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Computer Supported Cooperative Work 10: 211–246, 2001. © 2001 Kluwer Academic Publishers. Printed in the Netherlands.

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Bridging Work Practice and System Design: Integrating Systemic Analysis, Appreciative Intervention and Practitioner Participation HELENA KARASTI Department of Information Processing Science, University of Oulu, P.O. Box 3000, FIN-90014 Oulu University, Finland (E-mail: [email protected]) (Received 7 June 2000) Abstract. This article discusses the integration of work practice and system design. By scrutinising the unfolding discourse of workshop participants the co-construction of work practice issues as relevant design considerations is described. Through a mutual exploration of ethnography and participatory design the contributing constituents to the co-construction process are identified and put forward as elements in the integration of ‘systemic analysis’ and ‘appreciative intervention’. The systemic analysis proposes collaboratively grounding the emergent understandings on an inductive and iterative analysis of actual technologically mediated work practice. The appreciative intervention, in turn, calls for envisioning images of future system and context through a recognition of presence and change intertwined in the existing ways of working. The identified elements are joined into three dimensions of interplay, namely the analytic distance, the horizon of work practice transformations and the situated generalisations, which reformulate new conceptualisations of what the integration of work practice and participatory system design is all about. It is suggested that these dimensions together with practitioner participation call into question some of the taken-for-granted assumptions and commonly forwarded intractable disciplinary dichotomies and contribute more generally to bridging work practice and participatory design. Key words: analysis, ethnography, image interpretation, integration, interdisciplinarity, intervention, participatory design, practitioner participation, radiology, system design, work practice

1. Introduction For collaboration technologies to be successful it has become increasingly important to understand how work actually gets done and to find ways to integrate these understandings into design. The bridging of the gap between work practice and system design has been attempted from both sides. Social scientists have revealed through basic research studies interesting social phenomena or theoretical concerns of work that are considered highly relevant for the design of CSCW (Anderson, 1997; Plowman et al., 1995). The designers’ way to provide for the work setting, i.e. in approaches where the work context has been considered of importance, has been to include the users as participants in the design activities (Blomberg, 1995). Although there is plenty of variation within both of these

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strands, they seem to conform uniformly with the respective disciplines. A small number of studies have striven, however, to find ways to integration through interdisciplinary collaboration and mutual exploration. The integration strand is typically comprised of studies carried out in corporate or university research settings. The most prominent social science partner is ethnomethodologically informed ethnography with roots in either sociology or anthropology. The design side portrays a repertoire of approaches from traditional system design, e.g. computer science and software engineering to alternative design approaches such as participatory design. A closer look is taken at the current approaches that are based either on detached theoretical speculation or on empirically grounded research before moving on to an approach that puts forward the idea of integrating systemic analysis and appreciative intervention.

1.1. THEORETICAL SPECULATIONS OF INTEGRATION In CSCW interdisciplinary collaboration to bridge work practice and system design has been provocatively addressed by a vocal yet scattered agglomeration of researchers through attempts to bring together and reconcile the theoretical perspectives and core precepts of the involved disciplines. These discussions have resulted in vehement debates about the discrepancies between the disciplines (e.g. Grudin and Grinter, 1995; Bader and Nyce, 1998; Simonsen and Kensing, 1998; Button and Harper, 1996) and revealed disciplinary dichotomies, e.g. descriptive vs. prescriptive, rich descriptions vs. notational formalism, particular vs. general, concrete vs. abstract, present vs. future, understanding vs. intervention. I have found some of the debate stimulating, but the level of theoretical stipulation has made the disciplinary incongruities seem most intractable (Shapiro, 1994). In general the discussion has resulted in misdirected and inadequate characterisations of what is at stake (Anderson, 1994). One of the theoretically based approaches to address the fundamental issues of integration comes from the protagonists of technomethodology (Button and Dourish, 1996; Dourish and Button, 1998). Technomethodology refers to neither ethnomethodology nor design but an extensive reconsideration of the design process. It suggests a new area of research, equally radical in its consequences for both its parent disciplines. As an endeavour to develop a form of technological design that is grounded in the understandings employed by ethnomethodology, the technomethodologists seek a new position on the relationship between ethnomethodology and computer science, to allow ethnomethodology to determine and reconceptualise the foundational elements of system design. They suggest a reformulation of the work and resources of software developers (e.g. new software architectures and ideas in programming languages). I agree on the importance of addressing the fundamental issues, but I also think that it should be done in close relation to the actual practices of bringing work practice and system design together.

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1.2. EMPIRICALLY GROUNDED RESEARCH ON BRIDGING WORK PRACTICE AND SYSTEM DESIGN

As the study at hand is firmly based on empirical work, I shall outline three lines of empirically grounded research that portray different approaches to the problematics of integrating ethnographic studies of work and different types of system design or technology development. The interest below is especially on how the approaches achieve and integrate analysis and intervention in actual efforts and on the included theoretical reflections. 1.2.1. The COMIC project A significant line of pioneering studies to bring ethnography into the design context was carried out in the COMIC project (EU Basic Research Action 6225, 1993– 1995) in which sociologists and software engineers sought ways to collaborate. The problematics of integration were addressed as a practical matter, for example, in terms of language and communication, different traditions and practices of representation, real-world restrictions on resources, and design project management. The finding of ways in which ethnography could inform design (Hughes and King, 1994) typically relied on a disciplinary division of labour with no user participation. Professional ethnographers would take care of the analysis and mediation between the workplace and the system design community, while designers would make design decisions depending on the ethnographers’ explications of work in direct input to a requirements analysis. Communication and dissemination of information would typically take place in debriefing meetings where the designers asked questions of the ethnographers (Hughes et al., 1993). Although not much has been written about these meetings, we can assume that they must have been challenging, as further support for the structuring of observations has been developed, such as a framework for presenting the analysis of work in a more designer-friendly form (Hughes et al., 1997) and a software technology solution, called Designers’ NotePad, to render fieldwork notes into a more design relevant form (Twidale et al., 1993). In this line of research ethnography has been contracted to the role of informational input, and the analytic aspirations of ‘innocent’ ethnography have made room for a more ‘informed’ inquiry conscious of the design problematics. This has lead to critical reflections of the challenge and changing role of ethnography/ethnographers when in contact with design (Shapiro, 1994; Hughes et al., 1991). Curiously enough, the critical reflections on the part of ethnography have struck no responsive chords in the involved design community and the work has been continued along similar lines after the project (e.g. Viller and Sommerville, 1999; Crabtree et al., 2000; Hughes et al., 1999).

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1.2.2. Ethnographically informed studies of work and participatory design Another line of research integrates ethnographically informed studies of work with Scandinavian participatory design (see e.g. Ehn, 1988; Floyd et al., 1989; Floyd, 1993; Greenbaum and Kyng, 1991; Muller and Kuhn, 1993; Schuler and Namioka, 1993) and attempts to formulate a method for collaborative analysis and design. Although the PD approaches have traditionally emphasised work relevant issues, it is only recently that ethnography has been incorporated explicitly into design projects (Blomberg, 1995). PD approaches have increasingly started to include ethnographically-inspired fieldwork methods, such as open-ended interviews and participant observation, in addition to a repertoire of more traditional PD techniques such as scenarios, mock-ups, simulations, future workshops, organisational games, and cooperative prototyping (see e.g. Bødker et al., 1993). The field investigations are not viewed as something separate from other design activities. Ethnographic techniques are employed to gain insights into the work practices and to create shared views on the work (Kensing and Blomberg, 1998). There have been both attempts that engage designer/researchers in fieldwork (e.g. Bødker et al., 1993; Bardram, 1997) and ones in which professional ethnographers have been incorporated into design projects (e.g. Christensen et al., 1998; Crabtree, 2000; Büscher et al., forthcoming). The ways in which the users participate in work analysis vary depending on the PD tradition. With its long-standing traditions in prototyping, Aarhus University has integrated the participatory analysis of work into collaborative prototyping (Bødker and Grønbæk, 1991; Mogensen and Trigg, 1992; Kjær and Halskov Madsen, 1994). Meanwhile the researchers of the MUST program at Roskilde University have integrated ethnographic fieldwork techniques into the collaboration of designer/researchers and users in the early phases of system development (Simonsen and Kensing, 1994; Kensing et al., 1996, 1998). Instead of addressing the more fundamental issues of integrating ethnography and design (however, for an exception, see Crabtree, 1998), the interest has been in joining ethnographic methods with PD techniques to create a context for design. Some studies have taken a look at what takes place in prototyping sessions (Trigg et al., 1991; Bødker and Grønbæk, 1996). 1.2.3. Work Practice and Technology Group at Xerox PARC The third stream of highly influential research was recently summarised by the Work Practice and Technology group of ethnographers and computer scientists in a retrospective account of their work carried out at Xerox PARC (Suchman et al., 1999). In two decades they constructed a research program called “Reconstructing technologies as social practice” that draws on anthropology and action research. Their early research focused on the application of interaction analysis and ethnography to questions of the design and use of information systems (Suchman and Trigg, 1991). More recently they have explored productive ways of relating work practice studies and technology design (Blomberg et al., 1993; Blomberg, 1995).


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Involvement in two interrelated projects of reconstruction has been characteristic of this research program: the first one has dealt with ethnographic studies of culturally constituted meanings and socially organised practices at work and in the use of technology, and the second project has had a more reformist agenda aiming at critical analyses of existing technology design practices and the development of alternative approaches (Suchman et al., 1999). The group has explored new ways of getting access to the details of everyday work practices (Blomberg, 1987; Suchman, 1983, 1987). They have carried out critical studies of prevailing rhetorics and practices in the production of new technologies that have raised fundamental questions about and reconceptualised central concepts of technology design (Suchman, 1987; Blomberg, 1987, 1988; Orr, 1990; Suchman, 1994, 1997). As part of the reformist agenda they have developed alternative, work-oriented and cooperative ways to intervene into the processes of professional technology production, such as the Work-Oriented Design and case-based prototypes (Blomberg et al., 1996). In the projects they have sought to establish and maintain ongoing relations with work practitioners but have been restricted with regard, for instance, to bringing practitioners and designers into direct collaboration (Blomberg and Henderson, 1990; Blomberg et al., 1997). Furthermore, they have sought more intimate understandings of the dynamics and relations in integrating ethnographic findings into product development by analysing interventions that they have organised, e.g. an analysis of a workshop joining findings of work practice studies, case-based prototypes and product development (Blomberg and Trigg, 2000). 1.2.4. The study at hand – integrating systemic analysis and appreciative intervention For several years I have been involved in studying the technologically mediated radiology work practices as well as following the procurement and implementation of new technologies in clinical work. I have explored the integration of work practice and system design by introducing and promoting work practice-based and participatory design orientations into projects of technology development. I subscribe to ethnomethodologically informed ethnography and participatory design without being a ‘true’ member of either community. This kind of marginal status may offer insight that is not available to the regular community members by allowing one to see what others take for granted (Salter and Hearn, 1996). From this ‘interdisciplinary position of an outsider’ I have reconsidered several taken-for-granted assumptions of disciplinary dichotomies, as well as conventional frames of reference. This began (inspired by Trigg et al., 1991; Blomberg and Trigg, 2000) by returning to one successful work practice-based design intervention. I wanted to find out what really took place in the workshop and made it so propitious. Somewhere in the middle of the analyses I realised that the workshop activities could be read as concrete instances of some topical issues raised by the above theoretical stipulations. Thus, I have identified some essential issues

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of the interdisciplinary endeavour and reconstructed alternative conceptualisations based on the idea of integrating systemic analysis and appreciative intervention by addressing some of the fundamental issues outlined by Anderson (1997). My starting point resides in the strengths of the bodies of knowledge and practice of both ethnography and design. I also draw selectively on two approaches to work research, namely the Work Interaction Analysis Laboratory (WIAL) for its fine tuned collaborative analysis of workplace interaction in which practitioners also participate (Cefkin and Jordan, 1994; Jordan, 1994), and Developmental Work Research for its systematic stance on intervention with the researchers and workers developing work collaboratively (Engeström, 1999). The article starts with an introduction to the workshop. The next two main sections illustrate what actually took place in the workshop in which the participants analysed existing ways of working to create shared understandings of work practice as well as evaluated experimental system-in-use situations and envisioned future images to co-construct design issues for a redesigned system. Both sections also explore the elements that contributed to making the activities more inclined towards systemic analysis and appreciative intervention. The last section discusses the three dimensions by means of which the participants discovered the relevance of work practice for system design. The article ends with conclusions and ideas for future work.

2. The workshop The workshop described here was one in a series organised in connection with a project to develop a teleradiology system. Teleradiology is an indication of a major transition facing radiology work. Computerisation and digital imaging are currently changing the mediation of radiological material from reliance on films pervasive since the days of Roentgen over a century ago to digital images. In the Oulu University Hospital (OUH) the trial period with a teleradiology system was the first instance of clinical interpretation performed solely through monitor interpretation, although scans of computerised modalities, e.g. Magnetic Resonance Imaging (MRI) and Computed Tomography (CT), have typically been viewed preliminarily on monitors. The project had first developed an experimental system to meet the needs of primary health care centers with X-ray services, i.e. asynchronous transfer of digitised images with combined electronic requests and reports (Reponen, Lähde et al., 1995). The system was designed jointly by radiologists and physicists in the OUH with designers from two hardware and software companies collaborating on the development of the system. During the clinical trial period, clinicians in the Kuusamo Primary Health Care Center consulted radiology specialists in the OUH for the interpretation of patient images. Ethnographically informed fieldwork was carried out to study the emerging teleradiology work practice in both locations (Karasti et al., 1998).


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Workshops were organised after the trial period. Our interest was to provide work practice-based, participatory interventions in which the fieldwork findings and the experiences of participants could be taken into account in the evaluation and redesign of the experimental system as well as in the further development of teleradiology work before moving on to product design. The specific themes of the workshops included the new method of collaboration between two radiology units that had previously worked separately, distributed supportive work and the radiologists’ image interpretation work, with the latter being the theme of the particular workshop under scrutiny here. The foremost idea for the workshops was to base all collaborative activities on an analysis of existing work practice. A video collage was prepared of the materials collected during fieldwork to make visible actual instances of technology use in everyday clinical image interpretation work in a rich natural form which invites evocations and interpretations (Karasti, 1997a,b). My intention was to include in the collage similar opportunities for constructing informed understandings of radiology work and teleradiology redesign as I had discovered in my own fieldwork practice. The analytic work that went into working up the video collage comprised the construction of a participant observer’s understanding of work practice during fieldwork and the more design-oriented analysis and evaluation of forming an adequately detailed comprehension of the potential (re)design issues. This was accounted for in the video collage by including material both for the analysis of what is essential in everyday practice and for the evaluation of how usable the system was in clinical work. The video collage necessarily encompasses the fieldworker’s understanding in several ways. For instance, it reflects the participant observer’s inside-outside view (see e.g. Jordan, 1996; Forsythe, 1999) by making visible both the multiple partial views and situated locations of practitioners from within the actual practice (emic) as well as it integrates an overall account of work as it is edited according to the fieldworker’s outside, analytic and synthetised view (etic). Furthermore, it embodies the two perspectives of observation and intervention in which the fieldworker engages by including clips meaningful from the point of view of both practice and design. It presents entire sessions of actual image interpretation carried out by radiologists A and B including the unfolding technologically mediated practice of smoothly organising routine ways and the problems encountered and handled in the course of working, and relies on the categories ‘from within’ in the selection of work instances, e.g. a simple case (see Table I, clip 1), a complicated case (clip 2), and the same work of diagnosing thorax control cases also in the teleradiology environment (clip 3). The collage also features technology use situations selected as significant from the design perspective, e.g. instances depicting three specific topics relevant to monitor image interpretation (initial image layouts, clips 4–7; joining a patient’s images transferred in separate packets, clip 8; uses of several image processing functions, clips 9–14).

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Table I. An outline of video collage (total length approximately 19 minutes) Clip 1 (approx. 50 sec)

An entire image interpretation session of a ‘simple’ thorax control case in the traditional environment, sitting in front of an alternator radiologist A interprets two films mounted on the light panels, consults the patient’s film bag for comparison with old films and dictates a report.

Clip 2 (approx. 6 min)

An entire image interpretation session of a ‘complicated’ case in the traditional environment, radiologist A interprets four films hung on light panels, interrupts dictating, rereads the request and parts of the patient’s roentgen history, consults the patient’s folder for old films, mounts one of them, rewinds the dictaphone, continues with interpretation and reporting.


An entire teleradiology image interpretation session of a thorax control case, a successful case of image layout. Radiologist A says: “good, good, these came side-by-side” as two thorax images appear side by side on the computer screen.

Clips 4–7 (total 3 min)

Four clips of teleradiology system use show how the next patient is chosen and how the request and images are displayed on the screen (i.e. the initial display of images) at the beginning of an image interpretation session.


An edited clip of teleradiologist B demonstrating how the images of one patient transferred in two separate packets can be joined to be simultaneously displayed on the screen in the teleradiology system.

Clips 9–14 (total 4 min)

Each clip shows an instance where the available image processing functions (i.e. flipping, rotating, moving, step-wise zooming, enlargement by cropping, adjustment of greyscale) are used in actual sessions of image interpretation and reporting by teleradiologist A.

The video collage further aligned with the fieldworker’s ideas of how to support design based on an analysis of work practice. As the sequential order structures the workshop activities the collage starts with the film-based work with light panels and alternators (clips 1–2) for establishing shared understandings of traditional practice and only after this offers for juxtaposition the digital imagingbased teleradiology work with high resolution monitors and computer workstations (clips 3–14). Extensive participation by radiology personnel was encouraged in addition to the fieldworker/researchers and the professional designers. In this case, as diagnostic image interpretation is the speciality of radiologists, practising clinical radiologists provided divergent views of the traditional and teleradiology work practices ‘from within’, as their specialities and positions within the health care


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Table II. Workshop participants in the selected excerpts A – (tele)radiologist, responsible for daily clinical work with the experimental system in the OUH, specialist in the kinds of cases expected for consultation from the primary health care centers C – radiologist in a regional hospital, research interests include teleradiology and digital imaging D – radiologist, head of the MRI (Magnetic Resonance Imaging) department in the OUH S – senior physicist, technical expert in the OUH Clinic of Radiology L – designer in the company responsible for the image display and scanner interface hardware and software K – workshop facilitator, researcher (with a background in information system design) H – fieldworker, workshop organiser and facilitator, researcher (information system design)

Figure 1. Participants viewing image interpretation work on video collage.

institutions as well as degrees of experience with different technologies varied. Table II introduces the participants vocally active in the following excerpts. The work practice represented by the video collage formed a shared object for the participants’ activities (see Figure 1). The participants co-viewed sequences of video collage, then the tape was paused and discussion started. This observable regularity was made use of in chunking the transcript of the one hour and forty minutes workshop into more manageable episodes for analyses. In the following reference is made to these episodes to position the reader in the corresponding phases in the workshop. The first part of the workshop focused on explicating the traditional work practice. An interpretation session of a simple case (clip 1) was co-viewed and

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briefly discussed. The unfolding activities in the more complicated image interpretation session (clip 2) were scrutinised in more detail. The participants engaged in commenting and elaborating, sharing experiences and recounting related knowledge, asking questions and offering interpretations. In the process a shared ground for understandings of work practice was co-constructed. As an example of this, we shall take a look in the following section at the co-construction of shared understandings of image comparison in the film-based practice. Moving on to an entire image interpretation session in the teleradiology environment (clip 3), the participants started to make comparisons by pointing out similarities and differences between the traditional and teleradiology ways of working. As the video collage proceeded into clips 4–14, analysis and evaluation became interleaved, as the participants continued to juxtapose the two differently mediated work practices. Problems with the use of the experimental system were identified and improvements suggested. Essential issues of (tele)radiology and (monitor) image interpretation work practice that had not been considered in the initial design phase were distinguished. Some early assumptions were questioned and abandoned as they did not correspond to the actual teleradiology practice, and relevant design (re)considerations were composed. Through these processes the participants formed shared understandings, not one uniform comprehension but rather a co-constructed platform of understandings that provided emergent and evolving criteria for the evaluation of the propositions for the future system and work practice (Karasti, 2000). The ‘redesigning teleradiology system’ section will illustrate how the participants engaged in the co-construction of work practice-based design issues for the future system. The first example continues with the issue of image comparison and depicts how it was used in the reformulation of a central design concept. Another example of greyscale adjustment portrays the assessment of relevance and usefulness of an experimental system function to future teleradiology practice. The structure of the following illustration, starting with the analysis of work practice then moving on to teleradiology redesign, reflects the actual order and temporal emphasis of activities in the workshop. 3. Analysing image interpretation work practice This section first depicts how the participants co-constructed shared understandings of work practice by engaging in analyses of traditional image interpretation. Then it discusses the underlying elements that contribute demonstrably to the analysis of work practice with a focus on technology.


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Figure 2. Video clip 1 presented radiologist A sitting in front of an alternator, facing two front thorax films hung side-by-side on light panels and patient materials in folders on the table. He performed the interpretation in about 50 seconds, occasionally juxtaposing a third, side thorax film in his left hand with the mounted ones. At the same time he dictated a report onto a dictaphone in his right hand.

3.1. CO - CONSTRUCTING SHARED UNDERSTANDINGS OF WORK PRACTICE The process of co-constructing shared understandings of work practice is illustrated by two excerpts of participants co-viewing and analysing film-based image interpretation. 3.1.1. Elaborating on observable work activities The first video clip made visible the routine ways in which radiologists use previous films together with the new ones in everyday image interpretation (see Figure 2). After co-viewing clip 1 discussion started by K pointing to the use of “the side film” observable in the sequence (transcript 1, lines 1–2). Radiologist A elaborated on his videotaped activities and related them to the everyday rationale of diagnostic image interpretation (lines 3–12). He explicated the use of several films, new and old ones, for comparison which is essential in creating a longitudinal perspective over the patient’s changing condition. He recounted how the radiologists’ professional expertise in discerning gradual alterations between progressive diseases and normal variations is based on having access to all the relevant films. He brought in more contextual information by explaining that the material and technical infrastructure provides for the availability of films for comparison.

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Transcript 1. Episode 1

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Co-viewing clip 1 K:When things go fluently, they really go fluently. It really does not take very long. Perhaps one thing that attracts attention there is that you also use the side film. A: Yeah, there have to be several (images). Often it is so that one has to have several films for comparison, the previous one plus for example a one-year old film, if one is available, or maybe a four years old one. Gradual alterations can be discerned there. There are plenty of normal variations and then there are also progressive diseases. They cause changes in the form in different places. As it is, all information is used. A general practitioner may look at one film against a window but he does not get the perspective that we get as we can use the light panels and we can get films easily from the archives. When one can only compare to a single film, and the exposures are the same, and one cannot for example see behind the shadow of the heart, then one has to make use of all available image information. That’s when a roentgen doctor dictates the images. K:Dynamics is the essential concern there, I mean how the situation progresses, how it changes. A: Yeah, that is one thing that comes up only through image comparison. Co-viewing continues with clip 2

Figure 3. In the video sequence 2B radiologist A reaches out from the left to the right in front of the light panels.

3.1.2. Analysing in more detail and uncovering previously invisible work The issue of image comparison was continued in the more detailed analysis of the unfolding image interpretation activities presented in clip 2. Episode 2B brought up the issue of simultaneous reading of images mounted side-by-side on the light panels (see Figure 3). In responding to H’s pointer about changing his position in front of the alternator from one side to the other (transcript 2, line 1), radiologist A recalled his presence in the instance as he situates himself back there in time (“getting a view”, line 2) and into intimate proximity with the films (“a view at right angles at both of the films”). He was immersed back in the particular events of the clinical problem


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Transcript 2. Episode 2B Co-viewing sequence 2B 1 H: So here you move all the way from one end to another, or what are you doing there? 2 A: I think it’s necessary to reach out to get a view at right angles at both of the films. You 3 cannot look at the film, or at the monitor from the side. In a way, you look perpendicularly, 4 and when you are comparing two images, you search a position in the middle of them to be 5 able to see them in about the same size. It has to be the reason for moving like this, I 6 suppose. I’ve never really thought there is so much body work involved in image 7 interpretation, but so it seems to be . . . Co-viewing continues with sequence 2C

solving situation replayed from the tape. Reminded about his recent experiences with monitor interpretation, he juxtaposed traditional and teleradiology image interpretation practices to point out a similarity in the environments (line 3). He unravelled the meaning for this particular observable behaviour from the point of view of everyday practice: the radiologists need to find a position in middle of the films to be able to read them at a perpendicular angle in more or less the same size (lines 4–5). As if surprised he noted that he “never really thought” that there was so much body work involved in the search for optimal spatial relations with the films spread over the large area of light panels (lines 5–6). Realising this he, however, contented that “so it seems to be” (line 7) having uncovered such an essential, but previously invisible aspect of image comparison. 3.1.3. Sharing understandings of work practice Radiologist A engaged actively in elaborating and sharing experiences as the video collage portrayed his everyday work practice. The other radiologists joined him by offering their interpretations of the videotaped work. The practitioners’ lived experience found expression in their accounts and evocations, articulated in the characterisations of typical aspects and common patterns of behaviour in work. Detailed analysis of the actual unfolding activities enacted in the process helped the practitioners to discover aspects of routine work that had been obvious enough to be unremarkable to them. They realised that an essential part of image comparison, in addition to having all relevant films available (episode 1), is to have an unrestricted visual access to the appropriate films required in simultaneous reading (episode 2B). The non-radiologists familiarised themselves with the way in which the work is actually performed in real world clinical practice and followed the radiologists’ explications and elaborations. They (in these episodes K and H are the vocal ones) were able to join the discussion by asking questions, translating terms and concepts into words more readily understandable to others and summarising descriptions.

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The collaborative analyses helped to make the complicated practices of image interpretation more easily accessible, shareable and understandable also for the non-practitioners. The co-constructed understandings of traditional work practice served as a shared foundation for the subsequent activities in which the participants moved on to scrutinise and evaluate the experimental system-in-use situations and teleradiology practice. 3.2. EXPLORING SYSTEMIC ANALYSIS OF WORK PRACTICE WITH TECHNOLOGY IN FOCUS

This section explores the elements in the workshop that contribute demonstrably to the systemic analysis of work practice focusing on technology: the ‘double presence’ of work practice, the dual strategy of familiarity and strangeness of video-based representations of work, and the interplay between particularities and meanings of work. The notion of systemic here refers to Jordan’s delineation of the systemic paradigm which is based on the idea of working inductively and grounding the emergent understandings of work practices in iterative recourse to the data (1996). 3.2.1. Double presence of work practice The workshop setting provided for the presence of work practice in two ways, i.e. through the video collage representing instances of actual work practice and through the practitioners’ active participation. 3.2.1.1. Unfolding technologically mediated work on video collage. The video collage offered the participants a chance to observe radiologists’ image interpretation almost in situ, as the work was actually performed in the workplace. The idea of making the work visible ‘as it is’, i.e. the richness of everyday practices with smooth routines and problematic situations, bears similarities to the profound interest of ethnomethodology in the everyday methods and practical reasoning in and through the application of which the activities of work are practically accomplished as routine, taken-for-granted activities (Crabtree et al., 2000). The video collage revealed in detail the methods that the practitioners find relevant in their everyday work (e.g. comparing new and old films) and what they use in the course of accomplishing their work (e.g. occasionally juxtaposing an old film in the hand with the new ones hung on the light panels). The otherwise hard to grasp moment-by-moment temporal organisation of unfolding activities was subjected to an analysis, e.g. how reading the request, interpreting the images and dictating the report succeed each other, and especially how they entwine. The work ‘as it is’ provided also for the scrutiny of everyday technologically mediated interactions (e.g. the intertwined use of films, patient records, light panels in the alternator environment) as well as the intrinsic details (e.g. the radiologist using the right hand for the dictaphone and the left


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hand to hold the film). In addition to the technologically mediated work on video collage, keeping technology in focus was supported by the facilitators’ questions and pointers that directed the participants’ attention to the use of technology at work. 3.2.1.2. Practitioners’ lived experience and professional expertise. In analysing the practitioners verbalised their interpretations and evocations of the videotaped work by describing and characterising activities and events. Through their explications the there and then of the video collage also became the here and now of the workshop. They recounted circumstantial information that cannot be seen on the tape (e.g. the film archives). They brought in the vocabulary of radiology practice (e.g. shades, alterations, changes, exposures, read images, dictate), the everyday methods (e.g. comparing films, using all image information) and common practices (e.g. image comparison in image interpretation), and the categories from within the work practice (e.g. normal variations vs. progressive diseases and radiologists vs. general practitioners interpreting images). In all these explications the practitioners drew on their lived experiences as practising radiologists and their professional expertise in clinical work. The analyses in which the practitioners participate are by nature different from video based analyses of work performed by only researchers (e.g. Interaction Analysis, see Jordan and Henderson, 1994) but bear more similarities to analyses of work carried out in work research approaches, e.g. Interaction Analysis in the Workplace, WIAL (Cefkin and Jordan, 1994) and Change Laboratory of Developmental Work Research (Engeström et al., 1996), neither of which, however, has been used in the system design context. 3.2.2. Rendering work practice both familiar and strange In addition to rendering the work practices familiar so that practitioners’ experiences are evoked, the video collage worked also in a different way, as if rendering the work extraordinary to the practitioners. The very familiarity of working activities which makes them invisible, as if they were seen but went unnoticed when immersed in everyday work, was broken and they became somehow strange when depicted in the video collage. A similar strategy of making the ordinariness somehow extraordinary yet recognisable is exercised in ethnographic literary practice (Anderson, 1994). In Developmental Work Research another similar scheme called ‘mirrors’ is used to represent problematic instances of the ‘original task’ to be worked on collaboratively (Engeström, 1996). Through detachment from the everyday routines the workshop setting allowed the practitioners a rare opportunity for an outsider perspective, significantly different from having to cope to get the job done. An example of this can be seen in the episode 2B where the unremarkable embodied use of films and light panels became manifest. Reflecting on the meaning of the body moving in front of the light panels, radiologist A distanced himself from the everyday immersion

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of doing the work and was able to note the inherent bodywork (“I’ve never really thought . . . so it seems to be”, lines 6–7). In the propitious conditions the ambivalence of strangeness and familiarity grew into a dialogue, a two-way relation for exploration. Iteration between them made room for analytic distance for the practitioners. The tacit and taken-for-granted aspects in the technologically mediated routine practices became accessible and articulable. 3.2.3. From particular activities to meanings of work The situated positions within the everyday clinical practice in combination with the newly gained analytic distance allowed the practitioners to relate the particular instances of videotaped work to their experiences of what is common1 in everyday work practice. Rather than producing mere descriptions of the specific activity, they articulated what was important with concern to their lived experience. In more ethnographic terms, the practitioners’ explications captured the deeper patterns and patterning of work being played out in and through the everyday detail of local scenes (cf. analytic vs. impressionistic images of work, Anderson, 1994). The situated particularities on the videotape evoked the practitioners to characterise the issues and concerns germane to the actual work practice that they found relevant in the unfolding course of accomplishing the work. Their meanings could be formulated as the practitioners understand the means and intelligibility of everyday practices by which the observable ways of working arise and are constituted (cf. sensibilities of work, Button and Dourish, 1996). 4. Redesigning the teleradiology system After the film-based interpretation the participants proceeded to monitor interpretation (see Figure 4) in the teleradiology environment (clips 3–14). This section illustrates first how the participants engaged in co-constructing issues of teleradiology system and work practice. The latter part discusses the elements that contributed to the appreciative, work practice-based intervention in the workshop. 4.1. CO - CONSTRUCTING WORK PRACTICE BASED DESIGN ISSUES FOR A FUTURE SYSTEM

Two examples, namely the reformulation of an initial design concept and the evaluation of two image processing functions, depict how the construction of work practice-based issues for design was an emergent achievement for the participants. 4.1.1. Reformulating an essential design concept The following excerpts from episode 8A (transcript 3) illustrate an instance that was a culmination point in the workshop in the sense that one of the most central


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Figure 4. Radiologist A interpreting images in the teleradiology environment.

Figure 5. In video clip 8 teleradiologist B opened the first packet, searched for the internal image code, memorised the lengthy code, closed the packet (A), opened the second one (B), and through a special procedure of selecting the code of the first packet from a long list of image codes (C) opened the images of the first packet together with the images of the second packet (D).

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Transcript 3. Excerpts from episode 8A Co-viewing sequence 8A 1 H: Did you often do that, putting on display images from several packets? 2 A: Well, I used it as little as possible. Sometimes when the image was transferred and 3 displayed, I rapidly read the image and tried to memorise it before going to the second 4 packet of images, so that I would not have to go through it again ... doing so causes anguish. (. . . ) 5 C: This is an interesting issue. Comparison is an important word here. In all issues that we have 6 talked about here today we have seen that our original concept was more like solving 7 individual problems. Now, this work has also proved that comparison is needed even in 8 teleradiology and we just must make it possible . . . Discussion continues

original design concepts that was complexly interlinked with image comparison was called into question and the construction of a new one began. The reconsideration came about gradually; discussions on image comparison that contributed to it had already begun with clips 1 and 2, and had continued recurrently.2 The participants had broadened their initial view of image comparison (see section 3.1) from the availability of all relevant images for interpretation (episode 1) to unrestricted visual access to the appropriate films during the unfolding interpretation process (episodes 2A-K). Analyses of situations where the image display application was used in actual interpretation work (clips 3–7) had revealed that there was no explicit support for simultaneous, side-by-side image comparison in the experimental system. The discussion was evoked again by video sequence 8A that depicted teleradiologist B engaged in a rather complicated procedure of joining patient images transferred in two packets to be able to display them simultaneously on the monitor (see Figure 5). As the tape was paused H asked radiologist A if he had been frequently engaged in the same procedure (line 1). Radiologist A recounted that he would rather resort to the work-around of memorising images than get engaged in the ‘tormenting’ procedure (lines 2–4). A little later, confirmed by the video sequence and radiologist A’s disclosure, radiologist C questioned the original teleradiology design concept (lines 5–8). The idea of “solving individual problems” (lines 6–7) had been based on the presumption that typical cases of teleradiology consultation require a timely interpretation of only a few images which had implicitly implicated little or no image comparison. The more informed understandings of the key role of image comparison in interpretation and the obvious problems with the experimental system not supporting the juxtaposition of images, however, suggested the essential nature of simultaneous comparison of side-by-side images in all image interpretation, “even in teleradiology” (lines 7–8). Radiologist C began to outline a new design concept (“comparison of images is needed . . . and we just must make


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Figure 6. Adjusting the greyscale of an image on the monitor by dragging the mouse.

it possible”, lines 7–8) that was more in line with the actual teleradiology practice and which was refined as the participants continued to bring up the issue later in the workshop. 4.1.2. Assessing the relevance of an experimental system function for future teleradiology practice The following excerpt (transcript 4, episodes 10A and 10B) where the use of one image processing function, namely greyscale adjustment, was considered, involves three specific instances to illustrate how the participants found ways to relate work practice and system design (first, lines 5–11; second, lines 12–19; and third, lines 20–31). It is obvious that greyscale adjustment of images in the digital environment to adjust both contrast and brightness of images has no counterpart in film-based practice, as the exposure of a film cannot be changed once the image is printed. The experimental system included two functions for greyscale adjustment, called here the mouse-based and the histogram-based function. The video clip 10 presented radiologist A adjusting the greyscale of an enlarged image (see Figure 6). He used the mouse-based function which was meant for adjusting all images simultaneously on screen by mouse-dragging: horizontally to adjust contrast, vertically to adjust brightness and diagonally to adjust both at the same time. The sequence evoked radiologist C to ask – as he was aware of the two different functions – radiologist A about the use of the other greyscale adjustment, the histogram-based one (lines 1–2), which had been built for the adjustment of individual images “from the raw data”. It was designed to be executed through a menu selection for the histogram diagram of the image and then changing the S-curve of the image’s greyscale dispersion. Radiologist A, being the only one to have gained clinical experience with the system, disclosed not having used the

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Transcript 4. Excerpts from episodes 10A and 10B

1 2 3 4

5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Co-viewing video sequence 10A C: Radiologist A, did you use the histogram-based greyscale adjustment, the one in which the adjustment to use is selected from the histogram? A: No, I just used the one fixed to the mouse and determined the optimum position at each moment through the tone adjustment given by it . . . the other one seems difficult to use . . . (. . . ) Co-viewing video sequence 10B A: It does not aim at a fixed adjustment. There is so much tone difference between the upper and lower parts of the image that one has to search for momentarily optimal adjustments for certain regions. I can screen the region of interest with one adjustment. There is no way to have the entire image optimally adjusted with only one adjustment. C: There has to be an option to do it on the fly, you must be able to do it at same time as you are reading the image. A: Yes, when there is so much difference in tone within an image. (. . . ) K: Is there a need for adjustment of individual images then? D: Yes, if we want to compare two images that have been slightly differently exposed. We need to have them with the same tones, simultaneously. C: Now we come to the analogy with light panel interpretation. This quick adjustment works generally, as in cases like the 50 seconds image interpretation. But then with difficult, complicated cases, like when you were searching for a calcification and had differently exposed films, then you needed more thorough adjustment of individual images. It’s like some second generation tool that we could use in such cases. K: How about setting initial values for adjustment, adjusting images to a pre-set level? S: Histogram equalisation? K: It would not necessarily be right. But then we should, anyhow, . . . C: But there is a visual problem there. . . . In film based practice we gain a visual registration of the images, how they were at the beginning. We know how to proportion our interpretation to them in comparing images. But if the images were equalised evenly, we would not be able to differentiate what is real alteration of tones and what is caused by the program. There can be truly small shades in images that are important in thoraces. C: We must able to stay in control. D: We know if an image is underexposed or overexposed. But as we know film technology and the anatomical object, and how X-rays penetrate, we also know how it influences the interpretation. Discussion continues


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histogram-based option due to its inconvenient user interface (“difficult to use”, lines 3–4). 4.1.2.1. From the evaluation of a system-in-use situation to system requirements. In the first instance (lines 5–11) radiologist A verbalised his analysis (lines 5–8) of his usage of the mouse-based greyscale adjustment (in video sequence 10B). He stressed how adjusting was intertwined with the simultaneous process of image interpretation: reading images with a lot of tone variation was possible by finding an optimal combination of contrast and brightness for a certain region of interest within an image at a time. He doubted whether it would be even possible to find one adjustment that was optimal for all regions in such unevenly exposed images. Radiologist C agreed with A’s explication that greyscale had to be adjustable at the same time as the images were read (lines 9–10). Collaboratively they established through an insightful analysis and evaluation of a particular instance of work that a need for “doing it on the fly” generally exists in cases where “there is so much difference in tone within an image” (lines 9–11). 4.1.2.2. Arguing for future system functions with an analogy based on coconstructed understandings of work practice. In the second instance (lines 12–19) K brought up the issue of the histogram-based greyscale adjustment function (line 12) mentioned at the beginning of episode 10A (lines 1–4). Radiologist D confirmed the need for such a function as there exist slightly differently exposed images that need to be juxtaposed simultaneously with the same tones (lines 13– 14). Then radiologist C engaged in arguing for the need for two different greyscale adjustment functions in the future system (lines 15–19). In the reasoning he juxtaposed the two greyscale adjustment functions from the experimental teleradiology system with the two cases of film-based image interpretation analysed at the beginning of the workshop. He explained that the mouse-based option for rapid greyscale adjustment worked for simple cases such as in clip 1 (“the 50 seconds interpretation”, line 16), and that a more thorough adjustment was needed in more complicated cases such as the six minute interpretation in clip 2 where radiologist A had to search for differently exposed images to confirm his assumptions about a suspicious calcification (lines 16–19). To the initial question stated on an abstract level: “is there a need . . . ” (line 12) the practitioners were able to give an affirmative answer on a general level which, however, was intimately based on work practice. Even though the histogrambased function could not have been assessed by analysing actual use situations, as radiologist A had not used it, radiologist C came up with a resourceful solution of using the available representations of work and the previously co-constructed understandings of them to create an analogical tool to which also other participants could relate. He associated the two clips of traditional image interpretation as shared categories (simple and complicated case) with the greyscale adjustment

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functions of the experimental system (mouse-based and histogram-based) and of the envisioned context (“quick adjustment” and “second generation tool”). 4.1.2.3. Ruling out an infeasible design idea. In the third instance (lines 20–31) a design idea that further exploited the technical potential of digital imaging was put forward. K and S suggested that the adjustment of initial images on screen could be preset to a histogram equalisation to provide more evenly toned images from which to start the interpretation (lines 20–21). The idea alarmed the radiologists as they were able to evaluate the images of the future system by juxtaposing them with their extensive experience of image interpretation. They could see the detrimental implications of the proposed technical enhancement that were not apparent to non-radiologists. Radiologist C pointed out that there was a visual problem (lines 23–27) as it was important for the radiologists to see all images with their initial exposures to be able to differentiate between what is a real and application inflicted change in image tone. Such slight variations in image shades that a lay person cannot perceive are essential for the radiologists. Their professional expertise is about seeing medical meanings in minute changes in shades of grey, about distinguishing the normal from the pathological and actual signals from irrelevant noise. The proposed prior equalisation would make it impossible for the radiologists to stay in control of image tone variations (line 28). Radiologist D further explained that they were able to interpret and diagnose even less perfectly exposed images based on their knowledge of how radiological images are produced and of human internal anatomy, physiology and pathology. Part of their proficiency was to adjust their interpretation flexibly to the varying factors in different situations (lines 29–31). 4.1.3. Relating work practice and design issues The above examples illustrate how relating work practice and system design was a continuous process that varied in complexity. It could span the entire workshop as in the case of cultivating the issue of image comparison, or something could be found a worthy design consideration through one time collaborative viewing of an instance of work followed by a focused discussion, as in the example of addressing the relevance of image processing functions to future teleradiology practice. Issues mostly arose from within the interest of work practice but also from the potentials of new technology. The legitimacy of design ideas was weighted by considering their implications for everyday work practice, i.e. practitioners envisioned how the suggestions would affect particular use situations by projecting their lived experience into the future practice. In envisioning a realistic future technology the outsiders’ views hardly match the practitioners’ unique understandings that combine long-time lived experience ‘from within’ and the new more analytic reflection.


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4.2. EXPLORING APPRECIATIVE INTERVENTION BASED ON TRANSFORMATIONS OF WORK PRACTICE

This section explores the elements that demonstrably contributed to the appreciative intervention in the workshop, i.e. how presence and change were intertwined through the analysis of existing ways of working and how the horizon of work transformations was expanded through the exploration of work mediated by different technologies. 4.2.1. Presence and change intertwined in existing work practices The actual work practices became concrete and tangible, as if present in the workshop, through the viewing and detailed analyses of current work activities and the practitioners’ elaborations on them (see section 3.2.1). The change was made visible by the participants exploring the same work in both co-existing work practices with different types of technological mediation. A’s traditional work practice (clips 1 and 2) represented the lived experience of all radiologists who have learned their trade in the film-based environment. All the participants had a chance to familiarise themselves with the emerging way of working by seeing the radiologists A and B working on the experimental teleradiology system (clips 3–14) and hearing about A’s experiences. The intertwined character of presence and change became manifest through the comparison of the co-existing ways of working and learning about the indigenous change in the (tele)radiologist’s practice (cf. indigenous innovation initiated from within the work group, Blomberg, 1995). By staying close to the work activities the participants discerned a variety of ways in which the transition took place, e.g. the teleradiologist had a decisively smaller screen estate on the computer monitor for digital images in comparison with the films on the large light panels in the traditional environment, and the teleradiologist constantly used a mouse to organise and process images on the screen during the interpretation, whereas in the filmbased environment the radiologist would move about in front of the light panels to be able to read the films. They witnessed that radiologist A’s work underwent an observable self-organisation during the trial period, e.g. he had learned to adjust the greyscale of an image to be optimum “on the fly” simultaneously as part of the interpretation process, and he had invented the work-around of memorising images to avoid using the cumbersome procedure of joining separately transferred images. The notion of intertwined presence and change in existing work practice bears similarities to Anderson’s description of the ethnographers’ interest in change (1997, p. 177): if we set the context for the ethnography at the level at which many ethnographers feel most comfortable, we will find they are almost obsessed with change of one sort or another. In picking their way through the minutiae of routine action, prominence is (endlessly) given to the innovative, the ad hoc,

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and the unpredictable rife in the workplace. Change, here, is the very stuff of ethnography. Here, however, the interest in indigenous change was more focused on technologically mediated activities and technology induced transformations than “change of one sort or another”. 4.2.2. Broadening the horizon of work transformations The analysis of two different yet co-existing ways of working made room for perceiving the transformations from the traditional to the teleradiology work practice. The radiologists started relating their experiences of light panel interpretation with the monitor interpretation of digital images, though the latter drastically differed from the familiar film-based work. The main teleradiologist already compared the two environments in the middle of the intensive analysis of traditional work (episode 2B), as he was able draw on his experience with the system. Other practitioners became active in juxtaposing the different ways of working in relation to exploring and becoming more familiar with the teleradiology practice (from clip 3 onwards). Emerging understandings of the changes introduced by the experimental system to everyday work and the practitioners exploring the relation of past and future development of their work paved the way for envisioning further transformations. For instance, the participants explored what image comparison meant for interpretation and how the conditions for reliable and accurate diagnostics could be guaranteed in the digital environment despite the reduced image estate. Visions of the future context were constructed based on the understandings of existing work practices and transformations in them as the practitioners became able to expand their thinking to the foreign digital imaging-based forms of working. “The horizon is as far as we can see from where we are. It is not fixed; if we move in space the horizon shifts. What is within one’s horizon is subject to revision and expansion” (Hastrup, 1995, p. 11). The notion of horizon is dynamic; it allows for learning from situated points of view and it invites expansion. 5. Integrating systemic analysis and appreciative intervention with practitioner participation The previous sections have described how the participants found collaboratively the relevance of work practice for system design by constructing shared understandings of work practice and envisioning images of future system. The following three dimensions of this co-construction process are essential from the point of view of integrating systemic analysis and appreciative intervention (Figure 7).


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Figure 7. The dimensions of integrating systemic analysis and appreciative intervention: (1) The analytic distance: the possibility to get at a distance from everyday work, and to encounter work activities as if in a mirror. (2) The horizon of technologically mediated contexts of old and new work: analysing, evaluating and juxtaposing existing ways of working on video collage and envisioning images of the future system and work practice. (3) The situated generalisation: the practitioners’ unique sense in giving meaning to the particularities of work for the co-construction of design issues.

5.1. ANALYTIC DISTANCE The workshops were based on the idea of providing a setting where all the participants could engage in a collaborative analysis of work. The focus here is on the practitioners’ participation in analytic work which has not received much attention in previous studies on the integration of work practice and system design as analysis has been seen as a realm reserved for researchers and designers. Ethnographic traditions, for example, have seldom sought to invite members of the community to participate in the analytic work of writing and (re)interpretation, and ethnographers have acted as mediators between the two worlds of the natives and the academic audience (Hastrup, 1995). This seems to have been passed on to the technology development settings. Many studies have described ethnographers as mediators between the work place and system development (Bentley et al., 1992; Hughes et al., 1993; Blomberg and Trigg, 2000; Crabtree, 1998). Some have considered it too problematic to have users directly involved in design (Bentley et al., 1992). Some openly reveal their prejudice against the practitioners’ analytic abilities: “no set of practitioners, no matter how expert, can articulate analytic frameworks and categories. Not for that matter can they abstract out of context, and HCI researchers and developers cannot immediately use their experience infor-

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mation” (Graves and Nyce, 1992, referenced in Nyce and Löwgren, 1995). Even proponents of user participation have reported on practical difficulties hindering the incorporation of workers into the analysis of their work (Jordan, 1996). Participatory Design approaches, on the other hand, have always incorporated users into the collaborative design processes. They have relied on users as ultimate experts of the work context who are able to bring in the relevant skills, experiences and interests. However, the role of practitioners in analytic work has often been rather passive, although analysis is usually conceived as the activity in a development project that involves users the most (Mogensen and Trigg, 1992). Furthermore, the foremost focus on designing systems has superseded the analytic mentality towards users’ work. Understandings of work practice may have emerged through user participation but explicit analysis of work has not been attempted (Blomberg, 1995). Recently researchers attempting to integrate participatory design and ethnographically informed studies have explicitly incorporated field studies and analyses of work into their design projects. Some even mention “teaching practitioners how to include ethnographic techniques into their repertoire for actions” (Simonsen and Kensing, 1998), but unfortunately experiences of this have not been explored any further. In the workshop the participants maintained a sustained analysis of videotaped instances of everyday practice. Practitioner participation in the analytic work resulted in multidimensional explorations and co-constructed understandings of existing work, whereas more future-oriented and technology-centered techniques may, in fact, have a distorting effect as the focus in them is somewhere else than everyday work. What users find relevant in the course of accomplishing PD activities is not necessarily what they find relevant in the course of actually accomplishing the work (Crabtree, 1998). In the workshop the actual work practices became the appreciated and legitimate starting points for technology design (cf. challenging practice, Mogensen, 1994). The practitioners did not only participate to share their experience and expertise with the other participants. They also learned more about their work themselves, as they were capable of taking an analytic perspective and they came to appreciate their new awareness: “one does not often have a chance to look at one’s own work as an outsider” (radiologist A, episode 2H). The analytic distance allowed them to articulate meanings of work and to discover previously invisible taken-for-granted aspects of routine practices. In this sense the intentional co-analysis of existing work differs from the notion of mutual learning widely practised in PD approaches. Mutual learning, based on the idea that design professionals learn about the actual context of use from the practitioners, and the workers in turn acquire knowledge of possible technological options from the designers (see, e.g. Bjerknes and Bratteteig, 1989), does not support explicit analysis of work practice and learning more about it than is already known.


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5.2. JUXTAPOSING EXISTING AND NEW WORK PRACTICES The participants created a horizon of work transformations by juxtaposing current and new ways of working. This was supported by making the two co-existing work practices visible in the video collage. The idea for including different forms of work was inspired by Developmental Work Research (see e.g. Engeström, 1999) where the dimensions of past, present, and future are used to explore the problems of work in the Change Laboratory (Engeström et al., 1996). However, instead of using the predefined categories of “historical forms of work” (Engeström, 1995) we found it important to represent the existing forms of practice, in this case, by the work mediated by different technologies. The traditional way of working has been prevalent since the days of Roentgen and all radiologists have been trained in film-based image interpretation. The teleradiology work practice based on digital imaging and computerisation was emerging, and the trial period was the first instance of solely relying on monitor reading for clinical interpretation in the OUH. Towards the end of the workshop the redesigned teleradiology context received increased attention, as analysis of existing ways of working and evaluation of system-in-use opened frequent opportunities for creating images of an improved system and future work practice. The possibility to juxtapose existing ways of working gave the participants a new perspective to understand more profoundly the changes involved in moving on to digital imaging. By juxtaposing existing, historical, emerging and envisioned contexts of work they were able to broaden their horizon of work practice transformations. In comparison to the horizon of work transformations both ethnography and system design depict restricted yet differently limited interests. Ethnography has a strong orientation to the social organisation of current practice. Therefore it has been criticised for being inimical to change (see, e.g. Grudin and Grinter, 1995). Although this seems too harsh, it is clear that the interest of ethnography in change is different from that of system design. Ethnography recognises indigenous change “of one sort or another” in current practices and ethnographers have been cautious about using this explicitly to promote understandings about work and technology transformations (Anderson, 1997). System design, on the other hand, has an inherent orientation to the future. Its interest in current practices is typically limited to identifying practical problems which can be solved with future technological means. The problem-solution frame of reference has been criticised for producing perfect technological solutions to wrong problems of work due to an ignorance about existing practices (ibid.). The analytic aspirations of ethnography and the interventive orientation of system design are intertwined in the horizon of work transformations. Its interventionist impulse appreciative of current work is based on close alignment with the everyday practices and explicit interest in the use of technology in work mediated with different technologies.

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The idea of work transformations is not common in the integration of work practice and system design. A notable exception that has used the idea implicitly is formed by the case-based prototypes (Blomberg et al., 1996) that incorporate materials from the actual working site as well as from experimental or potential solutions informed by new technological possibilities. In a particular study the different ‘worlds’ of a case-based prototype were the user’s practice, the prototype, and the product (Blomberg and Trigg, 2000). Blomberg and Trigg put forward mediation and translation between the worlds as “general characteristics of interactions across ethnography and system design” in co-constructing the relevance of work practice for design (ibid.). Mediation and translation between the contexts were also considered relevant here. However, juxtaposing was seen as contributing more directly to design, as the participants used it in generative thinking about the similarities, differences, alternatives and analogies between different work practices.

5.3. THE SITUATED GENERALISATION The relevance of work practice to system design was achieved through the possibility to explore particular work activities collaboratively with a special focus on technologies-in-use in an interplay with realistic design considerations. The analysis of actual work practice defined the importance of the particular. The participants could not just talk ideally about image interpretation, or about the general possibilities and overall potential of digital imaging. Throughout the workshop they were reminded of and could go back to the actual cases and situated instances of technologically mediated everyday work. The co-construction of shared understandings was an ongoing and intensive process. The explications created were not just descriptive images of what takes place in the particular instances. They were more analytical in the sense that they articulated the underlying patterns of what is common in clinical work. The practitioners gave meanings to the particularities by drawing on their lived experience and knowledge of the rationale of diagnostic image interpretation. The analytic explications and meanings worked like intermediaries in the interplay between work practice particularities and system design issues. Some of them became distinguished as something so common or general that they would have to be taken into account in further development of the technology, as in cases where the practitioners conceived that certain aspects of work need to stay the same regardless of the technology used. They were also used as emergent criteria in the assessment of the design ideas based on technology potentials for their relevance and implications for particular instances of work. Design considerations acquired a prominent role in the discussion, as the participants proceeded to teleradiology practice and gradually learned about the indigenous change taking place in work. The broadening of the horizon of work transformations to the future context inspired envisioning and generative thinking.


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A crucial issue in forming situated generalisations3 was the possibility to explore the issues in and through the horizon of work transformations, i.e. as the participants found something important for the work in one context (such as identifying an essential aspect of work in a particular videotaped instance) they could apply it into and compare it with other contexts (finding out if it can be generalised to other ways of working). The dimension of situated generalisation relates to a set of concerns that have been put forward as most incommensurate in the debates over the disciplinary discrepancies between ethnographic studies of work and system design, such as descriptive vs. prescriptive, particular vs. general, concrete vs. abstract, present vs. future, and understanding vs. intervention. However, in the workshop setting that supported practitioner participation and the above three dimensions for exploring the relations between work practice and system design, these dichotomies were not manifested.

6. Conclusions and future work This article has illustrated and discussed the challenges and opportunities of bridging work practice and system design through the integration of systemic analysis and appreciative intervention where practitioners participate. From ‘my outsider disciplinary position’ I have acknowledged the strengths but also questioned some taken-for-granted assumptions of ethnography and participatory design as well as some seemingly insurmountable discrepancies between disciplines. The different viewpoints can be seen to be systematically integrated through the systemic analysis of work practice with a focus on the technologies in use and appreciative intervention respecting existing work practices and indigenous change. A reconceptualisation for bridging work practice and participatory system design was outlined in the form of three dimensions: first, the analytic distance that allowed for rendering the work practice both familiar and strange through an interplay of going back and forth between being immersed in the accustomed activities on the tape and distancing from them to reflect; secondly, the horizon of work transformations where the present work practice and indigenous yet technology induced change get intertwined by juxtaposing new and old ways of working; and thirdly, the situated generalisations in which the particular instances of work gain their meaning from lived work experience and become relevant as design issues through consideration across other contexts of technologically mediated work. A major benefit of the integration of systemic analysis and appreciative intervention was the overall gravitation towards actual work practice. Its appreciation was intertwined into and informed the processes of technology evaluation and envisionment. Most particularly, new awareness of what is important to attend to in design was achieved, for example, in the form of co-constructed understandings of the essential aspects of work that need to be preserved regardless of the techno-

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logical environment. Such awareness cannot be deliberated without very detailed understandings of actual work practices. Another important advantage was manifested by the practitioners’ active participation. It opened possibilities for multidimensional explorations of work practice understandings as well as design considerations. The analytic distance made it easier for the practitioners to become informed critics and visionaries of technological possibilities and restrictions on their work. Practitioner participation also relieved some problems of interdisciplinary work. Tensions already lessen in situations where the designers and ethnographers engage in a joint enterprise (Blomberg and Trigg, 2000). Practitioner participation does not, of course, wipe away the disciplinary differences, but it provides opportunities to avoid the presumed gap in actual design situations, as the practitioners move easily between and outside the territories of ethnography and system design. As the setting in this study was a propitious one, it could be interesting to see how the dimensions could be reproduced in other undertakings. This is, of course, an empirical question, but some speculation may be quite in order. First, my contention is that the dimensions evident in the workshop discourse suggest more general features of border crossings in the integration of work practice and participatory system design. Along similar lines, Blomberg and Trigg have argued for mediation and translation as general characteristics of interactions between ethnography and system design in settings where ethnographers and developers collaborate (ibid.). Secondly and quite obviously, participants can be supported to take advantage of these dimensions for the co-construction of work practice-based design issues. Providing an opportunity for analytic distance requires a mirror of actual work practices represented in an accessible form, and video has proved to work well in this role (see, e.g. Muller, 1991; Brun-Cottan and Wall, 1995; Chin et al., 1997). The practitioners need to be able to confront the mirror outside their everyday settings to be able to engage in analysis and reflection. Practitioner participation in analysis can be already fostered during fieldwork by engaging them to develop an analytic mentality towards their work, for example, in stimulated recall interviews (Karasti, 1997a). A more experienced analyst could be helpful to facilitate the coanalyses, and facilitation can also be useful to take into account the power-related inequalities in workplace interaction. Lastly, it may seem difficult at first to provide materials for the horizon of work transformations when, in fact, current workplaces accommodate various practices of technology use, offering several ways for juxtaposition. For instance, it may be possible to find historical forms or types of work that intertwine in the existing practices (Engeström, 1996) or to distinguish between technologies acquired in different periods, or to examine technologies in different phases of their development (Suchman et al., 1999; Goodwin and Goodwin, 1997; Barley, 1990). Furthermore, in larger than workshop settings the ideas put forward here could be combined with more future-oriented and technology-centered methods which in turn may provide for different technology use contexts.


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Acknowledgements Special thanks are due to the staff of the two radiology departments and the two participating companies, to Sari Tuovila for sharing the fieldwork and Kari Kuutti for joining in as a facilitator in the workshops. Thanks are also due to the participants in the Work Practice & Technology course at the University of Karlskrona/Rönneby, Marjo Favorin, Juhani Iivari, Kari Kuutti and the three anonymous reviewers for discussions and/or comments on earlier drafts of this article. Notes 1. In episodes 1 and 2(A-K) the following words and expressions are used in relation to image interpretation in film-based environment: often, there is a lot, a common pattern of behavior, always, common, frequently, in a central position, ordinary, general, there is very much, as a rule, on average, usual, a normal pattern, and a result of a dozen years of practice. 2. Image comparison and related issues were discussed in episodes 1, 2B, 2C, 2E, 2G, 2I, 2J, 3B, 3C, 3D, 3E, 5, 6, 8A, 8B, 10B, 12, 13, 14. 3. One of the anonymous reviewers is thanked for suggesting the term of ‘situated generalisation’.

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