Balancing priorities A field study of coordination in distributed elder care

Troels Mønsted, Andreas Johansen, Frederik Lauridsen, Vlad Manea, Konstantin Slavin-Borovskij

Department of Computer Science, University of Copenhagen

Hawaii International Conference on System Sciences HICSS-49. January 6, 2015

What we did

Field study of coordinative practices in distributed elder care, in the Capital Region of Denmark, from the perspective of a care center.

Analysis of coordinative challenges to inform the design of a better informations infrastructure that provides better support for inter-organizational coordination of activities.

What we found

Coordination within the heterogeneous ensemble of health providers involved in elder care is not well-supported by the current information infrastructure.

* Care center: care givers achieve coordination by communicating through various information tools and making compromises.

* Collaboration with other care providers: a fragmented information infrastructure and incompatible interests make it difficult to communicate and find compromises.

* Problem: care givers have little authority and little support from the information infrastructure, to prioritize when interests are incompatible.

We propose it to be a priority for future design to develop support for care givers in balancing priorities.

Study in sum

Aging population

Danish population % 1980 1990 2000 2015

0 - 19 years 28.7 24.3 23.7 23.2

20 - 59 years 51.9 55.3 56.6 52.2

60 years and up 19.3 20.4 19.7 24.5

Statistics Denmark, 2015

60 years and up 19.3 20.4 19.7 24.5

Elderly and multi morbidity

24 2632

4452

5968 70

15 1925

3647

53 58 56

16-24 25-34 35-44 45-54 55-64 65-74 75-79 80+

% women

% men

age

Danish Health Authority 2010

59 68 70

53 58 56

age

Organization of elder care

Current challenges

A fragmented information infrastructure

* Consists primarily of local, non-integrated systems: patient administration systems, databases, records

* Little information is shared among the involved care providers, including schedules

* Health providers report on challenges with inter-organizational coordination of activities

Purpose of studyTo further our understanding of the coordinative practices and challenges in this type of distributed care, to scaffold the design of an improved information infrastructure

care center

medical clinics

general practice

resident

family

activity centers

care giver

bus

Methods

Project

* Conducted as part of Innosund, a participatory design project aimed at developing improved IT-support for elder care in a municipality in the capital region of Denmark

Field study

* Study dedicated to investigate coordinative challenges in elder care

* Interviews: 26 with care givers, activity center, residents, dentist, senior counsel member, and driver from resident transport

* Observations: 60 hours, 15 field visits

Coordination

* Can be supported by coordination mechanisms, which are “[…] a specific organizational construct, consisting of a coordinative protocol imprinted upon a distinct artifact […]” Schmidt & Simone, 1996

* Can be achieved by bringing practices together, e.g., through direct manipulation of a common field of work, or by keeping them apart, e.g., by segregation, fine-tuning, aligning, and articulating relationships clearly Møller and Dourish, 2010

Care givers as coordinators

Care giversResponsible for daily care of the elderly, including scheduling of activities

Balance the life and care of the residents

Typical procedures* Morning meeting: discuss schedules, distributed

responsibilities and distribute tasks in the morning

* During the day: ad-hoc rescheduling in case of unforeseen events

Information systems in use* Patient administration system

* Whiteboard

* Paper calendar

* Paper notes

* Cell phones

care center

resident

care giver

care center

medical clinics

general practice

resident

family

activity centers

care giver

bus

Coordination at the care center

* Compatible interests

* Efficient means of communicating unforeseen events

* Coordination by making compromises

Coordination inside the center

Case: coming over for lunch

07:00 10:30 11:00

Scheduled activitiesResident transportation Appointment with dentist

Unforeseen eventFamily calls to have lunch with the resident

Incompatible interestsLife (social life with family) versus Care (tight schedule of resident transport)

Coordination at the care center

* Compatible interests

* Efficient means of communicating unforeseen events

* Coordination by making compromises

Coordination in the extended care network

* Incompatible interests, often life versus care

* Inefficient means of communication

* Prioritization required

care center

medical clinics

general practice

resident

activity centers

care giver

bus

family

Coordination outside the center

Findings, in sum• Coordination inside the care center is enabled by efficient communication and the

caregivers' ability to find compromises

• Coordination in the extended care network is hindered by a fragmented information infrastructure and incompatible interests, that often prevent compromises

• We need a mechanism to support inter-organizational coordination

Discussion• Make schedules global instead of local - coordination by bringing things together?

• We must embrace the existence of incompatible interests - therefore someone needs to prioritize

• Acknowledge and empower the care givers' important role as advocates for the elderly’s life and care

Thank you Balancing priorities: A field study of coordination in

distributed elder care

Troels Mønsted, Andreas Johansen, Frederik Lauridsen, Vlad Manea, Konstantin Slavin-Borovskij

Department of Computer Science, University of Copenhagen

http://innosund.bitbucket.io