Designing Healthcare That Works: A Sociotechnical Approach

Designing Healthcare that Works

A Socio-technical Approach

Editors

Mark S. Ackerman

Sean P. Goggins

Thomas Herrmann

Michael Prilla

Christian Stary

Table of Contents

Cover image

Title page

Copyright

List of Contributors

Biography of Authors

Introduction

Chapter 1. Socio-technical Design for the Care of People With Spinal Cord Injuries

1. Introduction

2. Spinal Cord Injury

3. Scenario

4. SCILLS, the Spinal Cord Injury Living and Learning System

5. System Description

6. Formative Evaluation

7. Technical Lessons

8. Reflections on Socio-technical Design

Chapter 2. Design Principles for Supporting Patient-Centered Journeys

1. Introduction: Health Care as a Journey

2. Background: Personal Health Management Challenges During Cancer Care

3. Case Study: The Breast Cancer Journey

4. Lessons Learned: Supporting Health Care Journeys

5. Future Work

6. Conclusion

Chapter 3. Supporting Collaboration to Preserve the Quality of Life of Patients at Home—A Design Case Study

1. Introduction

2. Background: Supporting Collaboration in Home Care

3. The Case

4. Method

5. Results of the Empirical Analysis of Practices

6. Design and Evaluation of the CARE Application

7. CARE Pilot Study

8. Lessons Learned

9. Conclusion

Chapter 4. A Community Health Orientation for Wellness Technology Design & Delivery

1. Introduction

2. PHI Research in Community-Based Organizations

3. Case Study

4. Findings

5. Discussion

6. Conclusion

Chapter 5. Socio-technical Betwixtness: Design Rationales for Health Care IT

1. Introduction

2. A Short Historical Brief on Rationales Behind the Design of Work, Technology, and Organizations

3. A Foundational Model for Electronic Health Records

4. Empowering and Managing Distributed Work: IT for Hospital Porters

5. Discussion: On the Betwixness of Design in Health Care

6. Central Points

Chapter 6. Stakeholders as Mindful Designers: Adjusting Capabilities Rather Than Needs in Computer-Supported Daily Workforce Planning

1. Introduction

2. Description and Course of Study

3. Learnings for Socio-technical Design

4. Conclusion

Chapter 7. Dashboard Design for Improved Team Situation Awareness in Time-Critical Medical Work: Challenges and Lessons Learned

1. Introduction

2. Background: Domain Overview and Approaches to Dashboard Design

3. TRU-Board Design Goals and Display Features

4. TRU-Board Design and Evaluation Process

5. Socio-technical Challenges in Designing Dashboards for Safety-Critical Medical Work

6. Conclusion and Future Work

Chapter 8. The Recording and Reuse of Psychosocial Information in Care

1. Introduction

2. Literature Review

3. About the Study

4. Doctors’ Work

5. Documenting Health care Information

6. Discussion

7. Design Implications

8. Conclusion

Chapter 9. Challenges for Socio-technical Design in Health Care: Lessons Learned From Designing Reflection Support

1. Introduction: Designing Support for Collaborative Reflection in Health Care

2. Background: Supporting Reflective Learning in Health care

3. The TalkReflection App to Support Reflection at Work

4. Design Process and Results

5. Reflections: Socio-technical Design Challenges in Health care

6. Conclusion

Chapter 10. Double-Loop Health Technology: Enabling Socio-technical Design of Personal Health Technology in Clinical Practice

1. Introduction

2. Background: Personal Health Technology

3. Case: Designing for Double-Loop Treatment in Mental Health

4. Lessons Learned

5. Conclusion

Chapter 11. Designing Health Care That Works—Socio-technical Conclusions

1. The Extended View of a Socio-Technical Perspective

2. Consequences for Design

3. Methods That are Applied

4. Challenges and Problems

5. How to Deal With the Problems

6. Summary and Future Work

Index

Copyright

Academic Press is an imprint of Elsevier

125 London Wall, London EC2Y 5AS, United Kingdom

525 B Street, Suite 1800, San Diego, CA 92101-4495, United States

50 Hampshire Street, 5th Floor, Cambridge, MA 02139, United States

The Boulevard, Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom

Copyright © 2018 Elsevier Inc. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).

Notices

Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.

To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.

Library of Congress Cataloging-in-Publication Data

A catalog record for this book is available from the Library of Congress

British Library Cataloguing-in-Publication Data

A catalogue record for this book is available from the British Library

ISBN: 978-0-12-812583-0

For information on all Academic Press publications visit our website at https://www.elsevier.com/books-and-journals

Publisher: Mica Haley

Acquisition Editor: Rafael E. Teixeira

Editorial Project Manager: Fenton Coulthurst

Production Project Manager: Anusha Sambamoorthy

Cover Designer: Christian J. Bilbow

Typeset by TNQ Books and Journals

List of Contributors

Khuloud Abou Amsha,     Troyes University of Technology, Troyes, France

Mark S. Ackerman,     University of Michigan, Ann Arbor, MI, United States

Martina Augl,     Tirol Kliniken, Innsbruck, Austria

Jakob E. Bardram,     Technical University of Denmark, Lyngby, Denmark

Claus Bossen,     Aarhus University, Aarhus, Denmark

Randall S. Burd,     Children’s National Medical Center, Washington, DC, United States

Ayşe G. Büyüktür,     University of Michigan, Ann Arbor, MI, United States

Carmen Castaneda-Sceppa,     Northeastern University, Boston, MA, United States

Mads M. Frost,     IT University of Copenhagen, Copenhagen, Denmark

Sean P. Goggins,     University of Missouri, Columbia, MO, United States

Thomas Herrmann,     Ruhr University of Bochum, Bochum, Germany

Jessica A. Hoffman,     Northeastern University, Boston, MA, United States

Pei-Yao Hung,     University of Michigan, Ann Arbor, MI, United States

Maia Jacobs,     Georgia Institute of Technology, Atlanta, GA, United States

Myriam Lewkowicz,     Troyes University of Technology, Troyes, France

Ivan Marsic,     Rutgers University, Piscataway, NJ, United States

Michelle A. Meade,     University of Michigan, Ann Arbor, MI, United States

Elizabeth D. Mynatt,     Georgia Institute of Technology, Atlanta, GA, United States

Mark W. Newman,     University of Michigan, Ann Arbor, MI, United States

Andrea G. Parker,     Northeastern University, Boston, MA, United States

Michael Prilla,     Clausthal University of Technology, Clausthal-Zellerfeld, Germany

Herman Saksono,     Northeastern University, Boston, MA, United States

Aleksandra Sarcevic,     Drexel University, Philadelphia, PA, United States

Christian Stary,     University of Linz, Linz, Austria

Kai Zheng,     University of California – Irvine, Irvine, CA, United States

Xiaomu Zhou,     Northeastern University, Boston, MA, United States

Biography of Authors

Khuloud Abou Amsha is a postdoctoral fellow at Troyes University of Technology (France). Her research area is Human-Computer Interaction (HCI), primarily in Computer-Supported Cooperative Work (CSCW). Her research focuses on analyzing and designing applications that support collaborative activities. She is interested in new ways of organizing collaborations that go beyond the boundaries of organizations. She was involved in several projects in the field of health care at the regional and national levels.

Mark S. Ackerman is the George Herbert Mead Collegiate Professor of Human–Computer Interaction and a Professor in the School of Information and in the Department of Electrical Engineering and Computer Science at the University of Michigan, Ann Arbor. He also has a courtesy appointment in the Department of Learning Health Sciences in the College of Medicine. Mark’s major research area is human–computer interaction (HCI), primarily social computing and computer-supported cooperative work (CSCW). Mark has published widely in HCI/CSCW, including expertise sharing (especially for chronic conditions), collaborative information access, and pervasive environments for health. His work spans both technical and social analytic studies. For his work on socio-technical systems, Mark was elected as a member of the CHI Academy and as an ACM Fellow. Previously, Mark was faculty at the University of California, Irvine, and a research scientist at MIT’s Laboratory for Computer Science (now CSAIL).

Martina Augl is head of the Organizational Development Team at Tirol Kliniken GmbH, a leading regional health care provider in Austria. She designs and implements organizational change processes utilizing knowledge management techniques, to improve the effectiveness and agility of organizational units. Promoting a stakeholder-centered approach she has managed to streamline different organizational cultures toward focused patient care and quality-assured health care procedures.

Jakob E. Bardram is a professor at the Technical University of Denmark, where he directs the Copenhagen Center for Health Technology (www.cachet.dk). His research interests include pervasive computing, HCI, and software architecture, with a special focus on health technologies. Bardram has a PhD in computer science from the University of Aarhus, Denmark.

Claus Bossen conducts research into health care and health care IT, including the design, development, implementation, and evaluation of such technologies. Especially creating a fit between technology, work practices and organization to ensure that technologies support and augment work rather than hinder and make is more troublesome has been at the center for attention, and he has conducted extensive research into these issue around electronic health care records. Most recently he has started research into health care data and governance including value-based health care and diagnose-related groups. With a PhD in anthropology he is especially interested in qualitative methods, including interviews, participant-observation, and more generally research that entails engagements with people. Research fields include anthropology, participatory design, computer-supported cooperative work, and health care informatics. He is presently associate professor at Aarhus University, Denmark.

Randall S. Burd is a pediatric surgeon and the Chief of the Division of Trauma and Burn Surgery, at Children’s National Medical Center, Washington, DC, USA. He is also a Professor of Surgery and Pediatrics at the George Washington School of Medicine and Health Sciences. His research focuses on developing novel strategies for improving the early care of injured children. Dr. Burd’s research has been funded by the US National Institutes of Health (NIH), US Department of Health and Human Services (DHHS), and US National Science Foundation (NSF). Dr. Burd received the BA degree from Dartmouth University in 1983, the MD degree from Columbia University in 1987, and the PhD degree from the University of Minnesota in 1994, where he also completed his residency in surgery. He is trained in pediatric surgery at the Children’s Hospital of Michigan in Detroit, MI.

Ayşe G. Büyüktür is a researcher at the University of Michigan School of Information. She is also affiliated with the Michigan Institute for Clinical and Health Research. Her primary research interests are at the intersections of health informatics, computer-supported cooperative work, and human–computer interaction. She is particularly interested in the design and use of health information technologies to manage and coordinate care in chronic illness and disability. Ayşe received her PhD in Information, and her Master’s degrees in Public Health and Pharmaceutical Sciences, from the University of Michigan.

Carmen Castaneda-Sceppa is professor and Chair of the Department of Health Sciences in the Bouve College of Health Sciences at Northeastern University. She holds an MD from Francisco Marroquin University, Guatemala, and a PhD in Nutrition from Tufts University. Dr. Sceppa’s translational research focuses on the design, evaluation, and dissemination of nutrition and physical activity/exercise interventions that promote health and reduce the risk of chronic conditions among older adults and through the lifespan.

Mads M. Frost is a post doc at the IT University of Copenhagen and a member of ITU’s Pervasive Interaction Technology Lab. His research interests include pervasive computing and HCI, with a special focus on personal health technologies. Frost has a PhD in computer science from ITU.

Sean P. Goggins is an associate professor at Missouri’s iSchool, with courtesy appointments as core faculty in the University of Missouri Informatics Institute and Department of Computer Science. He teaches, publishes, and conducts research on the uptake and use of information and communication technologies by small groups in medium to large-scale socio-technical systems; from Facebook, to online course systems and open online communities. Sean conceptualizes group informatics as a methodological approach and ontology for making sense of the interactions between people in medium to large-scale social computing environments. His research examines the information behavior, knowledge construction, identity development, performance, and the structural evolution of small, online groups. Goggins’ recent work focuses on large-scale meta studies of open online communities, measuring performance in virtual organizations, and identifying factors that influence performance and learning in technology-mediated environments. Goggins is currently leading the development of gaming analytics on the Mission Hydro Sci projects at the University of Missouri.

Thomas Herrmann is a professor of Information and Technology-Management at the Institute of Applied Work Science (IAW), University of Bochum, Germany since 2004, and a fellow of the Electrical Engineering Department. Current research interests include design methods for socio-technical systems in various areas such as health care, computer-supported collaboration, knowledge management, (work-)process management. He teaches courses in groupware, knowledge management, socio-technical systems design, information systems and privacy, human–computer interaction, organizational communication, and process management. He has developed, evaluated, and refined a method which combines socio-technical design and process management and works together with several institutions in the health care sector. He has specialized on the design of socio-technical processes and has published more than 100 papers in this area.

He was an Associate Professor from 1992 to 2004 at the Computer Science Department at the University of Dortmund and was in charge of the development of infrastructure and new media for the University of Dortmund as a vice president from 2002 to 2004. Currently he is the privacy protection officer of the University of Bochum and a member of Paluno—The Ruhr Institute for Software Technology.

Jessica A. Hoffman is an associate professor at Northeastern University in the Department of Applied Psychology. She holds a PhD in School Psychology and an MEd in Human Development from Lehigh University and a BA in Psychology from Hamilton College. Dr. Hoffman’s research focuses on the design, implementation, and evaluation of interventions that promote healthy eating and physical activity among children.

Maia Jacobs is a PhD candidate in Georgia Institute of Technology’s Human-Centered Computing department. Her primary research focus is in ubiquitous computing and personal health informatics, developing and evaluating tools to support individuals’ dynamic personal health management needs and goals. In her work, Maia utilizes qualitative research methods and longitudinal technology deployments to understand the benefits and limitations for personalized and adaptive support tools for individuals managing chronic illnesses. This research has gained national attention, having recently been recognized in the 2016 report to the President of the United States from the President’s Cancer Panel, which focuses on improving cancer-related outcomes. In 2018, Maia will join Harvard University as a CRCS Postdoctoral Fellow.

Myriam Lewkowicz is full professor in Informatics at Troyes University of Technology (France), where she is head of Information System Management teaching branch and Tech-CICO research group (part of UMR CNRS 6281). Her interdisciplinary research consists in defining digital technology to support existing collective practices or to design new collective activities. For 10  years now, her main application domain is health care, with a focus on fostering social support among people in difficult situations (informal caregivers, isolated elderly people), and another one on supporting coordination among professionals.

Ivan Marsic is a Professor of Electrical and Computer Engineering in the School of Engineering at Rutgers University, New Jersey, USA. His research interests are in software engineering and sensor networks for health care applications, advanced groupware systems to support distributed multimedia collaboration, and gesture- and speech-based human -computer interfaces. Dr. Marsic’s research has been funded by the US National Science Foundation (NSF), US National Institutes of Health (NIH), US Army, and several corporate sponsors. He received the BS and MS degrees in Computer Engineering from the University of Zagreb, Croatia, and the PhD degree in Biomedical Engineering from Rutgers University in 1994.

Michelle A. Meade is an associate professor in the Department of Physical Medicine and Rehabilitation in the School of Medicine at the University of Michigan and Clinical Rehabilitation Psychologist in Michigan Medicine. She provides psychotherapy for and conducts research with adolescents and adults with spinal cord disorders and other physical disabilities. Her primary focus is on optimizing health and quality of life, promoting self-management, and reducing health care disparities among individuals with disabilities.

Elizabeth D. Mynatt is the executive director of Georgia Tech’s Institute for People and Technology, a distinguished professor of interactive computing, and the director of the everyday computing lab. She investigates the design and evaluation of health information technologies across multiple chronic care conditions including cancer, diabetes, epilepsy, and mental health. Mynatt is also the Chair of the Computing Community Consortium, an NSF-sponsored effort to engage the computing research community in envisioning more audacious research challenges. She serves as member of the National Academies Computer Science and Telecommunications Board (CSTB) and as an ACM Council Member at Large. She has been recognized as an ACM Fellow, a member of the SIGCHI Academy, and a Sloan and Kavli research fellow.

Mark W. Newman is an associate professor in the School of Information at the University of Michigan, Ann Arbor. His research interests lie broadly in the field of human-computer interaction, and particularly in the areas of ubiquitous computing and end-user programming. Mark’s research group is the Interaction Ecologies group. Before joining UMSI, Mark was a research scientist at the Palo Alto Research Center (PARC, formerly known as Xerox PARC) and a doctoral candidate in Computer Science at UC Berkeley.

Andrea G. Parker is an assistant professor at Northeastern University, with joint appointments in the College of Computer & Information Science and the Bouvé College of Health Sciences. She holds a PhD in human-centered computing from Georgia Tech and a B.S. in computer science from Northeastern University. Dr. Parker directs the Wellness Technology Lab at Northeastern University, where she designs, implements, and evaluates technological approaches to reducing health disparities. Her research contributes to the fields of human–computer interaction, computer-supported cooperative work, and personal health informatics.

Michael Prilla is a professor for Human-Centered Information Systems at Clausthal University of Technology, Clausthal-Zellerfeld, Germany. He has written more than 100 research papers and book chapters. His research interests are cooperation, cooperative work in mixed and augmented reality, learning, and reflection at work, socio-technical systems and IT in health care environments, ubiquitous computing and the convergence of digital and physical interaction. He has published in the Communications of the ACM and in conferences such as ACM Group, ECIS, and ECSCW. He is deputy chair of the German special interest group on CSCW and a member of the steering committee of the German SIG on human–computer interaction. He serves on committees for conferences like ACM Group, CSCW, ECSCW, and CHI.

Herman Saksono is a computer science PhD student at Northeastern University. He holds a Master’s degree in computer science from Northeastern University and a B.Eng. in Electrical Engineering from Universitas Gadjah Mada in Indonesia. Herman’s research examines how technologies can be designed to positively influence human behavior in the context of health promotion and community empowerment.

Aleksandra Sarcevic is an assistant professor of Information Science in the College of Computing and Informatics at Drexel University, Pennsylvania, USA, where she directs the Interactive Systems for Healthcare (IS4H) Research Lab. Her research interests are in computer-supported cooperative work and medical informatics, with a focus on ethnographic studies of practice in safety-critical medical settings to inform technology design and implementation. Dr. Sarcevic’s research is supported by the US National Institutes of Health (NIH) and US National Science Foundation (NSF). She was awarded a 2013 National Science Foundation Early CAREER Grant to support her work on information technology design and development for fast-response medical teams. Dr. Sarcevic received the MS and PhD degrees from the School of Communication and Information, Rutgers University, in 2005 and 2009, respectively.

Christian Stary is currently full professor and Chair of the Department of Business Information Systems—Communications Engineering as well as Head of the Knowledge Management Competence Center at the University of Linz, Austria. He researches the design of learning support systems, using knowledge-based and organizational development techniques. He initiates and manages projects targeting intelligent design while focusing on the needs and capabilities of stakeholders. He has been involved in several national health care projects with respect to socio-technical developments of clinics’ organization of work. Thereby, modeling and process management plays a crucial role, besides epistemologically grounded method development, in particular aligning value network analysis and subject-oriented business process management. His work is reflected in a number of scientific journal contributions, international conferences, and workshops on cross-disciplinary systems engineering research. He serves in several international scientific bodies with key responsibilities, such as Editor-in-chief of Springer’s Journal of Interaction Science, and Board Chair of the International Council on Knowledge Management.

Kai Zheng is associate professor of Informatics and Associate Adjunct Professor of Emergency Medicine at the University of California, Irvine (UCI). He is also co-director of the Center for Biomedical Informatics at the UCI Institute for Clinical and Translational Science. Zheng’s research draws upon techniques from the fields of information systems and human–computer interaction to study the use of information, communication, and decision technologies in patient care delivery and management. His recent work has focused on topics such as interaction design, workflow and socio-technical integration, and diffusion and evaluation of health IT. Zheng received his PhD degree in Information Systems from Carnegie Mellon University. He is the recipient of the 2011 American Medical Informatics Association New Investigator Award that recognizes early informatics contributions and significant scholarly achievements.

Xiaomu Zhou is an assistant teaching professor at Northeastern University, where she leads the Master of Science in Informatics Program in the College of Professional Studies. Her teaching and research focus on human–computer interaction (HCI), health informatics, and computer-supported cooperative work (CSCW). Her managerial responsibilities include new curriculum development, faculty mentoring, and building business partnerships, with the ultimate goal of improving education. Prior to joining Northeastern, Dr. Zhou worked as an assistant professor in the School of Communication and Information at Rutgers University. She received her PhD from the School of Information at University of Michigan, Ann Arbor. She co-authored a number of papers focusing on understanding clinical documentation processes, patient-provider communication, and chronic illness management from the perspectives of diabetic and depressed patient populations.

Introduction

What if doctors, nurses, health administrators, and even (non-)patients become capable to design health care systems? A fantasy? We do not think so. When closer looking to the increased stakeholder involvement in system developments in constituting elements of societies, such as education, economy, and health care, it rather appears to become a necessity. Why is that? Particularly, health care systems have become increasingly complex, not only because of increasing in-depth expertise and the subsequent diversification of medical fields but also because of cost pressure, volatile settings, external changes (e.g., social security, insurance reform), increased speed of scientific research and innovation, and last, but not least, high expectations with respect to patient care and life quality for the elderly.

This book presents and analyses IT support for different aspects of health care in the light of socio-technical systems, in which technical developments are integrally connected to social dynamics and the needs of users. The different cases studies in this book illustrate how technology and social systems can be analyzed, developed, and sustained together.

This perspective is especially helpful for health care: supporting a system and helping it to operate despite this quickly increasing complexity can be achieved by revisiting the nature of the involved systems—in particular technology, people, and their interface—viewing them as socio-technical systems. This is a key perspective for IT systems in health care. For example, whenever a citizen gets in touch with a health care system, personal data are processed and needed for further activities, ranging from diagnosis to treatment planning, treatment, and payment. At the same time, various professional user groups, such as medical experts, care takers, administration, political bodies, must get in touch with technical systems when addressing health care issues.

Originally, socio-technical design referred to organizational redesign based on a specific theoretical basis and a strong methodology (e.g., Mumford, 1987–2003). It argues that when new work systems are being designed equal weight should be given to social and technical factors. It places great emphasis on improving the quality of working life rather than on gaining competitive advantage (Mumford, 1994, p. 313). In this volume, we enrich the definition of socio-technical design to include as central foci not only of organizational issues but also the technology itself, social interactions and dynamics outside organizations, people’s practices, and so on. This is common usage in human–computer interaction, computer-supported cooperative work, science and technology studies, and software engineering, among other areas. This enrichment establishes a practical theory for health care domains.

Who should get involved when tackling socio-technical design issue and becoming aware of opportunities, barriers, and capabilities? Anyone can become an active designer concerned with and involved in the design and implementation of health care systems, including software designers, medical informatics professionals, health care administration, and potential patients. This book provides several examples in which actors often not involved into the design of IT in health care were key to the success of the socio-technical design process. In particular, practitioners and academics from areas such as information systems, public health, health and medical informatics, and user experience/human–computer interaction need to become knowledgeable and skilled in health care design processes to create usable, useful, and sustainable solutions for all stakeholders. Finally, and maybe most important, we need to give the stakeholders in the day-to-day working of health care (doctors, nurses etc.) agency to make changes in the design of their socio-technical systems.

In this volume, we go beyond traditional software design and implementation for health care, as we take up the pragmatic, messy problems of designing and implementing socio-technical solutions. They integrate organizational and technical systems for the benefit of human health. There are a broad range of individual and social (organizational, institutional, societal) needs that must be addressed. Since health care IT systems are notoriously expensive, difficult to implement, and hard to manage for health care providers, we believe the cases presented in this volume will be valuable and should be broadly considered by people responsible for and affected by the design and implementation of health care IT systems.

With the presented cases, we intend to help practitioners to apply principles of socio-technical design in health care, and consider the adoption of new theories of change. Practitioners need new processes and tools to create a more systematic alignment between technical mechanisms and social structures in health care.

To make health care IT more closely suited to care provision, this systematic alignment of the social and technical will, when appropriate, include consideration of organizational change. For patient-facing applications, social issues more broadly construed will be important. We must also recognize that the requirements of the alignment between social and technical aspects in health care are dynamic. For example, the inertia and local dynamics in health care often present substantive obstacles to the implementation of socially and technically aligned systems. Practitioners therefore need more adaptive techniques for evaluating progress and measuring system impacts.

The systematic understanding developed within this book’s chapters includes new ways of designing and adopting socio-technical systems in health care. For example, as often mentioned in the literature, this might include helping practitioners examine the role of exogenous factors like health-related quality of life. Or, more globally, helping practitioners learn how to consider systems external to the boundaries drawn around a particular health care IT system is another key design challenge.

To serve designers and managers of a broad range of health care IT systems, each case study focuses on specific projects and covers an iterative cycle of socio-technical design in health care (and in some cases, its entire lifecycle). Each case represents an empirical, field-based study situated in a health care organization, network, or community. To deepen the understanding of the socio-technical challenges in health care design, each case reflects on the social and technical obstacles designers need to overcome. We complement North American health care views on socio-technical design with a European perspective.

Qualitative descriptive reporting from field studies has turned out useful for demonstrating the practicability of (novel) paradigms and the state of affairs in several fields. Each study in this book therefore describes socio-technical design focused on an essential issue, such as qualifying caregivers for planning daily patient routines. This does not only include a description or story, but also an analysis, which concerns the design problem that has been solved. Each solution is described in terms of a socio-technical design approach, the results, detailing design accomplishments, and the design process.

Finally, an evaluation for each solution is described, before summarizing the lessons learned from that case. The case studies can be considered from various eHealth aspects related to stakeholder support as indicated in the table:

• Application domain/field of intervention: this category refers to the addressed health care (IT) domain or field of concerned socio-technical design activities in the case.

• System architecture/tool chain/(organizational) IT device or application: this perspective provides insights into the technical system (including its structure) that has been used, designed, and/or provided, however, with respect to organizational effects or capabilities. It also refers to integrated infrastructures or platforms built to provide health care services.

• Methodological approach: this category comprises all methodological details, either with respect to existing concepts and methods, or innovative approaches and formats.

• Achievements according to objectives: last but not least, the effect of the case intervention is provided with respect to its objectives.

Table 1 provides an overview of the chapters.

Table 1

Designing Health care for Stakeholder Support