Articulating User Needs in Collaborative Design: Towards an Activity-Theoretical Approach

Challenging the belief in simple solutions: The need for epistemic practices in professional work

CONTEXT

As a contribution to the State of the Science issue on 'The problem with solutions', this paper discusses how technology-mediated and assumedly simple and straightforward solutions to professional problems in fact require extensive work from professionals in order that generalised tools and procedures can be made sense of, adapted and employed in local practice.

THEORETICAL PERSPECTIVE

The authors introduce a perspective on epistemic practices in professional work and learning in order to conceptualise and discuss the diversity of the knowledge-related actions required to perform professional services. They discuss how the growing numbers and diversity of knowledge-generating actors who aspire to inform professional practice create 'multi-charged' work settings, imbued with multiple objectives and purposes. This development presents new epistemic challenges to professionals, which require extended capacities for knowledge work.

SUMMARY

The authors give examples from empirical studies conducted in Nordic health care settings, which relate to nurses' engagement with repositories of clinical procedures and to the development of new medical technologies for clinical use. They show how work performance in both cases depends on a range of epistemic practices (ie, collective ways of exploring, assessing, critically examining and justifying knowledge claims), which are necessary if the general tools and technologies are to be put to work in the local environment. This forms a core dynamic in practitioners' work-based learning as it moves between what is known and what remains to be explored or improved.

CONCLUSIONS

The paper argues that the widespread belief in simple or versatile solutions is challenged by research that reveals the diversity of the knowledge practices needed to perform professional services. The paper suggests that professional communities might pay more attention to epistemic practices as means to handle complexity. It raises intriguing questions and discusses implications for medical education.

JointCalc: A web-based personalised patient decision support tool for joint replacement

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JointCalc is the first complete web decision support tool for joint replacement.

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User-centred design helps avoid common health information system design.

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Modern software production methods synergise with and enable user-centred design.

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JointCalc implementation supports claims of high efficiency of eHealth.

Background and purpose

Health information systems (HIS) are expected to be effective and efficient in improving healthcare services, but empirical observation of HIS reveals that most perform poorly in terms of these metrics. Theoretical factors of HIS performance are widely studied, and solutions to mitigate poor performance have been proposed. In this paper we implement effective methods to eliminate some common drawbacks of HIS design and demonstrate the synergy between the methods. JointCalc, the first comprehensive patient-facing web-based decision support tool for joint replacement, is used as a case study for this purpose.

Methods and results

User-centred design and thorough end-user involvement are employed throughout the design and development of JointCalc. This is supported by modern software production paradigms, including continuous integration/continuous development, agile and service-oriented architecture. The adopted methods result in a user-approved application delivered well within the scope of project.

Conclusion

This work supports the claims of high potential efficiency of HIS. The methods identified are shown to be applicable in the production of an effective HIS whilst aiding development efficiency.

Developing medical device technologies from users' perspectives: A theoretical framework for involving users in the development process

Objectives: The aim of this study was to suggest an acceptable and generic theoretical framework for involving various types of users in the medical device technology (MDT) development process (MDTDP).

Methods: The authors propose a theoretical framework suggesting different routes, methods and stages through which various types of medical device users can be involved in the MDTDP.

Results: The suggested framework comprises two streams of users’ involvement in MDT development, that is, what might be called the end users’ stream and the professional users’ stream for involving these two groups respectively in the process of developing both simple and more complex and innovative medical devices from conceptualization through to the market deployment. This framework suggests various methods that can be used for users’ involvement at different stages of the MDT lifecycle. To illustrate the application of the framework, several MDT development scenarios and device exemplars are presented.

Conclusions: Development of medical devices from users’ perspectives requires not only the involvement of healthcare professionals but also that of the ultimate end users, that is, patients, people with disabilities and/or special needs, and their caregivers. The evidence shows that such end users quickly discard devices that do not fulfill their personal expectations, even though both manufacturers and healthcare professionals may consider those end users’ requirements met. Developers and manufacturers need to recognize this potent potential discrepancy between the parties involved, and involve end users and professional healthcare staff directly in the MDTDP. The framework, the authors contend, is a step forward in helping medical device manufacturers plan and make decisions about users’ involvement at different stages of the MDTDP.

From user needs to system specifications: multi-disciplinary thematic seminars as a collaborative design method for development of health information systems

This paper presents a new multi-disciplinary method for user needs analysis and requirements specification in the context of health information systems based on established theories from the fields of participatory design and computer supported cooperative work (CSCW). Whereas conventional methods imply a separate, sequential needs analysis for each profession, the "multi-disciplinary thematic seminar" (MdTS) method uses a collaborative design process. Application of the method in elderly homecare resulted in prototypes that were well adapted to the intended user groups. Vital information in the points of intersection between different care professions was elicited and a holistic view of the entire care process was obtained. Health informatics-usability specialists and clinical domain experts are necessary to apply the method. Although user needs acquisition can be time-consuming, MdTS was perceived to efficiently identify in-context user needs, and transformed these directly into requirements specifications. Consequently the method was perceived to expedite the entire ICT implementation process.

Benefits of and barriers to involving users in medical device technology development and evaluation

Objectives:This study investigated the benefits of and barriers to user involvement in medical device technology development and evaluation.

Methods:A structured review of published literature in peer-reviewed journals was conducted.

Results:This literature review revealed that the main benefits of user involvement were an increased access to user needs, experiences, and ideas; improvements in medical device designs and user interfaces; and an increase in the functionality, usability, and quality of the devices. On the other hand, resource issues, particularly those of time and money were found the key impediments to involving users in the development and evaluation of medical device technologies. This study also has categorized both the benefits of and barriers to user involvement.

Conclusions:The involvement of users in medical device technology development and evaluation requires resources, which are limited; however, this involvement is essential from both users and manufacturers perspectives.

User involvement in healthcare technology development and assessment: structured literature review

PURPOSE

Medical device users are one of the principal medical device technology stakeholders. The involvement of users in medical device technology development and assessment is central to meet their needs. This study aims to examine this issue.

DESIGN/METHODOLOGY/APPROACH

A structured review of the literature published from 1980 to 2005 in peer-reviewed journals was carried out from a social science perspective to investigate user involvement practice in the development and assessment of medical device technologies. This was followed by a qualitative thematic analysis.

FINDINGS

Medical device users include clinicians, patients, carers and others. Different kinds of medical devices are developed and assessed by user involvement. The user involvement occurs at different stages of the medical device technology lifecycle and the degree of user involvement is in the order of: design > testing and trials > deployment > concept stages. The methods most commonly used for capturing users' perspectives are usability tests, interviews and questionnaire surveys.

RESEARCH LIMITATIONS/IMPLICATIONS

The relevant engineering, medical and nursing literature, which might have been useful, was not reviewed. However, useful findings emerge that apply to health care generally.

ORIGINALITY/VALUE

This study shows that medical device users are not homogeneous but heterogeneous in several aspects, such as needs, skills and working environments. This is an important consideration for incorporating users' perspectives in medical device technologies.