As a result, relational skills are delegitimized, work is slowed down, conflict results from incorrect assumptions, and inefficient technology is tolerated. We identify intended and unintended consequences, on individuals and organizations, of relational veiling as a strategy that emerges in response to the everyday realities of the workplace....

Close Encounter: Finding a New Rhythm for Client-Consultant Collaboration

HEINRICH SCHWARZ, MADS HOLME and GITTE ENGELUND In the current economic uncertainty ethnographic consultants are asked to intensify their client focus and to demonstrate and improve the relevancy and impact of their work. This paper reports on a case of close collaboration between client and consultant during an ethnographic consulting project. It discusses three crucial challenges: the challenge of aligning expectations and clarifying roles, the challenge of cultural differences and confusion over ethnographic methods, and the challenge of finding the right rhythm between close interaction and useful separation. Written from both the consultant and the client perspective we describe how similar situations were experienced differently by both parties, analyse what underlies some of these tensions, and suggest some lessons for ethnographers and clients alike for future close encounters. The paper suggests that the central challenge lies in finding the right balance between client-emic and client-etic positions and in inviting clients...

Taking the Driver’s Seat: Sustaining Critical Enquiry While Becoming a Legitimate Corporate Decision-Maker

ROGERIO DE PAULA, SUZANNE L. THOMAS and XUEMING LANG Staying relevant (to the business) is at the heart of career-advancement and (increasingly) job-security, particularly, in a business unit. It embodies a number of different meanings to the different players in corporate—from supporting product definition to creating strategic plans to making the appropriate business decisions. Rather surprisingly, though, we find EPIC talking about it with a certain discomfort, particularly when it comes to affect our identities as social researchers. On the other hand, we, in the industry, have little choice but to “play the game” and find ways whereby we can best utilize our knowledge, experiences, skills, our unique perspective to endow us an edge—creating interesting possibilities to stay relevant. This paper investigates our own trajectories in the past few years in a product group at Intel where we suddenly found ourselves increasingly more involved with decision-making, taking actions that would ultimately affect the course of the...

Guides Not Gurus

CATHERINE HOWARD and PETER MORTENSEN The past quarter century has seen the deployment of ethnographic methods in business grow from a curiosity to a prerequisite for success. But in the process, the outcomes of ethnographic research—customer empathy, strategic directions, lasting market insights that shape design—have not been adopted at the same rate. The hand-off from ethnographers to designers and business decision-makers is the biggest challenge to success. The time has come for ethnographers to again reframe their role within business. Rather than acting as interpreters between the lives of ordinary people and the companies who serve them, ethnographers have the opportunity to instead help the entire business organization to gather a clear sense of its customers’ lives. Ethnographers need to switch from being gurus of customer experience to being guides who take everyone in the company into the outside world....

The Rise of the Techno-Service Sector: The Growing Inter-Dependency of Social and Technical Skills in the Work of ERP Implementers1

ASAF DARR This paper attempts to move away from portraying service and knowledge work as opposite trends in advanced economies. Instead, it maintains that a closer look at the changing nature of work will highlight the need to rearrange our aggregate occupational data so as to include special categories for a hybrid form: the techno-service sector. After presenting a typology of occupations based on the degree to which knowledge and service elements are intertwined, the paper analyze the work of Enterprise Resource Planning [ERP] implementers as a key example of techno-service work. It highlights the practices of ‘reverse customization’ and ‘translation’ performed by the implementers, which effectively combine service and knowledge work. The paper explains the growing inter-dependency of social and technical skills by the shift from the sale of a product to the sale of a process. This shift underpins the growing penetration of professional work into the heart of the industrial enterprise....

Thoughts on Representation

TONY SALVADOR I have a great job! I feel privileged to do it. In fact, my kids think my job is so great they think I go on vacation whenever I travel. Maybe it’s because I send home photos like this. I’d like to start with a rather personal story to which I will return at the end (and, since you’re going to wonder why I have told this story, it will provide a handy distraction if what I say in the middle of this talk is not to your interest…) Five years ago, I had an opportunity to walk a two week portion of the Camino de Santiago. It’s an ancient Catholic pilgrimage route starting in southwestern France and ending in Santiago de Compostela, on Spain’s western coast. As I walked, the simple rhythms of each day – rising in the morning, walking through the day, settling in the evening – immersed me deeper and deeper into the wholeness of the journey. It became less and less about making progress and more and more about being aware and present in that moment. Gradually, the journey took on a “lightness of being”;...

Mapping the Loss of Reflexivity in the Age of Narcissism

BRIDGET WALSH REGAN and AJAY REVELS PART I: AN EXPLOSION OF VOICES, BUT LITTLE SENSE-MAKING With the rise of social networking sites like MySpace and Facebook, as well as YouTube, and the popularity of blogs, there has been no other time where so many voices are being heard on so many topics. Personal blogs, many of which contain writing and photos and video are kept by 12 million Americans and are read by 57 million Americans. (Brown 2007) YouTube is a beacon site on the Web, a much-touted success story since it’s $1.6B acquisition by Google in November 2006. At the time of its acquisition 100 million videos were being watched on the Web every day. A BBC report in June of 2007 stated that “every minute of every day, six hours of fresh video are uploaded.” These numbers point to an explosion of personal stories, in text, pictures and video, available for any and all to digest. The ability to wander from one person’s story to another linked story to another and so on is infinite. It is easier than ever before to join in the...

Who We Talk about When We Talk about Users

KRIS R. COHEN I begin with some questions: how have the theories and methods which subtend design research been changed by their migration from academy to industry? How have they adapted to their new commercial culture? What languages and customs have they had to acquire to fit in? To address these questions, I consider a facet of design research which I think most problematically bears the marks of this passage: how we choose who we will study. I go on to think about both the causes and implications of exclusions so often resident in this choice. The ideal that drives my analysis forward is that design researchers are in the business of designing not products for “users,” but landscapes of possibility for public life. A final suggestion, inspired by my recent work on Internet-based personal photography and here briefly sketched, is that design researchers take the publicness of our work more seriously—that we design for it....

Let’s Have A Conversation

RICK E. ROBINSON As an introductory set of remarks for the theory session, this short paper sets up some issues facing both the field of ethnography applied in industry and those who undertake theoretical work in the field. The author proposes some simple dimensions for discussion: how we might consider work in industry a definite and distinct location for theory work; the nature of relationships with key interlocutors that are fundamental to working in industry; and finally, the role, opportunity, and responsibility that theory work might have going forward....