2. Ethnography and Evaluation Dr. K. Neil Jenkings DuDEHR

3. Ethnography and Systems Design in DuDEHR Project Workplace studies and socio-technics based approach to technology design “Optimal utilization of IT applications… is dependant on the meticulous interrelation of the system’s functioning with the skilled and pragmatically orientated work of health care professionals.” (Berg 1999) Non-participant observation of situated workplace activities Descriptions of practices, vignettes and informal interviews The communication of this information to the rest of the team – facilitating architectural modelling and planning grounded in situated practices User centred design – problem of end users lack of knowledge of what would constitute an EHR Development of animators (based upon field work & future vision)

4. Evaluation of Animators Pilot the usefulness of both the animators (non- technical and technical versions) for the elicitation of Durham & Darlington EHR design information Collect information for the iterative development of the animator and technical animator Collect procurement specific information Continuous evaluation as part of the design process Involve healthcare professionals in the research process

5. Evaluation Methodology - Animator Animator target Audience - general Animator - Focus groups –11 Groups size of 1-16 (Various Healthcare Professional) –Audio recordings of discussions –Content analysis of recordings (NVivo) –Questionnaire

6. Structure of focus groups Baseline discussion Presentation of the Animator Post Presentation Discussion – Questionnaires Post Presentation Discussion resulted in rich data (see WP5.2 document on CD)

7. Animator Results Animator Questionnaire –Overwhelmingly Positive –Good Mean Score All Questions. –Little Deviation Across Respondents. Animator Focus Groups –Positive Response to Animator –Provoked Discussion (Animated Audience) –Engendered Further Data for Iterative Development

8. Evaluation Methodology – Technical Animator Target Audience – IM&T Technical Animator – Workshop –Recording of following discussion –Questionnaire – 29 questions with comments boxes under each question for additional comments –17 Responding Attendees (IM&T professionals working in D&D and Tees Valley)

9. Technical Animator Results Overall Positive Response Positive Evaluation of Production Quality Positive view of Durham & Darlington EHR vision Non-committal about early versions’ use in procurement Positive response for liaison with users N.B. Iterative design process has allowed these issues to be addressed – as seen in version shown today. Detailed findings (see WP5.2 document on CD)

10. Ethnographic Research Primary Care – Various Types –Urban, Rural, Single Practitioner, Multi-Practitioner, Dispensing and Non-Dispensing Secondary Care – Various Departments –A&E, CCU, Emergency Ward, Medical Records, Out- patients etc. Mental Health and Social Services –Community Mental Health Teams

11. General Findings Healthcare professionals work is interdependent Activities centre around treatment and the production, recording, use, filing and transmission of information Information recorded and used electronically and on paper based systems with varying overlap Different access to information by various personnel Informal and formal work practices need supporting Importance of interpersonal communication

12. Communicating Ethnography The project has collected detailed information on actual working practices and processes, including vignettes, collections of screen shots from computer software, copies of paper documentation, information faxed and the use of telecommunications at various not just systems information This information is not usually available to architectural modellers, system designers and change management personnel Used Software to organise and make them useful Demo of the software

13. To Conclude Ethnographic investigations provide key information regarding existing processes and practices Animators show future scenarios grounded in ethnographic research Animators evaluated: successful in gathering information from healthcare professionals; getting user involvement; craeting a sense of ownership and facilitating user centred design The use of control to embed information, ethnographic description, focus group reports, system screen shots and copies of paper documents into process models allowing rich descriptions of processes Rich description allowing verification of processes and practices with users, access to this information by design teams and change managers to check designs against user needs and organisational change requirements The procurement of well-designed user orientated systems