This paper describes a qualitative study of organizational implementation of a mobile information system in social home care. Implementation of a new information technology affects the working community in many ways. In addition to expected outcomes, unexpected changes in the work arrangements, work practices and in interaction relationships between the actors in question are likely to emerge (e.g. Vaast and Walsham 2005).
Home care offers help to vulnerable, usually elderly clients coping with their everyday life in order to support independent living at homes. Work in home care consists of distributed activities between different workers at different times and in different locations. The new information system was introduced for gathering information about client service calls to ease the planning of working hours and to make the balancing of recourses and tasks more efficient. In practice, this meant that the home care workers received mobile computers to gather the needed information for care team managers. In addition, the home care workers can now access the client database through their mobile computers, which supports care workers’ action taking and decision making if something unexpected happens during a client service call.
Whilst the home care management saw the implementation project as an opportunity to increase quality and effectiveness of the service by upgrading and standardizing the working practices to a more professional direction, the home care workers expressed doubt while interpreting what actually were the purposes and outcomes of the implementation project. The home care workers resisted the mobile technology as one that promotes control of working time. They felt the mobile system as a threat to the accustomed independence at work and instead as creating new interdependencies between the actors. Before the implementation, home care workers used to work alone in the field and no official accounts were made of the services. By changing the visibility of working, the mobile system promoted a shift towards a new kind of control. Star and Strauss (1999) discuss the vulnerable situation of workers when invisible, often so called unskilled work, is made visible. Positive outcomes can be, for example, an increase of legitimacy and rescue from obscurity. Other possible outcomes are, depending on the case, reification of work practices, surveillance of the workers, and increase of communication and process burdens shared within a worker group.
Besides fearing loss of independence at work, for most of the home care workers the mobile system was their first learning experience of using information technology. Fears of unknown technology were expressed in rather stereotypic opinions such as that values embedded in care and in technology cannot be aligned. Negotiations about what were the best practices to carry out care work in the changing situation took place with other home care workers, clients, and managers as the workers tried to construct the unfamiliar technology to suit their professional identity and working practices.
The study explores how mobile information technology was constructed to be a part of professional care work, and a meaningful part of fluent interaction between the members of a care team. In the area, there were 750 home care workers, who were divided in 40 care teams. The implementation of mobile computers in home care began during winter 2001-2002. Appropriation process continued slowly until the year 2004. We explored whether the implementation of information technology would strengthen or weaken the care workers interpretations of their own abilities concerning the daily work. Interesting aspects were whether the changing visibility of the care work would affect the arrangements of daily work when technology was introduced for the first time, and what kind of new working practices emerge from the interaction between care workers and new technology.
Transforming care work was studied using qualitative ethnographic methods. With ethnographic approach we can inspect a phenomenon in situ, in its natural setting and from the members’ point of view (Blomberg et al. 2003, Schultze 2000). In home care case, work characteristics were mapped through observing the work, and then the emerging picture was deepened with interviews, as summarized in table 1.
First phase: observing 40 home care workers during the day and night shifts and during the meal services.
Latter phase: observing 60 home care workers during the day and night shifts.
First phase: interviewing 7 home care workers and 13 other participants in the implementation.
Latter phase: interviewing 20 care team managers and 20 home care workers.
Most of the home care workers’ interviews were group sessions.
In addition informal discussions during the breaks with the care team members.
Mapping of education, career paths and technology expertise within the home care workers.
Analysis of documents and forms used in the care work and generated from it.
Familiarizing with the information gathered in the new information system.
Table 1: Data gathering.
Blomberg J., M. Burrell, and G. Guest (2003). An Ethnographic Approach to Design. In Jacko J., and A. Sears (eds.): The Human Computer Interaction Handbook: Fundamentals, Evolving Technologies and Emerging Applications. Lawrence Erlbaum Associates, Inc., New Jersey, 964-986.
Star, S.L., and A. Strauss (1999). Layers of Silence, Arenas of Voice: the Ecology of Visible and Invisible Work. CSCW 8, 9-30.
Schultze, U. (2000). A Confessional Account of an Ethnography about Knowledge Work. MIS Quarterly 24(1), 3-41.
Vaast, E., and G. Walsham, (2005). Representation and actions: the transformation of work practices with IT use. Information and Organization 15, 65-89.