Skip to main content
Log in

Repetita Iuvant: Exploring and Supporting Redundancy in Hospital Practices

  • Published:
Computer Supported Cooperative Work (CSCW) Aims and scope Submit manuscript

Abstract

This paper discusses the role of redundancy in hospital work, especially in facilitating the cognitive and coordinative tasks of health practitioners in clinical settings. It also investigates the ways in which health information technology can preserve, support and even enhance this role by being grounded in the observations and analyses that two research groups in Italy and Norway carried out in independent studies. In the present study, this previous research is reassessed and shaped into a unified and coherent design-oriented framework. This framework considers four kinds of data redundancy and outlines their peculiarities and the typical conditions in which they occur. In particular, the paper reports how these kinds of redundancies are exploited in both written artifacts and oral communications and how they affect each other. The paper also reports the impact of redundancies on the articulation work of physicians and nurses by playing either a negative or, more often, a positive role depending on the context. A series of lessons learnt are then proposed for the design of suitable coordination mechanisms that could preserve or even utilize this neglected phenomenon, which is strongly related to the interpretative and coordinative practices that are articulated in the patient’s record.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Notes

  1. “Re-plicare” means “to fold back” in Latin.

  2. “Duplicate” means “to double” in Latin.

References

  • Ashkenas, Ron; Dave Ulrich; Todd Jick; and Steve Kerr (2015). The boundaryless organization: Breaking the chains of organizational structure. San Francisco: Jossey-Bass, a Wiley Company.

  • Atkinson, Paul (1995). Medical talk and medical work. London: Sage.

  • Baldwin, Loretta; and Cheryl McGinnis (1994). A computer-generated shift report. Nursing Management, vol. 25, no. 9, pp. 61–67.

    Google Scholar 

  • Benner, Patricia (2004). Designing formal classification systems to better articulate knowledge, skills, and meanings in nursing practice. American Journal of Critical Care, vol. 13, no. 5, pp. 426–430.

    Google Scholar 

  • Berg, Marc (1996). Practices of reading and writing: the constitutive role of the patient record in medical work. Sociology of Health & Illness, vol. 18, no. 4, pp. 499–524.

    Article  MathSciNet  Google Scholar 

  • Berg, Marc (1998). Medical work and the computer-based patient record: a sociological perspective. Methods of Information in Medicine, vol. 37, no. 3, pp. 294–301.

    Article  Google Scholar 

  • Berg, Marc; and Stefan Timmermans (2000). Orders and their others: on the constitution of universalities in medical work. Configurations, vol. 8, no. 1, pp. 31–61.

    Article  Google Scholar 

  • Berger, Robert; and J. Kichak (2004). Computerized physician order entry: helpful or harmful? Journal of the American Medical Informatics Association, vol. 11, no. 2, pp. 100–103.

    Article  Google Scholar 

  • Blomberg, Jeanette; and Karasti Helena (2013). Reflections on 25 years of ethnography in cscw. Computer Supported Cooperative Work (CSCW), vol. 22, no. 4–6, pp. 373–423.

    Article  Google Scholar 

  • Bomba, David; and Robert Prakash (2005). A description of handover processes in an Australian public hospital. Australian Health Review, vol. 29, no. 1, pp. 68–79.

    Article  Google Scholar 

  • Brown, JohnSeely; and Paul Duguid (1991). Organizational learning and communities-of-practice: Toward a unified view of working, learning, and innovation. Organization Science, vol. 2, no. 1, pp. 40–57.

    Article  Google Scholar 

  • Butcher, Howard; Gloria Bulechek; Joanne Dochterman; and Cheryl Wagner (2013). Nursing interventions classification (NIC). St. Louis, Missouri: Elsevier Health Sciences.

  • Cabitza, Federico; and Carlo Batini (2016). Information quality in healthcare. In: Batini, Carlo; and Scannapieco, Monica (eds) Data and Information Quality: Dimensions, Principles and Techniques, Springer, London, UK, chap 13, pp. 421–438.

  • Cabitza, Federico; and Alvise Mattozzi (2017). The semiotics of configurations for the immanent design of interactive computational systems. Journal of Visual Languages & Computing, vol. 40, no. Supplement C, pp. 65–90. https://doi.org/10.1016/j.jvlc.2017.01.003.

  • Cabitza, Federico; and Carla Simone (2008). Supporting practices of positive redundancy for seamless care. In: CBMS’08. Computer-Based Medical Systems, 2008. 21st IEEE International Symposium on, IEEE, pp. 470–475.

  • Cabitza, Federico; Marcello Sarini; Carla Simone; and Michele Telaro (2005). When once is not enough: The role of redundancy in a hospital ward setting. In: GROUP 2005. Proceedings of the 2005 International ACM SIGGROUP Conference on Supporting Group Work, ACM, New York, NY, USA, pp. 158–167. https://doi.org/10.1145/1099203.1099234, http://doi.acm.org/10.1145/1099203.1099234.

  • Cabitza, Federico; Marcello Sarini; and Carla Simone (2007). Providing awareness through situated process maps: The hospital care case. In: GROUP 2007. Proceedings of the 2007 International ACM Conference on Supporting Group Work, ACM, New York, NY, USA, pp. 41–50, https://doi.org/10.1145/1316624.1316631, http://doi.acm.org/10.1145/1316624.1316631.

  • Cabitza, Federico; Gianluca Colombo; and Carla Simone (2013). Leveraging underspecification in knowledge artifacts to foster collaborative activities in professional communities. International Journal of Human-Computer Studies, vol. 71, no. 1, pp. 24–45.

    Article  Google Scholar 

  • Cetina, KarinKnorr (2009). Epistemic cultures: How the sciences make knowledge. Cambridge: Harvard University Press.

  • Chen, Yunan; Charlotte Tang; Xiaomu Zhou; Aleksandra Sarcevic; and Soyoung Lee (2013). Beyond formality: informal communication in health practices. In: CSCW 2013. Proceedings of the 2013 conference on Computer supported cooperative work companion, ACM, pp. 307–312.

  • Deming, Edwards (1989). Foundation for management of quality in the western world. Osaka, Japan: Institute of Management and Sciences.

  • Dixon, Jennifer; and Cyril Chantler (2011). Clinically integrated systems: the future of nhs reform in england? BMJ, vol. 342, p. 741.

    Article  Google Scholar 

  • Dolin, Robert; Liora Alschuler; Sandy Boyer; Calvin Beebe; Fred Behlen; Paul Biron; and Amnon Shabo (2006). HL7 clinical document architecture, release 2. Journal of the American Medical Informatics Association, vol. 13, no. 1, pp. 30–39.

    Article  Google Scholar 

  • Donaldson, Molla; Janet Corrigan; and Linda Kohn (2000). To err is human: building a safer health system. Washington: National Academies Press.

  • Ellingsen, Gunnar; and Eric Monteiro (2003). A patchwork planet integration and cooperation in hospitals. Computer Supported Cooperative Work (CSCW), vol. 12, no. 1, pp. 71–95.

    Article  Google Scholar 

  • Ellingsen, Gunnar; and Glenn Munkvold (2007). Infrastructural arrangements for integrated care: implementing an electronic nursing plan in a psychogeriatric ward. International journal of integrated care, vol. 7, no. 2.

  • Ellingsen, Gunnar; Eric Monteiro; and Glenn Munkvold (2007). Standardization of work: co-constructed practice. The Information Society, vol. 23, no. 5, pp. 309–326.

    Article  Google Scholar 

  • Emery, Frederick; Michael Bucklow; and Einar Thorsrud (1978). The emergence of a new paradigm of work. Australian National University. Canberra: Centre for Continuing Education.

  • Fitzpatrick, Geraldine; and Gunnar Ellingsen (2013). A review of 25 years of CSCW research in healthcare: contributions, challenges and future agendas. Computer Supported Cooperative Work (CSCW), vol. 22, no. 4–6, pp. 609–665.

    Article  Google Scholar 

  • Forsythe, Diana (1999). It’s just a matter of common sense: Ethnography as invisible work. Computer Supported Cooperative Work (CSCW), vol. 8, no. 1, pp. 127–145. URL http://www.springerlink.com/index/JP26281Q33J0T240.pdf.

    Article  Google Scholar 

  • Garfinkel, Harold (1967). Studies in ethnomethodology. New Jersey: Prentice-Hall.

  • Gorman, Paul; Joan Ash; Mary Lavelle; and Jason Lyman (2000). Bundles in the wild: Managing information to solve problems and maintain situation awareness. Library Trends, vol. 49, no. 2, p. 266.

    Google Scholar 

  • Hammer, Michael (1990). Reengineering work: don’t automate, obliterate. Harvard Business Review, vol. 68, no. 4, pp. 104–112.

    Google Scholar 

  • Hardstone, Gillian; Mark Hartswood; Rob Procter; Roger Slack; Alex Voss; and Gwyneth Rees (2004). Supporting informality: team working and integrated care records. In: CSCW 2004. Proceedings of the 2004 ACM conference on Computer supported cooperative work, ACM, pp. 142–151.

  • Harper, Richard (2000). The organisation in ethnographya discussion of ethnographic fieldwork programs in CSCW. Computer Supported Cooperative Work (CSCW), vol. 9, no. 2, pp. 239–264.

    Article  Google Scholar 

  • Heath, Christian; and Paul Luff (1996). Documents and professional practice:bad organisational reasons for good clinical records. In: CSCW 1996. Proceedings of the 1996 ACM conference on Computer supported cooperative work, ACM, pp. 354–363.

  • Houben, Steven; Frost, Mads; and Jakob E. Bardram (2015). Collaborative affordances of hybrid patient record technologies in medical work. In: CSCW 2015. Proceedings of the 18th ACM Conference on Computer Supported Cooperative Work & Social Computing, ACM, pp. 785–797.

  • Hunter, Kathryn (1991). Doctors’ stories: The narrative structure of medical knowledge. Princeton: Princeton University Press.

  • Hutchins, Edwin (1995). Cognition in the Wild. Cambridge: MIT press.

  • Kane, Bridget; and Saturnino Luz (2006). Multidisciplinary medical team meetings: An analysis of collaborative working with special attention to timing and teleconferencing. Computer Supported Cooperative Work (CSCW), vol. 15, no. 5–6, pp. 501–535.

    Google Scholar 

  • Kennedy, Joan (1999). An evaluation of non-verbal handover. Professional Nurse, vol. 14, no. 6, p. 391.

    Google Scholar 

  • Kerr, Micky (2002). A qualitative study of shift handover practice and function from a socio-technical perspective. Journal of Advanced Nursing, vol. 37, no. 2, pp. 125–134.

    Article  Google Scholar 

  • Klein, Heinz; and Michael Myers (1999). A set of principles for conducting and evaluating interpretive field studies in information systems. MIS Quarterly, vol. 23, no. 1, pp. 67–93.

  • Kloss, L (2013). Never Missing a Beat. Redefining the Role of Health Information Management in the New World of Information Governance. Houston: Ironmountain.

  • Koppel, Ross; Joshua P. Metlay; Abigail Cohen; Brian Abaluck; A. Russell Localio; Stephen Kimmel; and Brian Strom (2005). Role of computerized physician order entry systems in facilitating medication errors. Jama, vol. 293, no. 10, pp. 1197–1203.

    Article  Google Scholar 

  • Korpman, R (1990). Patient care automation: the future is now Part 2. The current paper system–can it be made to work? Nursing Economic, vol. 8, no. 4, pp. 263–267.

    Google Scholar 

  • Kovalainen, Mikko; Mike Robinson; and Esa Auramäki (1998). Diaries at work. In: CSCW 1998. Proceedings of the 1998 ACM conference on Computer supported cooperative work, ACM, pp. 49–58.

  • Landau, Martin (1969). Redundancy, rationality, and the problem of duplication and overlap. Public Administration Review, vol. 29, no. 4, pp. 346–358.

    Article  Google Scholar 

  • Meum, Torbja (2013). Lost in translation: The challenges of seamless integration in nursing practices. International Journal of Medical Informatics, vol. 82, no. 5, pp. e200– e208.

    Article  Google Scholar 

  • Munkvold, Glenn; Gunnar Ellingsen; and Hege Koksvik (2006). Formalizing work: reallocating redundancy. In: CSCW 2006. Proceedings of the 2006 20th anniversary conference on Computer supported cooperative work, ACM, pp. 59–68.

  • Munkvold, Glenn; Gunnar Ellingsen; and Eric Monteiro (2007). From plans to planning: the case of nursing plans. In: GROUP 2007. Proceedings of the 2007 international ACM conference on Supporting group work, ACM, pp. 21–30.

  • NANDA (2005). Nursing diagnoses: Definitions and classification, 2005–2006. Mountain, WI: North American Nursing Diagnosis Association.

  • Nilsson, Agneta; Miria Grisot; and Margunn Aanestad (2002). Electronic patient records – an information infrastructure for healthcare. In: IRIS 2002. Proceedings of the 25th Conference in Information System Research in Scandinavian, Bautahaj, Denmark.

  • Normark, Maria (2002). Using Technology for Real-Time Coordination of Work: A study of work and artifact use in the everyday activities at SOS Alarm. PhD thesis.

  • O’malley, A.; Joy Grossman; Genna Cohen; Nicole Kemper; and Hoangmai Pham (2010). Are electronic medical records helpful for care coordination? experiences of physician practices. Journal of General Internal Medicine, vol. 25, no. 3, pp. 177–185.

    Article  Google Scholar 

  • Orr, James (1990). Sharing knowledge, celebrating identity: War stories and community memory. London: SAGE.

  • Patel, Vimla; Kayla Cytryn; Edward Shortliffe; and Charles Safran (2000). The collaborative health care team: the role of individual and group expertise. Teaching and Learning in Medicine, vol. 12, no. 3, pp. 117–132.

    Article  Google Scholar 

  • Perrow, Charles (2011). Normal accidents: Living with high risk technologies. Princeton: Princeton University Press.

  • Porter, Michael E.; and Elizabeth Olmsted Teisberg (2006). Redefining health care: creating value-based competition on results. Cambridge: Harvard Business Press.

  • Pratt, Wanda; Madhu Reddy; David McDonald; Peter Tarczy-Hornoch; and John Gennari (2004). Incorporating ideas from computer-supported cooperative work. Journal of Biomedical Informatics, vol. 37, no. 2, pp. 128–137.

    Article  Google Scholar 

  • Seidman, Irving (2013). Interviewing as qualitative research: A guide for researchers in education and the social sciences. New York: Teachers College Press.

  • Sexton, Amanda; Connie Chan; Malcolm Elliott; John Stuart; Rohan Jayasuriya; and Patrick Crookes (2004). Nursing handovers: do we really need them? Journal of Nursing Management, vol. 12, no. 1, pp. 37–42.

    Article  Google Scholar 

  • Siegler, Eugenia; and Ronald Adelman (2009). Copy and paste: a remediable hazard of electronic health records. The American Journal of Medicine, vol. 122, no. 6, pp. 495–496.

    Article  Google Scholar 

  • Solvang, A. (2005). Stille rapport. Sykepleien, vol. 93, pp. 58–60.

    Article  Google Scholar 

  • Star, Susan Leigh; and Anselm Strauss (1999). Layers of silence, arenas of voice: The ecology of visible and invisible work. Computer Supported Cooperative Work (CSCW), vol. 8, no. 1 , pp. 9–30.

    Article  Google Scholar 

  • Strauss, Anselm; Shizuko Fagerhaugh; Barbara Suczek; and Carolyn Wieder (1985). Social Organization of Medical Work. Chicago: University of Chicago Press.

  • Streeter, Calvin (1992). Redundancy in organizational systems. Social Service Review, vol. 66, no. 1, pp. 97–111.

    Article  Google Scholar 

  • Tang, Charlotte; and Sheelagh Carpendale (2007). An observational study on information flow during nurses’ shift change. In: CHI 2007. Proceedings of the SIGCHI conference on Human factors in computing systems, ACM, pp. 219–228.

  • Tang, Charlotte; Yan Xiao; Yunan Chen; and Paul Gorman (2015). Design for Supporting Healthcare Teams. In: Cognitive Informatics for Biomedicine, Springer, pp. 215–239.

  • Taylor, John (1995). Don’t obliterate, informate!: Bpr for the information age. New Technology, Work and Employment, vol. 10, no. 2, pp. 82–88.

    Article  Google Scholar 

  • Tjora, Aksel (2004). Maintaining redundancy in the coordination of medical emergencies. In: CSCW 2004. Proceedings of the 2004 ACM conference on Computer supported cooperative work, ACM, pp. 132–141.

  • Ulriksen, GroHilde; Rune Pedersen; and Gunnar Ellingsen (2016). Establishing ict governance for regional information infrastructures in healthcare. In: HICSS 2016. Proceedings of the 2016 49th Hawaii International Conference on System Sciences, IEEE Computer Society, Washington, DC, USA, pp. 5137–5146, https://doi.org/10.1109/HICSS.2016.636.

  • Voutilainen, Paivi; Arja Isola; and Seija Muurinen (2004). Nursing documentation in nursing homes: state-of-the-art and implications for quality improvement. Scandinavian Journal of Caring Sciences, vol. 18, no. 1, pp. 72–81.

    Article  Google Scholar 

  • Wallum, Ray (1995). Using care plans to replace the handover. Nursing Standard, vol. 9, no. 32, pp. 24–26.

    Article  Google Scholar 

  • Walsham, Geoff (1995). Interpretive case studies in IS research: nature and method. European Journal of Information Systems, vol. 4, no. 2, p. 74.

    Article  Google Scholar 

  • Wrenn, Jesse; Daniel Stein; Suzanne Bakken; and Peter Stetson (2010). Quantifying clinical narrative redundancy in an electronic health record. Journal of the American Medical Informatics Association, vol. 17, no. 1, pp. 49–53.

    Article  Google Scholar 

  • Zhang, Zhan; Aleksandra Sarcevic; Maria Yala; and Randall Burd (2014). Informing Digital Cognitive Aids Design for Emergency Medical Work by Understanding Paper Checklist Use. In: GROUP 2014. Proceedings of the 18th International Conference on Supporting Group Work, ACM, pp. 204–214.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Federico Cabitza.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cabitza, F., Ellingsen, G., Locoro, A. et al. Repetita Iuvant: Exploring and Supporting Redundancy in Hospital Practices. Comput Supported Coop Work 28, 61–94 (2019). https://doi.org/10.1007/s10606-017-9303-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10606-017-9303-z

Keywords

Navigation