Deployment "war stories"
War Stories, Ethnography, Healthcare, Risk
This work was conducted as part of the DIRC Targeted Activity ‘Dependable Deployment’. A variety of research has recently focused on the importance of stories or narrative descriptions as a means for sharing knowledge in the workplace. This is partly in response to the problems associated with formal approaches to knowledge management such as the difficulties of ensuring that knowledge is stored, and of building functional repositories that are structured so as to allow knowledge to be located easily. It is also in response to studies that have shown that knowledge is particularly well communicated in narrative form.
For instance, Orr’s (1996) study of photocopier technicians showed how much of their knowledge and expertise of how to solve machine breakdowns was communicated via the ‘war stories’ they shared, detailing problems and the process of solving them. For this project we wanted to create a web resource for healthcare system practitioners to share war stories about risks and hazards arising in healthcare systems design projects. Risks inevitably plague complex systems design projects and since few projects can be stopped and begun again professionals often try to avoid them or solve their emergent problems through sharing knowledge gained from personal experiences - ‘war stories’ - with other practitioners. We report on our development of a web site to list war stories - descriptions of risks and subsequent actions - arising from specific healthcare information systems development projects. This is intended as a resource to enable developers in this domain to learn from the problems and experiences of other projects. More information and guidance about how to produce and use war stories can be found here
An example of a war story is the following:
Healthcare War Story; ‘Configuration is the Most Problematic Design Phase’.
Although phases of design cannot be seen as completely discrete, database build and configuration has been the most problematic phase so far. As discussed above, although the system is to some extent off-the-peg, the work of describing current data sets and workflows, rationalising and transforming these and fitting them to the database model has been particularly difficult. This phase has run massively over-time taking at least twice as long as envisaged. This was partly due to the problems of adequately describing datasets and workflows in an agreed upon manner, partly due to requirements for integration of processes, and partly due to restrictions caused by the basic structure and configuration of the database (designed for the US insurance based system), terminology and so forth. Over time, new requirements emerge, are revised and work already completed places restrictions on further build or revision. Basically, ‘accurately’ modelling the work of the Trust then transforming it and fitting it to the system, and adapting the database is complex activity involving compromises, ‘satisficing’, workarounds and winners and losers as some fixes work better for some groups of workers.
Solution: It would be tempting to place blame with the fact that the system was originally designed for the US, or that since the database is hierarchical it does not afford as much flexibility during configuration, however, part of the problem was to do with a lack of current understanding of datasets and workflows within the Trust as well as how those individual procedures would integrate. Since any ‘generic’ solution will have to be tailored to any UK hospital, configuration is always likely to be the difficult phase. Better preparation concerning organisational knowledge of processes and how they integrate would make selecting a system and the job of configuration easier.
Martin, D., Mariani, J. and Rouncefield, M. (2005). Implementing an EPR Project: Everyday Features and Practicalities of NHS Project Work. In Proceedings of iSHIMR 2004, Sheffield, June 15-17th 2004. ISBN 0-903522-39-X
Mackie, J., Martin, D., Clarke, K., Ramduny-Ellis, D., Lock, S., Hartswood, M. and Hardstone, G. (2005). ‘Risks and Dependable Deployment’. Paper presented at DIRC Project Workshop, Edinburgh 15-17th March 2005.
Martin, D., Rouncefield, M., O’Neill, J., Hartswood, M. and Randall, D. (2005). Timing in the Art of Integration: ‘That’s how the bastille got stromed’. To appear in Group 2005, © ACM.
Orr, J. (2005) Talking About Machines: An ethnography of a modern job. ILR Press, Ithaca, NY, 1996.
David Martin (d dot b dot martin at lancaster dot ac dot uk)
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