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Striving for seamlessly integrated care . Eric Monteiro Norwegian Univ. of Science & Technology and Univ. of Oslo www.idi.ntnu.no/~ericm. Local solutions . Artefacts in use workplace studies ethnographies contingencies, glitches, situated action small commuties of practice.

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Striving for seamlessly integrated care l.jpg
Striving for seamlessly integrated care

Eric Monteiro

Norwegian Univ. of Science & Technology

and

Univ. of Oslo

www.idi.ntnu.no/~ericm


Local solutions l.jpg
Local solutions

  • Artefacts in use

    • workplace studies

    • ethnographies

    • contingencies, glitches, situated action

    • small commuties of practice

  • Artefacts in context

    • prototyping

    • users, participation

Pelle Ehn & Scandinavia


Beyond the local vertical horizontal l.jpg
Beyond the local: vertical & horizontal

How similar ?

- granularity

Standardisation !

Dependencies with Others ?

- scope

Integration !


Standardisation example l.jpg
Standardisation: Example

  • Portal Rikshospital

  • 556 systems, 160 clinical

  • Role-based, in principle

  • ex.: order entry

  • ”Too much details”

(Rikshospitalet, GK Bruun)


Standardisation example5 l.jpg
Standardisation: Example

“… but for us it is not helpful …. Just consider that

you have to scroll the listbox [the list of analyses codes].

This also means that there are too many available

options for the physician ordering a test….

Mixing everything together in a big chunk on the working

lists has caused a problem for several departments

because they want Microbiology results separated from the

mass produced blood results ”


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Standardisation: Analytical perspective

  • Standards as co-constructed practice

    • top-down enforced but also …

    • improvised locally

  • Relocate – not remove - work-arounds

    • J Grudin, revisited

    • benefits for whom? additonal work ?

  • Inherent, immanent ??

“The order and its disorder…. need and embody each other…

The orders … produce the very disorder they attempt to eradicate”

(Timmermans and Berg, 2000)


Integration example l.jpg
Integration: Example

Pharmacy

GP

prescription

identifier

Record sys.

inventory sys.

list of products

Vendor

Catalogue

NMD

Fabritius


Integration example8 l.jpg
Integration: Example

  • data standards

  • reporting

  • indicators

DHIS

GIS

ART/HIV

Morbidity & Mortality

Scheduler/FMHIS

(www.hispindia.org)

Adm/budgetting


Analytic i change to remain the same l.jpg
Analytic (I): ”Change, to remain the same”

  • change contents

    • different parts

    • different versions

    • different configurations

  • change context

    • community based

    • drilling equipment

  • Is Z Bush Pump an artefact ??

  • Fluid

Zimbabwe bush pump


Analytical perspective ii l.jpg
Analytical perspective (II)

  • Integration = add dependencies

    • integration ALSO multiplication & propagation of unintended consequences

    • removing slack (delay, quality ensurance, double check)

  • Complex + tightly coupled (C Perrow)

    • difficult to recognise outcomes (risks)

    • effects interact, travel

  • Integration

    • part of the solution or …

    • part of the problem ?


From artefacts to infrastructures l.jpg
From Artefacts to Infrastructures

Standardisation

  • Architecture vs Urban planning

    • houses vs neigherhood

    • blend in = ... ?

  • Heterogenous integration

    • oppose idealisations/abstractions

    • curb totalizing inclination/ambitions

  • ”Complexify concepts in response to complex phenomena” (Tsoukas)

Integration


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