Hedvig Aminoff | Norwegian University of Science and Technology (original) (raw)

Papers by Hedvig Aminoff

Background: A telemedicine service enabling remote surgical consultation had shown promising resu... more Background: A telemedicine service enabling remote surgical consultation had shown promising results. When the service was to be scaled up, it was unclear how contextual variations among different clinical sites could affect the clinical outcomes and implementation of the service. It is generally recognized that contextual factors and work system complexities affect the implementation and outcomes of telemedicine. However, it is methodologically challenging to account for context in complex health care settings. We conducted a work domain analysis (WDA), an engineering method for modeling and analyzing complex work environments, to investigate and represent contextual influences when a telemedicine service was to be scaled up to multiple hospitals. Objective: We wanted to systematically characterize the implementation contexts at the clinics participating in the scale-up process. Conducting a WDA would allow us to identify, in a systematic manner, the functional constraints that shape clinical work at the implementation sites and set the sites apart. The findings could then be valuable for informed implementation and assessment of the telemedicine service. Methods: We conducted observations and semistructured interviews with a variety of stakeholders. Thematic analysis was guided by concepts derived from the WDA framework. We identified objects, functions, priorities, and values that shape clinical procedures. An iterative "discovery and modeling" approach allowed us to first focus on one clinic and then readjust the scope as our understanding of the work systems deepened. Results: We characterized three sets of constraints (ie, facets) in the domain: the treatment facet, administrative facet (providing resources for procedures), and development facet (training, quality improvement, and research). The constraints included medical equipment affecting treatment options; administrative processes affecting access to staff and facilities; values and priorities affecting assessments during endoscopic retrograde cholangiopancreatography; and resources for conducting the procedure. Conclusions: The surgical work system is embedded in multiple sets of constraints that can be modeled as facets of the system. We found variations between the implementation sites that might interact negatively with the telemedicine service. However, there may be enough motivation and resources to overcome these initial disruptions given that values and priorities are shared across the sites. Contrasting the development facets at different sites highlighted the differences in resources for training and research. In some cases, this could indicate a risk that organizational demands for efficiency and effectiveness might be prioritized over the long-term outcomes provided by the telemedicine service, or a reduced willingness or ability to accept a service that is not yet fully developed or adapted. WDA proved effective in representing and analyzing these complex clinical contexts in the face of technological change. The models serve as examples of how to analyze and represent a complex sociotechnical context during telemedicine design, implementation, and assessment.

<sec> <title>BACKGROUND</title> Teleguidance, a promising telemedicine... more <sec> <title>BACKGROUND</title> Teleguidance, a promising telemedicine service for intraoperative surgical consultation, was planned to scale up between a major academic hospital in partnership with five other hospitals. If the service was adopted and used over time, it was expected to provide educational benefits and improve clinical outcomes during Endoscopic Retrograde Cholangio-Pancreatografy (ERCP), which is a technically advanced procedure for biliary and pancreatic disease. However, it is known that seemingly successful innovations can play out differently in new settings, which might cause variability in clinical outcomes. In addition, few telemedicine services survive long enough to deliver system level outcomes, causes of which are not well understood. </sec> <sec> <title>OBJECTIVE</title> We were interested in factors related to usability and user experience of the telemedicine service which might come to affect adoption. We therefore wanted to investigate perceptions and responses to use and/or anticipated use of a system. Technology acceptance, a construct referring to how users perceive a technology's usefulness, is commonly considered to indicate whether a new technology will actually be used in a real-life setting. Satisfaction measures are used to investigate whether user expectations and needs have been met through the use of technology. In this study, we asked surgeons to rate the perceived usefulness of teleguidance, and their satisfaction with the telemedicine service in direct conjunction with real-time use during clinical procedures. </sec> <sec> <title>METHODS</title> We designed domain-specific measures for perceived usefulness and satisfaction, based on performance and outcome measures for the clinical procedure. Surgeons were asked to rate their user experience with the telemedicine service in direct conjunction with real-time use during clinical procedures. </sec> <sec> <title>RESULTS</title> 142 remote intraoperative consultations were conducted during ERCP procedures at 5 hospitals. The demand for teleguidance was more pronounced in cases with higher complexity. Operating surgeons rated teleguidance to have contributed to performance and outcomes to a moderate or large extent in 111/140 (79.3%) of the cases. Specific examples are that teleguidance was rated as having contributed to intervention success and avoiding a repeated ERCP in 23 cases, avoiding 3 PTC, 11 referrals and in 11 cases, combinations of these outcomes. Pre-procedure beliefs about the usefulness of teleguidance were generally lower than post-procedure satisfaction ratings. The usefulness of teleguidance was mainly experienced through practical advice from the consulting specialist (119/140, 85%) and support with assessment and decision-making (122/140, 87%). </sec> <sec> <title>CONCLUSIONS</title> Users' satisfaction with teleguidance surpassed their initial expectations, mainly by contributing to non-technical aspects of performance, through help with general assessment. Teleguidance shows the potential to improve performance and outcomes during ERCP. However, it takes hands-on experience for practitioners to understand how the new telemedicine service contributes to performance and outcomes. </sec> <sec> <title>CLINICALTRIAL</title> N/A </sec>

<sec> <title>BACKGROUND</title> The starting point for this research w... more <sec> <title>BACKGROUND</title> The starting point for this research was a desire to understand the outcomes of scaling up a telemedicine service, which had shown promising results in a feasibility study. Teleguidance is a practitioner-to-practitioner service for remote surgical guidance during a highly technical endoscopic procedure, called ERCP (Endoscopic retrograde Cholangio-Pancreatografy). Due to numerous differences in how ERCP was conducted at the clinics involved, there was a need to create a fuller picture of what set the implementation sites apart sites in order understand the implementation and outcomes of teleguidance. However, the complexity that characterizes highly specialized clinical work systems made understanding the differences between the implementation contexts a methodological and practical challenge. There is increasing recognition that the outcomes of complex interventions are determined by dynamic interactions between social, organizational and design factors. While several recent implementation and evaluation frameworks emphasize complexity, they provide little guidance for how to understand or evaluate technological change in complex settings, or identify the interactions that contribute to implementation success and system-level outcomes. Work Domain Analysis (WDA), a method for analyzing and characterizing complex work settings in systems development, was identified as a candidate method for identifying and charting the contextual factors which shape clinical work during ERCP. However, applying the method was not straightforward, due to a number of methodological issues and practical hurdles: WDA method was initially developed for engineered, industrial systems which contrast to open, adaptive, healthcare systems. </sec> <sec> <title>OBJECTIVE</title> The objective was to investigate whether and how WDA could be applied to a widely defined clinical work system, by applying WDA to a practical case to create a baseline description of the work systems that would be impacted by the telemedicine implementation. </sec> <sec> <title>METHODS</title> As expected outcomes of the implementation had been expressed in terms of clinical, economical and training outcomes, the boundaries of the analysis were set widely. Three iterations of qualitative data collection were conducted at five clinical sites, followed by theoretically guided thematic analysis. Service blueprints were made as intermediary graphical representations during data collection. The common WDA representation, a matrix called the abstraction hierarchy (AH), was then constructed through multiple iterations, during which the results were presented to practitioners and suggestions about how to decompose the work system and to populate the cells of the AH-matrix gradually developed. </sec> <sec> <title>RESULTS</title> Multiple models of the domain representing three facets of the same work system were created. The clinical facet represents "primary" clinical work mainly performed in the operating room, and the administrative and development facets represent the "secondary" work systems providing infrastructure and resources necessary for the clinical procedures. The results show numerous contextual factors on multiple system levels which can come to impact the implementation and use of teleguidance. </sec> <sec> <title>CONCLUSIONS</title> WDA proved to be an efficient way to model the implementation context, providing guidance for qualitative analysis, identifying multiple sources of variability that can influence implementation outcomes. In addition, WDA provided a compact representation that supported multidisciplinary communication. </sec> <sec> <title>CLINICALTRIAL</title> n/a </sec>

AHFE International, 2019

Five different insulin pumps and three systems for continuous glucose monitoring were subjected t... more Five different insulin pumps and three systems for continuous glucose monitoring were subjected to usability tests at the School of Technology and Health. Each pump was trialed and rated by 30 respondents; 20 students with no experience of diabetes and 10 diabetic pump users. Each of the CGM systems was trialed and rated by 10 non-diabetic students. All participating students were enrolled in Medical Technology (Royal Institute of Technology) or Occupational Therapy (Karolinska Institute). The technical performance of pumps and CGM systems was tested independently. The respondents handled the insulin container, the software, the buttons, the screen and the manual through five scenario-based tasks. The trials and the accompanying attitude items were based on the ISO definition of usability. Efficiency was measured as the proportion of respondents succeeding to perform the tasks in less than 15 minutes, combined with the average time to do so. Effectiveness was the quotient of success...

Studies in health technology and informatics, 2015

As costs for healthcare are rising in society, information systems are often seen as enablers of ... more As costs for healthcare are rising in society, information systems are often seen as enablers of new cost-saving healthcare processes. But an on-going deployment of a wide range of new kinds of systems requires close attention to interoperability between new and legacy systems. Another challenge is to assure that the healthcare professions are given realistic opportunities to play an active part in designing the new ways of working that the new, integrated systems are designed to support. We argue that a feasible way to approach such a user participation in design of work processes and systems is to extend well known user-survey and strategy-mapping methods with the new value-based healthcare approach which invites health professionals to participate in strategic assessments of health outcome and costs along the care chain in which they work. We also argue that such a combination of practical research methods resonates well with Techno-Anthropology's foregrounding of ethical con...

International Journal of Social Robotics, 2020

Care robots are often portrayed as an exciting new technology for improving care practices. Wheth... more Care robots are often portrayed as an exciting new technology for improving care practices. Whether these robots will be accepted and integrated into care work or not, is likely to be affected by the assumptions, expectations and understandings held by potential end users, such as frontline staff and the people that are cared for. This paper describes how the conceptual framework of technological frames was used to identify the nature of care robots, care robots in use and care robot strategy as shared group level assumptions, expectations and understandings of care robots among care staff and potential care receivers. Focus groups were conducted with 94 participants. These groups consisted of line managers, frontline care staff, older people and students training to become carers. The technological frame of the nature of care robots revealed two complementary components: care robots as a threat to the quality of care, and care robots as substitute for humans and human care, held to...

International Journal of Integrated Care, 2016

Design of an in-car user interface requires knowledge from the field of Human Factors as well as ... more Design of an in-car user interface requires knowledge from the field of Human Factors as well as from usability theory. In this project, a user interface for an automatic parallel parking system has been developed. The main research question has been which display modality to choose, as current literature does not give a clear-cut answer to whether to use auditory or visual displays for in-car information systems. We also wanted to investigate how much information is needed in order to complete an automatic parallel parking. Results from three user evaluations with different prototypes indicate that audiovisual presentation is best suited for the task, and that feedback messages could be kept short. However, further research is needed since a real-life traffic situation differs from that in a sealed-off environment as the one used in this project.

JMIR Formative Research, 2021

Background A telemedicine service enabling remote surgical consultation had shown promising resul... more Background A telemedicine service enabling remote surgical consultation had shown promising results. When the service was to be scaled up, it was unclear how contextual variations among different clinical sites could affect the clinical outcomes and implementation of the service. It is generally recognized that contextual factors and work system complexities affect the implementation and outcomes of telemedicine. However, it is methodologically challenging to account for context in complex health care settings. We conducted a work domain analysis (WDA), an engineering method for modeling and analyzing complex work environments, to investigate and represent contextual influences when a telemedicine service was to be scaled up to multiple hospitals. Objective We wanted to systematically characterize the implementation contexts at the clinics participating in the scale-up process. Conducting a WDA would allow us to identify, in a systematic manner, the functional constraints that shape...

We are designing a novel telemedicine service, where an experienced endoscopist at a central site... more We are designing a novel telemedicine service, where an experienced endoscopist at a central site can guide endoscopists at remote hospitals during procedures (mainly ERCP). This can be done simultaneously to several hospitals at once, using several displays in a control room setting. As this is a new way of working, we design the teleguidance room at the same time as we learn about user needs. We have conducted field studies and created scenarios to gain knowledge about the usage context and target groups, and we have used mock-ups and highfidelity prototypes to evaluate the usage situations. The user-centered design activities have helped to articulate user needs, surface technical difficulties, iterate design solutions, create a shared understanding of the telemedicine service within the project team, and prepare for implementation in clinical work.

This paper describes and discusses analysis of an emergency management exercise. In the exercise ... more This paper describes and discusses analysis of an emergency management exercise. In the exercise scenario, different emergency management organizations jointly try to cope with a forest fire and related incidents. The Extended Control Model is utilized for examination of the establishment of en emergent emergency response organization. Ambiguity in how functions are to be handled in a large event, indicating vulnerabilities in face of larger crises; functions moving across roles during the evolving event; and recognizable phases of a response are uncovered. This is assessed by utilizing episodic analysis of the communication between different functions and roles in the participating emergency management organizations. The results indicate requirements for future information and communication technologies, and occurrences that can be explored in future studies.

JMIR Human Factors

Background Teleguidance, a promising telemedicine service for intraoperative surgical consultatio... more Background Teleguidance, a promising telemedicine service for intraoperative surgical consultation, was planned to scale up at a major academic hospital in partnership with 5 other hospitals. If the service was adopted and used over time, it was expected to provide educational benefits and improve clinical outcomes during endoscopic retrograde cholangiopancreatography (ERCP), which is a technically advanced procedure for biliary and pancreatic disease. However, it is known that seemingly successful innovations can play out differently in new settings, which might cause variability in clinical outcomes. In addition, few telemedicine services survive long enough to deliver system-level outcomes, the causes of which are not well understood. Objective We were interested in factors related to usability and user experience of the telemedicine service, which might affect adoption. Therefore, we investigated perceptions and responses to the use and anticipated use of a system. Technology ac...

JMIR Perioperative Medicine

Many promising telemedicine innovations fail to be accepted and used over time, and there are lon... more Many promising telemedicine innovations fail to be accepted and used over time, and there are longstanding questions about how to best evaluate telemedicine services and other health information technologies. In response to these challenges, there is a growing interest in how to take the sociotechnical complexity of health care into account during design, implementation, and evaluation. This paper discusses the methodological implications of this complexity and how the sociotechnical context holds the key to understanding the effects and outcomes of telemedicine. Examples from a work domain analysis of a surgical setting, where a telemedicine service for remote surgical consultation was to be introduced, are used to show how abstracted functional modeling can provide a structured and rigorous means to analyze and represent the implementation context in complex health care settings.

Emergency management (EM) can benefit from new information and communication technology (ICT). Ho... more Emergency management (EM) can benefit from new information and communication technology (ICT). However, the complexity of the field poses high demands upon prospective system developers. The design of technological support in a field where roles and actions are entwined and never completely predetermined, requires an understanding of interactions in the socio-technical system as a whole.
In this thesis, an attempt is made to work from a Cognitive Systems Engineering stance to identify important characteristics of coordination in intermunicipal EM. Applying perspectives from
distributed cognition, joint activity and common ground, Hollnagel’s COCOM and ECOM models have been applied to identify points of entry into work practices. Working with data from a simulated forest-fire in a role-playing exercise, an analysis of dialogues uncovered ambiguity in how
functions are handled in a large event, indicating vulnerabilities in face of larger crises. In addition, it became evident that functions moved across roles during the evolving event, and it was possible to uncover recognizable phases of a response. The results underline characteristics that should be supported by future ICT, and occurrences that can be explored in future studies.