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Homecare work is a definition that gathers many different occupations under

one roof providing patients or the elderly services in their homes. The

occupations this investigation focused on have been home help aids and

assistant nurses. In this chapter, these two occupations will both be denoted as

homecare workers, because the difference is hard to distinguish as they

perform the same work together. To separate them is, from my point of view,

not necessary and fills no purpose in order to answer the questions posed in the

introduction. Homecare work is autonomous, as the work mainly is carried out

individually in the homes of the elderly. However, the degree of autonomy

differs according to the organisation of work and to restrictions in work

descriptions. For instance, restrictions in the work description emphasise that

some tasks must be dealt with working in pairs, which require an effective

coordination of events if collaboration among the workers is to be solved with

ease, bringing in time and place restrictions that in turn also need to be solved.

The work I have studied can be divided into three separate dimensions, the

organising, the performing, and the networking. I have chosen to define

these dimensions not as functional levels even though they easily and correctly

can be discussed in such terms. These dimensions are the core structure of

homecare work, and within these dimensions, functional levels operate building

the dimensions, guiding our attention further towards mechanisms that are

central for the organisation of work and the uses of technology. The dimension

that this text mainly explores is the organising dimension, primarily since the

materials have shown that this dimension is crucial for the workers’ performance,

and the uses of the application designed to support their work.

The Organising Dimension of Homecare Work

The organising dimension consists in turn of a number of functional levels.

These are the administration and the coordination levels. The latter in turn,

is constructed of two sublevels that are defined as the functional sublevel of

articulation and the functional sublevel of notification. The sublevel of notification

concerns all communication mediated through technology and tools. Faceto-

face communication is denoted as face-to-face communication, when such

denotation is necessary. The functional sublevel of notification has a particular

role, as it functions as a bridge between the other dimensions of performing and


All assignments are organised and coordinated during morning meetings each

day. The static plan that is produced most often needs to be changed and

renegotiated, since conditions can change rapidly. Access to information is in

these situations important and the workers often discuss and exchange information

about how the work is performed, mainly to be aware of each other’s

activities. Information about the elderly has always been accessible in paper

binders located in the filing cabinets in the office. The information is found in

several different binders, which correspond to certain services, such as delivery

statistics about lunch boxes and assistance decisions. Information about their

own work has long been held in their own private calendars inaccessible for


The fragmentation of information is a crucial problem to deal with, especially

for newcomers, as one really needs to know where crucial information is to be

found, in particular when the unexpected occurs, as when an unplanned house

call needs to be dealt with, or an emergency call comes in that requires a direct

attention. If such situations occur, the workers need to have quick and easy

access to relevant information. Since homecare work until recently has been

forced to manage without the aid of computers, the manual information system

has been the main resource.

Table 1. The organising dimension of homecare work

Functional level Hierarchy Focus ICT Role Degree of support

by ICT

ICT used in


Coordination Main Group

Division of



Fully Partly

-Articulation Sub Group Articulation Fully Yes

-Notification Sub Group/





Fully No

Administration Main Group and



and preparation,


Partly Partly

The use of these traditional resources has evolved a culture of practice

maintaining the resources and its interwoven parts. This culture results in the

way in which communication and notification are handled, particularly in that

asynchronous communication sets the agenda for how communication and

messages are managed, as pointed out by Pinell et al. (2003). Today, this

culture and its ways of communication are challenged by the employment of

information technology and the inner logic of the system.

To ease the management of information, the homecare organisations have used

a computer-based information system. The system consists of a server software

application distributed on two interrelated components, a desktop

computer and a number of PDAs. The mobile information and communication

system has slowly been deployed into both homecare groups and is now, step

by step, taking over more and more of those roles traditional repositories have

had earlier. Instead of memorizing the content of different files held in the

archive cupboard, as before, the workers are now able to carry information

about the elderly stored in the PDAs. Before leaving the office, the PDAs are

synchronised with the stationary PC.

The management of information is possible both on the PDAs and on the

desktop computer. However, the latter is the resource where almost all the

changes of information are made. One reason for this is that the interaction

styles and the small screen on the PDA provide less support to manage these

tasks effectively. Table 1 shows that the application supports all the functional

levels of the organising dimension, the only functional level that is partly

supported is the administration level. The reasons for this is that some important

files and documents are only found on paper stored in binders, and have not yet

been converted to electronic documents. The functional level of notification is

also supported, but is in reality not used at all. The following discussion will

focus on two functional levels in the organising dimension, namely, the coordination

and the notification levels.

The Functional Level of Coordination

The uses of repositories in these functional levels have no connection to an

obvious hierarchal structure of power among the workers. Thus, none of the

workers is more in charge than any of the others. Homecare work is independent

and autonomous, carried out towards a collective goal and where all the

workers should be capable of handling all tasks. Everyone has a specific area

of responsibility. Each person handles the maintenance work of specific files

connected to their area of responsibility. Even if all the workers have specific

knowledge and interest areas, the workers’ knowledge coincides. This is one

of the collective strengths utilised in the organisation of work.

One of the roles the use of the application has taken is assisting the articulation

and coordination of work on a daily basis. The organization of basic homecare

work is more or less the same throughout the country, and similar tools and

ways of handling artefacts have been established over time. In this respect, to

use the system is a challenge for the whole branch. One of the artefacts that can

be seen as its predecessors is the wallboard concept (see Figure 1). The

concept of the wallboard is one important cognitive tool the designers managed

to encapsulate, and the software carries several similarities on that account.

Currently, the division of work is exclusively prepared by means of the software

in both organisations, functioning as virtual representation of the wallboard

(Orre, 2002).

Articulation Work Assisted by the Software Application

The personnel divide and coordinate their work in concert each morning and

the procedure is similar to that of an auction. All the elderly are represented by

Figure 1. The wallboard

numbers and one of the workers, the application operator, sits by the desktop

computer and calls out the numbers to the others. For her eyes only, all the

numbers are displayed on an assignment list that automatically lists all the

assignments for the particular day.

The assignments pop-up automatically according to service plans scheduled in

the system for each elderly person. The assistant, who wants to accept a

particular call, does so by saying “I’ll take him or her.” What happens next is

that the application operator drags the number from the frame on the screen

containing the assignment list, to a button corresponding to the specific name

of the worker that has accepted the call. The duties requiring collaboration of

two workers are not accepted by the application before two assistants have

accepted the call and the application operator has assigned it twice. The

application operator only articulates the assignments. She does not do any

coordination as to when these tasks are supposed to be carried out more than

prioritising assignments that need to be attended to during the morning hours;

those it concerns during the meeting negotiate the coordination of activities on

their own.

Previously, the tasks were coordinated within three smaller groups of four to

five workers. What the system does is to display the information and the tasks

on a specific information space that provides an overview that easily can be

Figure 2. The assignment list

Assignment list Calendar



handled by the application operator. In Alfa, the application has made a

considerable difference, and changed both the structure of the work group and

the “talk about the elderly” (Orre, 2002). If one follows the importance of war

stories, “Talking about machines,” discussed by Orr (1996), this is an important

dimension that functions as a carrier of knowledge, not only providing an

awareness of other workers’ activities but also as an exchange of experiences

that can be useful for the future development of one’s own practice. One

important aspect here is the automatic delivery by the system of assignments on

the assignment list. The application manager only needs to focus on the tasks

that need to be performed during a specific day. During this procedure, no

efforts are in to planning actions towards the elderly for a whole week,

indicating that the long-term coordination of actions is done through other

means. The role of the application is from my observations the repository that

is used to determine what is going to be done, and not to keep track of the

ongoing activities for the members of the group, even though such activities and

actions towards the elderly are recorded after their completion. The use of the

system in this respect in is more in line with what to do and what were done

questions, rather than questions searching for what is going on, which are more

relevant for practice and the activities of micro-coordination and exception


Uses of Tools at the Functional Level of Coordination

The discussion above may give the idea that the software is the only support

used during the procedure of coordination. At first glance, these morning

meetings are a mess of voices, telephone signals, mobile phones conversations,

PDAs, papers and binders, jokes and laughter, and it is difficult to see what is

being decided and coordinated. After a while, one can see patterns and roles

among the workers, and especially how different artefacts are used during this

procedure. The application operator and the computer, as discussed above,

play one distinct role. She is the only person doing the articulation tasks while

the others can focus on the coordination of tasks and events. However, what

about the other tools at hand? The picture below gives an account of tools that

are used during the coordination of work, providing a map of the functional

system in terms of actors and tools, where the thick black lines drawn between

tools and the application manager or the workers as a group indicate a direct

use in relation to the accomplishment of the procedure. The grey and spotted

lines point out uses of tools that are used, but have less or no immediate role

in the coordination procedure.

What we can see in the figure is that the computer provides no other assistance

than first- hand support for the application operator accomplishing her task,

that is articulation work, and later, providing the others after synchronising the

PDAs with updated information. The denotation of the application manager is

mine, mainly to separate her from the other workers. The complex network of

the other tools that are used in order to organise and prepare the work through

the procedure of coordination highlights tools functioning as important resources

in practice. The application and its connected mobile devices are not

alone in this procedure. The stationary computer provides the group during this

procedure with a single user interface that will prove important in the following

discussion of the functional system of notification. Another resource that needs

to be mentioned is the use of mobile phones. There are a number of mobiles

used to stand guard for the safety and emergency system installed in the homes

of the elderly. These phones, three in number, together with the personal

mobiles the staff have access to are an important resource for coordination of

Figure 3. An illustration of the tools used during the meetings

meeting points, etc. During the morning meetings calls not connected to the

work at hand are handled, which can be seen as a distraction from the task, but

also a natural part of the daily work.

The Functional Sublevel of Notification

The use of notes and messages is one central aspect and can be seen as a

continuum of actions taken during the morning meeting. Notes and messages

can in this context be discussed in terms of what Sellen & Harper (2001) define

as hot and warm files — frequently used documents in the workplace. Hot and

warm documents in this case function as a means for coordination and

awareness of ongoing activities in the mobile work place. Notification is one

important factor in the accomplishment of the collective strategy for the whole

group. One repository that plays a leading role in this work is a diary found on

the desk in the office.

The diaries have a central role at both sites but the uses of them differ. Different

uses of similar tools indicate dissimilarities in how the social organisations of

Figure 4. A page of the diary

Day shift



tools and work are structured (Hutchins, 1995). Following this indication, one

needs to go further and see where these differences can be identified and why

they occur, especially in relation to the use of the software application and other