Abstract In this paper, we analyze the efforts of a public healthcare business intelligence unit to implement and disseminate their data products and thus make the healthcare organization more data-driven. The paper is based on ethnographic fieldwork in a healthcare business intelligence unit (the BIU) whose mission is to improve healthcare efficiency and quality by making data and data analyses available to healthcare managers and staff. Their primary products consist of a data warehouse and Data Reports, both providing curated and daily updated data for healthcare staff to analyze and visualize. We conceptualize these Data Reports and the data warehouse as boundary objects through which cooperation around data between various users is achieved. Our focus is on the BIU’s efforts to introduce and promote the use of boundary objects to healthcare staff while providing them with the competencies to use them in practice. Efforts that we conceptualize as collaborative boundary work through which a new joint field of working with data is created between the BIU and healthcare staff. Based on the analysis of the ethnographic fieldwork, we point to three important aspects in creating this new joint field: Mobilizing interest, building local capabilities, and propagating data locally. The paper makes three contributions: It adds to our understanding of how new joint fields can be cultivated through collaborative boundary work to make healthcare data-driven; it contributes to the emergent field of data work studies; and finally, it adds to the largely normative literature on business intelligence and self-service business intelligence through an ethnographic analysis of its efforts to make healthcare data-driven.

This paper describes work practices at a public, non-profit healthcare business intelligence unit involved in creating BI reports and sharing these with healthcare management and professionals. Based on ethnographic fieldwork, we detail the various work tasks and processes involved in building data products that are applicable across various wards and healthcare professions, and, at the same time, intelligible and relevant for specific users: a challenge we frame as working with the tension between making the local and the global relevant to each other. We identified four ways in which this tension unfolds in the business intelligence unit's data work: consolidating standards, creating order out of chaos, engaging with healthcare professionals, and negotiating data and conflicts. We provide three contributions: we show how data work can unfold in close collaboration between professional data workers and domain experts; we nuance the existing research on data work by focusing on a less researched group of data workers; and we add to the few detailed ethnographies of business intelligence units.

This article describes the successful collaboration “in the wild” between Clinical Documentation Integrity Specialists (CDIS) and an Artificial Intelligence (AI)-embedded software to conduct knowledge work. CDIS review patient charts in near real-time to improve clinicians’ documentation, with the goal to make medical documentation more accurate, consistent and complete. CDIS collaborate with an AI-embedded “Computer Assisted Coding” (CAC) system that scans records from the Electronic Healthcare Record and auto-suggests codes based on natural language processing. CDIS find the CAC's suggestions are often inaccurate—often humorously so. Still, they find the CAC to be a useful helper, like Robin is to Batman. This human-AI collaboration is contingent on several factors: the flexible integration of the AI into the workflow similar to the notion of unremarkable AI; supporting the CDIS’ sensemaking; the CDIS’ knowledge about the CAC being predictably unreliable, an experience by the CDIS of the AI's value; humans remaining in control; and ability to experiment with the AI, which spurs reflection and learning for these knowledge workers.

There is growing evidence of ride-hailing platforms’ adverse impact on drivers. Nonetheless, hundreds of thousands of drivers continue to work on these platforms. Why? The key contribution of this paper is to show that workers in technology-mediated labour markets come to be increasingly dependent on the technology-provider in order to connect with the customers. As more and more customers choose to get various tasks done via intermediary platforms, for workers who perform such tasks for a living, this translates into growing dependencies on these infrastructuralized platforms for their livelihoods and thus increased vulnerabilities to the impact of platform design and policies. These ‘new dependencies’, therefore, make it critical for us not to conflate workers’ continued use of platforms with their experiencing benefits. By drawing upon a qualitative study with auto-rickshaw drivers using Ola, a ride-hailing platform similar to Uber in India, the paper shows that a consequence of ‘new dependencies’ for drivers is that they are stuck ‘between a rock and a hard place’ whereby: a) on the one hand, the platform design heightens their precarity, provides them with little benefit, and often leads to tensions with customers, b) on the other, a shift of more and more customers from street-hailing to app-based hailing over time exacerbates dependencies for drivers on these very platforms, leaving them with little choice but to continue to use them for work.

In this paper, we present the results of an ethnographic study focusing on food deliveries for the digital platform Wolt. The platform manages food transport ordered by customers to be delivered at home from restaurants, and subcontracts the transport to workers called 'couriers', who act as independent firms or entrepreneurs. The paper is based on six months of participant observation, during which time the first author worked as a courier, as well as on ad-hoc conversations and semi-structured interviews with other couriers. We describe couriers' work for the platform and discuss our findings using Möhlmann and Zalmanson's definition of algorithmic management. We found both similarities and differences. It was noticeable that the couriers were positive about their work that no penalties or wage reductions were enforced, and that human support complemented the platform's algorithmic management. Thus, the algorithmic management we observed is neither harsh (as it has been described on other platforms including Uber), nor like the algorithmic despotism present on Instacart, for example. Hence, we refer to it as 'lenient algorithmic management' and underline the importance of adding new perspectives to our understanding of what algorithmic management can be, as well as looking at the context in which it is practised. To complement this finding of lenient algorithmic management, we present a set of strategies couriers must engage in to be effective on the platform: Thus, couriers must 1) schedule their work for peak hours to limit the amount of time they waste, 2) bundle orders to increase their payment per tour, 3) make use of support to handle customers and cancel orders involving delays, and 4) make use of the ecology of local support structures. The contribution of this paper is to add new perspectives to the way we perceive algorithmic management by presenting a lenient form of algorithmic management and indicating the importance of looking at the context in which it is practised, while describing what it takes to be an effective worker on the Wolt platform.

In this paper, we compare two cases of collaboration within healthcare in two European countries, Denmark and France respectively. In each of these two cases, we conducted a design case study, and we found that collaboration is ad hoc, temporary, and shifting with regards to collaborators, aims, and processes. We argue for the relevance of knotworking and its analytic potential for investigating the kind of collaborative work we observed. We also argue that our two cases present a higher complexity level than how knotworking has previously been described in the literature. We describe complex knotworking as having three characteristics: 1) collaboration happens between a dynamic number of actors (who are usually loosely connected), 2) collaboration happens in episodes, and 3) cooperative work arrangements are constantly negotiated. Using the concept of complex knotworking for a comparative analysis of our two design solutions, we outline generic design guidelines for developing computer support to manage complex knotworking situations.

This paper empirically investigates a Common Information Space (CIS) established by medical secretaries so they could support each other during their workplace’s transition to a new comprehensive electronic health record, called the Healthcare Platform (HP). With the new system, the secretaries were expected to become partially obsolete, as doctors were to take on a significant load of the clerical work, such as documenting and coding. To handle their changing work situation, the medical secretaries set up an online support group in parallel to, but independent from, the official implementation support organization. The paper’s contribution is a characterization of the support group as a common information space (CIS), and analysis of the specific qualities of a worker-driven CIS as a forum for 1) articulation work required for re-grounding changing tasks and responsibilities, 2) archiving discussions (posts) and guidelines to further their collective interpretation, and 3) creating a space independent of management for employees to work out their new role in an organization in a situation of transition and change.

Financial inclusion has been defined and understood primarily in terms of access, thereby constituting ‘inclusion’/‘exclusion’ as a binary. This paper argues such a view to be myopic that risks treating financial inclusion as an end in itself, and not as means to a larger end. ‘Access’ oriented perspectives also fail to take into account considerations of structural factors like power asymmetries and pay inadequate attention to user practices. Through the case of auto-rickshaw drivers in Bangalore, India, and their use of Ola, a peer-to-peer taxi hailing service similar to Uber, we show that access is a necessary, but not sufficient condition to achieve financial inclusion in a substantive sense. By examining in detail, the financial needs and practices of rickshaw drivers, we identify the opportunities and constraints for digital technology to better support their financial practices and enhance their wellbeing. The paper proposes adding ‘autonomy’ and ‘affordances’ as two crucial factors to be included in the discourse on financial inclusion. Finally, we outline design implications for P2P technologies to contribute towards the financial inclusion of drivers.

This paper reports on the changes in the monetary ecology around loan payments by auto rickshaw drivers shortly after the introduction of a mobile app in Karnataka, India. A for-profit, social enterprise facilitates loans for purchasing auto rickshaws. The mobile app was designed and implemented to provide accurate, timely loan information for drivers, to support the collaborative work of loan collection payment, and streamline the workflows of the organization. In this paper, we report on the initial experiences with the app, and argue that its introduction led to a tighter coupling of the actors involved and moved control to the back office, which especially impacted the pre- and at-transaction interactions of the monetary ecology. The paper reflects on how these changes impact adoption and use of the app and suggests a number of changes to the design which might address the observed problematics.

This paper investigates coordination and real-time information sharing across four emergency medical teams in a high-risk and distributed setting as they provide care to critically injured patients within the first hour after injury. Through multiple field studies we explored how common understanding of critical patient data is established across these heterogeneous teams and what coordination mechanisms are being used to support information sharing and interpretation. To interpret the data, we drew on the concept of Common Information Spaces (CIS). Our results showed that teams faced many challenges in achieving efficient information sharing and coordination, including difficulties in locating and assembling team members, communicating and interpreting information from the field, and reconciling differences in team perspectives and information needs, all while having minimal technology support. We reflect on these challenges to suggest an extension of the classic CSCW time-space matrix, as well as future development of CIS as an analytical framework. The paper concludes with design opportunities for supporting highly distributed and heterogeneous teamwork in time-critical work environments.

The 'project' is a prevalent form for organising endeavours of construction, innovation, IT development and organisational change. 'Projects' involve coordination and cooperation between colocated and distributed actors, and are relevant for CSCW (computer supported cooperative work) research as a particular kind of cooperative work. A survey of CSCW publications only identified 26 papers that explicitly address project management (PM), of which most primarily focus on IT development. We argue that CSCW's conceptual and methodological tools can make significant contributions to PM research, practice and its computational support. We point to four issues of relevance for future CSCW research on projects: continue to sophisticate the empirical and conceptual understanding of projects, broaden research beyond IT projects into other domains, develop agile approaches beyond IT development and focus on computational support for project work and management. In all, we argue that CSCW can advance our understanding of project work and management and the design of adequate computational support.

In this paper, we describe the collaborative work of hospital porters. The profession of hospital porters is understudied in sociology and in Computer Supported Cooperative Work, despite numerous studies of healthcare IT. We describe how a new IT system for hospital logistics provided porters with more influence on, and responsibility for their work; supported collaboration among porters, clinicians, and middle management; and effected a new ecology of visibility and accountability of porters' work. We discuss how the new system simultaneously supported collaboration and generated representations and accounts of porters' work. We compare the particular work arrangement in this study with other studies of porters' work, show the widely different configurations of how IT and work can be organized, and argue for the benefit of making comparative studies within CSCW. Finally, we argue for moving beyond dualisms of coordination and accountability for work.

In this paper, we analyse the challenges of working between organizations and established information infrastructures. The Care Hotel is a municipal healthcare facility where persons, typically following a hospital stay, undergo rehabilitation to enable them to live independently at home. Admission, stay, and discharge from the Care Hotel entail numerous coordination activities with a variety of frequent and sporadic, heterogeneous, external collaborators, including general practitioners, relatives, and hospitals, some of which are already part of large information infrastructures, whereas others are too small or shifting to allow for stable arrangements. Hence, work at the Care Hotel may be characterized as "collaboration in-between". We propose a design solution for flexible use to further stimulate reflection on design implications, and how to meet the challenges of collaboration in-between. As large infrastructures continue to develop, we posit that many "in-between settings" will encounter similar challenges to collaboration. Healthcare providers in contexts of fragmented healthcare are also likely to face such challenges.

Clinicians' work in hospitals is safety- and time-critical, and often stressful due to the number and complexity of patient cases they must attend to. Therefore, how clinicians gather information, identify problems and make decisions concerning patients is a crucial concern, a process that can be labelled 'achieving overview'. In the process, clinicians use various artefacts amongst which medical records are central. Decades of experience is embedded in the structure and use of paper-based records. However, the development of electronic patient records (EPR) will change both structure and use of medical records, including 'achieving overview'. We conducted an ethnographic study in a hospital ward using paper-based medical records in order to understand how clinicians achieve overview. Inspired by the approach of exnovation, we elicit the use of paper-based records in order to inform the design of EPRs. We propose five axes which span out the process of achieving overview and describe implications for design of EPRs.

We describe the cooperative work of medical secretaries at two hospital departments, during the implementation of an electronic health record system. Medical secretaries' core task is to take care of patient records by ensuring that information is complete, up to date, and correctly coded. Medical secretaries also do information gatekeeping and articulation work. The EHR implementation stressed their importance to the departments' work arrangements, coupled their work more tightly to that of other staff, and led to task drift among professions. While medical secretaries have been relatively invisible to health informatics and CSCW, this case study identifies their importance, and suggests that they and other non-clinical groups should be considered, when developing health care IT. We propose the term 'boundary-object trimming', to conceptualize their contributions to hospitals' cooperative work arrangements.

We report on experiences gained from the use of large, shared interactive displays to support coordination and communication at a surgery ward. The displays combine on-line, updated surgery schedules, video feed, RFID tags, chat and mobile phones to improve the coordination and articulation of work tasks and enhance the context-awareness of collaborating physicians, nurses and surgery technicians. Implementing the system implied creating a fit, i.e. adapting technology and work processes to each other, attributing appropriate meaning to new clues for interpretation and action, and learning new ways of cooperating. We describe the implications of the system for work processes and focus on changes in coordination, articulation work and context-awareness. Trade-offs had to be made, since work and benefits were differentially redistributed. We propose that computer support for medical work should support flexible appropriation and learning.

Representations are at work in IT technology. As plans of and for work, they enable cooperation, coordination, accountability and control, which have to be balanced off against each other. The article describes a standard developed for electronic health records (EHR) and the results of a test of a prototype built on that standard at a department of internal medicine in 2004. It is argued that the prototype did not support clinical work, which is attributed to the model of work embedded in the standard, called Basic Structure for EHR (BEHR). The article concludes by calling for critical conceptualizations of the relations between representation, work and knowledge production.

This paper reports from a field study of a hospital ward and discusses how people achieve coordination through the use of a wide range of interrelated non-digital artifacts, like whiteboards, work schedules, examination sheets, care records, post-it notes etc. These artifacts have multiple roles and functions which in combination facilitate location awareness, continuous coordination, cooperative planning and status overview. We described how actors achieve coordination by using different aspects of these artifacts: their material qualities, the structure they provide as templates and the signs inscribed upon them that are only meaningful to knowledgeable actors. We finally discuss the implication for the design of CSCW tools from the study.

Transformations in collaborative work due to the introduction of new technology are inevitable, but are often difficult to study. In this paper, we consider the patterns of transformation that are seen in a patient-physician relationship based on the introduction of homecare monitoring equipment. We report findings from interviews and fieldwork with patients and physicians participating in a clinical experiment of homecare monitoring. By studying both the group of patients who receive homecare-based treatment and the control group we were able to identify transformations in the collaborative activity as caused by the homecare monitoring technology. We apply activity theory as a theoretical basis for this analysis. We consider the implications of these findings for the design of pervasive health monitoring technologies.

A context-descriptive prototype is an interactive graphical animation, driven by a formal, executable engine, implemented in some programming or modelling language. The two main properties of a context-descriptive prototype are: (1) it is an integrated description that describes system, work processes, and context of use; (2) it is a formal description. Because of (1), designers, including users, are provided with a means to investigate the system in the context of the envisioned work processes. Because of (2), investigations into questions of formalisation and automation, not only of the system, but also of the work processes, can be made explicitly and become subject for discussions and further elaboration. We describe a concrete context-descriptive prototype of the hospital work process medicine administration and its support by a new pervasive system. We discuss findings from evaluation of the prototype in cooperation with nurses, and finally compare context-descriptive prototypes with other kinds of prototypes.

We describe requirements engineering for a new pervasive health care system for hospitals in Denmark. The chosen requirements engineering approach composes iterative prototyping and explicit environment description in terms of workflow modelling. New work processes and their proposed computer support are represented via a combination of prose, formal models, and animation. The representation enables various stakeholders to make interactive investigations of requirements for the system in the context of the envisioned work processes. We describe lessons learned from collaboration between users and system developers in engineering the requirements for the new system.

The paper proposes a refinement of the concept of 'Common Information Spaces' (CIS), which has been proposed as a conceptual framework for the CWCW field in order to provide analyses of cooperative work. The refinement is developed through an introductory discussion of previous analyses of CIS and on the basis of a thorough description of the CIS of a hospital ward based on ethnographic fieldwork. The initially definition is refined by the introduction of 7 parameters: (i) the degree of distribution of work; (ii) the multiplicity of webs of significance; (iii) the level of required articulation work; (iv) multiplicity and intensity of means of communication; (v) the web of artefacts; (vi) immaterial mechanisms of interaction; (vii) the need for precision and promptness of interpretation. These parameters provide a more detailed conceptual framework and can be applied to characterize the particularity of a given CIS.