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A recently published study by Pinell et al. (2003) that directly concerns

homecare work delivers a proposal based on extensive field studies for how

homecare work can be supported by ICT. They have in their work explored

how the characteristics of loosely coupled mobile groups found in multidisciplinary

teams of homecare workers can be supported by technology using

a wide area mobile groupware. Their studies show that groupware applications

can be a favourable approach to support homecare work, even though the

homecare workers were autonomous in both the planning and execution phases

of work, and mostly relied on asynchronous communication that provided an

awareness of other persons’ activities. In their study, the latter dimension was

an important aspect of how the communication in the system should be

designed; both due to the reliability of network access, and due to the work as

such, especially in situations when communication with colleagues was inappropriate,

i.e., while tending to a patient or the elderly. Their work pinpoints

well the context the following text will discuss: their focus is how the flow of

information goes, and how awareness can be attained due to the complex

conditions the context imply. From my point of view, their perspective is that

of design, while this chapter aims at understanding the uses of a system that

already has been employed.

Struggling with Predecessors and Mechanisms

A starting point to understand the culture homecare workers are involved in is

to follow researchers that have studied implementations of information technologies

in similar contexts. Berg (1997) brings in his studies of the new

technology implementations in medical work forward, that the predecessors

always will be the standard or the reference when its users’ judge new

technology. Berg addresses the embedded logic artefacts carry and the

importance of having an intention to understand its relation to practice,

especially how these tools get involved and get incorporated into work

practice. Berg stresses the importance to see the inner logic that technology


Groupware has been one core issue for the CSCW community, and one scholar

that has brought intriguing insights into the role of these systems is Schmidt

 (1991). He provides us with a modest suggestion that design of groupware

applications should aim to support the coordinative and collaborative dimensions

of a work practice in order to fit into organisational practice. He states

further that embedded mechanisms within a work practice that involves

coordination and collaboration are important dimensions, as they are unique for

each context. (Schmidt & Simone, 1996). Thus, if these aspects were considered,

one could argue that technology would melt into practice in a more natural

way than if one needs to reconfigure practice according to technology demands,

a discussion that aligns to the problems of customisation versus


The expectations homecare organisations seem to have on the employment of

mobile information and communication technology are very similar to what

Sellen & Harper (2001) see as the advantages of paper, and why paper

according to them in the future will still be a natural piece of office work. Sellen

& Harper (2001) discuss the role of paper in offices from the standpoint of its

affordance and its role in human activities. They conclude that paper functions

as a tool for managing and coordinating action among co-workers in a shared

environment, paper provides a material for discussion and exchange of relevant

information among co-workers, and the fact that paper is easy to carry, store,

file, and reuse if necessary, makes it even more useful.

Distributed Cognition

Distributed cognition (Dcog) was originally developed by Hutchins and his

colleagues in the mid to late 1980s. The approach gives us means to understand

how tools and technologies are intertwined with humans in collective activities.

Earlier studies are found in work on navigation of naval vessels (Hutchins,

1995), air traffic control (Halverson, 1994), and construction work (Perry,

1997). Hutchins (1995) states that the same model used within cognitive

science where computations take place by means of the propagation of

representational states across representational media also can be applied to

reveal the cognitive work in collective and external activities. Following this line

of thinking means that a collective activity needs to be seen as a “computational

or information-processing system” (Hutchins, 1995, p. 49). The solution here

is to see collective work towards common goals as a computational activity,

which in Hutchins terms is socially distributed cognition. Key concepts that

Dcog comprise are representational states and the propagation of these states

in representational media (Hutchins, 1995). A representational state according

to Hutchins (1995, p. 117) is, “a configuration of the elements in a medium that

can be interpreted as a representation.” The representation refers to a meaningful

aspect of the practice, as in Hutchins’ case, a symbolic abstraction and

representation of the ship by pointers found at the naval chart. The naval chart

is, in Hutchins’ case, one example of a representational media. These media

may either be internal or external resources, e.g., the individual memory, or

found in different tools, e.g., manuals, calendars, coordination tools, drawings

on paper, and in an ICT artefact, etc.

According to Halverson (1998), the sequence of analysis that Dcog provides

can be seen as an action in three phases. The first phase is to work out a

functional definition of the cognitive system. The second phase is to make a list

of the representational states and processes in the system. The third phase is

to determine the physical instantiation of the representations, what Halverson

calls the algorithm(s) that control the processes. A work context is from the lens

of Dcog seen as functional system. This system in turn involves several

functional levels, which encompass shared task knowledge and a shared

understanding of the conditions that structure the work situation. In these

different functional levels, information follows certain trails incorporating both

individuals and technology. If one follows these trails of information, one also

will have an opportunity to grasp an understanding of the cognitive work, and

thereby understand the role technology has in these activities. Through these

activities, the actors develop a common ground, maintain an awareness of

ongoing activities, and build up the shared body of knowledge that continuously

is developed over time. Thus, one has an opportunity to uncover the role and

transformation of tools and technology in the context, but more importantly, one

has the opportunity to inform the design of representational media in a particular

practice. As the unit of analysis concerns the specific practice, we are facing an

activity-centred approach of events (Thereau & Filippi, 2001) rather than usercentred

approach (Norman & Draper, 1986).

Coordinative Tools and Common Information Spaces

In collective work, the social organisations of distributed cognition are,

according to Perry (1997), embodied in artefacts where a common information

space, discussed by Bannon & Bødker (1997), would be one example of such

a tool. Representations of such tools can be found in paper and files or, for

example, as an interface in a groupware application or similar application,

which offer common views of information to its’ users. Common information

spaces are negotiated and established by the involved actors (Bannon &

Bødker, 1997); the space functions as an important factor when co-coordinating


The understanding of the common information space as such, however, does

not need to be identical among actors, but simply common enough to coordinate

their work activities (Reddy et al., 2001). As individuals, we interpret the

information provided by the common information space as it best will suit and

be relevant for our work and us. This implies, as argued by Reddy et al. (2001),

that people engaging in different work, but sharing the same information, will

frame and interpret it differently from different perspectives. The work maintaining

such an information space is what it takes to balance and accommodate

these different perspectives. One must assume that this balancing and accommodation

is managed through everyday communication and interaction, and not

necessarily through prescribed structures of work.

What we have here are coordinative tools and collaborative means that can be

seen as representations of mechanisms embedded in practice. In order to

understand why certain tools are preferred in relation to others, we need to

identify those mechanisms that structure the world of the specific practice. Such

a position would ease the identification of design incentives for information

technologies that aim to support practice.

Research Method

The empirical material presented in this text has been collected by a study of

two different homecare organisations that have employed the same mobile

information and communication system. These organisations will be denoted

Alfa and Beta in the following text. Alfa is an organisation that had used the

system for period of two years and Beta had used the system for half of a year

when the study was performed. One could have chosen to study one single

organisation that has employed, and one that has not yet employed, mobile

information and communication technology in their work. However, since the

focus is upon the relation between traditional tools and mobile information and

communication technology, such an option falls out of the scope of this study.

Data was generated from a number of visits and an observational study during

three weeks in the fall of 2002. Sellen & Harper (2001) emphasise a relational

perspective on the use of technology and other artefacts. The method I have

used follows a similar approach, directed towards the relation between the

collective activities and technology and tools used in practice. The goal has

been to understand the work that people do and engage in, on a daily basis, and

from there understand how practice and technology coevolves and gets

integrated together.

In this study, ethnographic observations (see Hutchins, 1995; Harper, 1998;

Orr, 1996, Weilenmann, 2003) have been the main source of information.

These observations have been complemented with informal discussions and

interviews, providing an understanding of knowledge embedded in practice. In

my investigations of the mobile workplace, I have used a number of strategies,

which all take different dimensions of the workplace into account. These

strategies have also been used successfully by other scholars such as Weilenmann

(2003) and Harper (1998). One strategy has been to follow the actors, which

in this case illuminated what the actors did and how they handled the technology

in different situations. The actors that I followed were carrying out their work

in many locations, e.g., people’s homes, and what the approach especially

helped me to understand was situations where the technology was left aside,

even if one could have supposed to observe a use situation according to the

rationale of the system and other incentives. An alternative approach has been

to follow the technology, which in this case mean to follow the technology and

observe when the technology is used. This strategy illuminated places where the

technology was kept, carried, and used. A third approach was to follow the

information and its way in and through different artefacts. In this case, the use

of these approaches illuminated connections between the micro and the macro

levels of the mobile work place, which discovered the purpose and strategies

the information is part and parcel of.

The strategies above reveal a whole field of study, and the results are a joint

effort of them all, describing the functional systems the workers act within. The

data presented in this chapter have mainly been obtained while studying the

workers’ actions out in the field, and the actions occurring in the homecare

office. I have recorded meetings and interviews on video and on tape from both

organisations, which in part have been transcribed. Regarding one of the

organisations, I have paid extra attention to the historical dimension and the

development of the system. This was because the homecare workers from this

organisation had an important role in the design of the system, which currently

both organisations use. In the reconstruction of the developmental process and

implementation, I have relied on documents and other information documented

through processes, e.g., photographs and access to key persons, from both the

homecare organisation and the software company.