=Paper=
{{Paper
|id=Vol-1251/paper2
|storemode=property
|title=Shaping of Technology and Place in Municipal Healthcare in Norway - an Explorative Study
|pdfUrl=https://ceur-ws.org/Vol-1251/paper2.pdf
|volume=Vol-1251
|dblpUrl=https://dblp.org/rec/conf/pahi/Haland14
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==Shaping of Technology and Place in Municipal Healthcare in Norway - an Explorative Study==
https://ceur-ws.org/Vol-1251/paper2.pdf
The Shaping of Technology and Place in Municipal Healthcare in
Norway – an Explorative Study
Erna Håland
Department of Adult Learning and Counselling (IVR)
Norwegian University of Science and Technology (NTNU), Norway
Abstract. Technologies shape how places are defined and experienced (and
create and connect new places), and places shape how technologies are defined
and experienced (and used and developed). In this paper, inspired by literature
discussing technology, place and health, I will present an explorative study of
how technology and place shape each other in a competence program for
healthcare workers in Fosen in Norway.
1 Introduction
The introduction of various kinds of telecare technologies is often highlighted as a
solution to challenges regarding ‘lack of hands’ in future healthcare. Telecare tech-
nologies are promised, by policy makers, designers and others, to make modern
healthcare more efficient and more accessible – and often also to deliver higher quali-
ty care at reduced costs [1-4]. The same promises are often presented when introduc-
ing various types of information and communication technology (ICT) for compe-
tence development of health personnel. Common across these promises is the em-
phatic rhetoric that these technologies can erase the importance of distance and
place. However, is this true? Place still matters, Oudshoorn [1] argues, and, draw-
ing on insights from human geography and science and technology studies (STS),
goes on to show how technology and place co-constitute each other within
healthcare. Technologies shape how places are defined and experienced (and create
and connect new places), and places shape how technologies are defined and experi-
enced (and used and developed). Technology is here understood within a soci-
otechnical approach, meaning that the ‘social’ and the ‘technical’ are seen as tightly
interwoven [5,6], and where the dialectic relationship between technology and its
users is highlighted [7].
In this paper, inspired by the literature discussing technology, place and health, I
will present an explorative study of how technology and place shape each other in a
competence programme for healthcare workers in Fosen in Norway. It is important
to know more about how health personnel experience technology and place, since
Copyright © 2014 by the paper's authors. Copying permitted for private and academic purposes.
In: E.A.A. Jaatun, E. Brooks, K.E. Berntsen, H. Gilstad, M. G. Jaatun (eds.):
Proceedings of the 2nd European Workshop on Practical Aspects of Health Informatics
(PAHI 2014), Trondheim Norway, 19-MAY-2014, published at http://ceur-ws.org
10 Håland
technologies promising to transcend distance and place are being introduced into
healthcare at a rapid rate. This study brings forward some initial reflections on this
subject and outlines some suggestions for further research.
2 Theoretical Point of Departure
Place has traditionally been treated as a ‘black box’ within technology studies, health
studies and social science studies, and even within the field of medical geography [8],
even though geographers have always been interested in places and regions. The
renewed interest in health and place within some of these fields in recent years
implies an awareness that place does matter, and an understanding of place as a so-
cially constructed and complex phenomenon [8]. This means that place is no longer
treated as a passive ‘container’. Places shape people’s activities and people’s activi-
ties shape people’s places. Furthermore, place is not treated as merely a geograph-
ically defined site, but is also connected to people’s experiences and emotions. This is
implied in the concept ‘sense of place’, indicating the consciousness people have of
places of particular significance to them [9]. For example, people can have an expe-
rience of ‘home’ in relation to the house they grew up in, the country they come
from, the neighbourhood they live in now, etc. – and it is the experiences of this
place more than the catalogued characteristics that are of interest to explore. Entrikin
[10] argues that the understanding of place must include both the subjective experi-
ence and the knowledge of place as object, much in line with how the materi-
al/technology and the social/context/users is understood as interwoven in science and
technology studies.
The importance of place for health has also gained renewed interest. Kearns [9] ar-
gues that “what occurs in a place (in terms of the relations between people and ele-
ments of their environment) has profound importance to health” (p.141). He further
describes that the elements which constitute a place influence the health of the people
in this place, and, vice versa, the way healthcare is provided also influences the char-
acter of a place. This is a dual relationship. The experience of medicine/health cannot
be detached from the place in which it occurs [9,11]. Cummins et al. [12] argue that
there is a mutually reinforcing and reciprocal relationship between people and places,
which is important to include in health research, as place both creates and contains
social relations. Halford and Leonard [13] explore how hospital spaces/places influ-
ence the daily work practice of nurses, and show how different spaces/places hold
different meanings to different actors. They highlight how space/place can act as tools
through which different actors construct and perform professional identities, and ar-
gue that attention to space/place contributes to original knowledge of nurses’ working
conditions and inter-professional relations.
Oudshoorn [1] brings insights into place to the field of technology studies, as she
shows how places in which technologies are used influence how technologies enable
or constrain people’s activities and identities. She investigates the use of several tel-
ecare applications and shows how patients’ homes and public places shape how these
technologies are adapted and used (or resisted), and how the technologies shape pa-
The Shaping of Technology and Place 11
tients’ homes and public places. For example, the home is reconfigured and trans-
formed into an electronic outpost clinic (which is not embraced by all patients). This
is also shown by Langstrup [14], who investigates the interpretations and negotiations
taking place regarding the home in chronic disease management. Oudshoorn argues
that the meaning and use of technology depends upon place, implying that research-
ers, designers and others should be more place-sensitive when introducing or investi-
gating new technology. Both Oudshoorn and Langstrup question the claim that mod-
ern healthcare is increasingly independent of place, and Langstrup argues that
healthcare “more than ever rests on social, material and spatial arrangements and the
work that holds these in place” (p.1020). Poland et al. [15] propose making place the
lens through which to view practice. They investigate place, power and technology in
health and social care by bringing together diverse theoretical perspectives, and show
how place impacts health and social care, and how technology and power are inter-
woven and emplaced.
3 Case and Methods
Fosen is a region in Norway with small municipalities and large geographical dis-
tances. The region has a long tradition of cooperation between the different munici-
palities, and has now also introduced common initiatives for competence develop-
ment within health and care services. Due to the large geographical distances, various
alternatives to extensive travelling to attend courses have been introduced, among
them lectures transmitted through video conferences and internet-based discussion
fora. The empirical material for this paper is based on a research project evaluating
one course using these technologies, namely the course ‘Ageing on the Internet’.
‘Ageing on the Internet’ is a course for healthcare workers (mainly working in
home care services or in nursing homes) in Fosen aiming to strengthen their com-
petence on caring for elderly people and also learning to use ICT-tools for com-
munication, cooperation and learning. The course included an internet-based dis-
cussion forum, lectures transmitted through video conferences and physical semi-
nars. The participants worked in groups throughout the course and were supposed
to write and hand in group assignments for different modules in the course. The
participants were supposed to use the internet-based forum and video conferences
to discuss and work with the group assignments.
The research project evaluating this course was conducted in 2010-2011, aiming
to explore face-to-face interaction and technology-mediated interaction in compe-
tence development. The empirical material consists of interviews and observations.
This qualitative approach is well suited for investigating participants’ own experi-
ences of a phenomenon [16]. 23 people were admitted to the course, 19 completed
it, and interviews were conducted with 14 of those who completed it (individual
interviews and group interviews). The interviews were recorded and transcribed. In
addition, observations were carried out of one of the lectures transmitted through
video conference and two of the physical seminars. The project was approved by
The Ombudsman for Privacy in Research (Norwegian Social Science Data Services).
12 Håland
The notion of place was not part of the focus initially, but the material has been re-
read to include this dimension. Guided by own observations of the importance of
place when doing field work in Fosen, and by the literature on technology and
place, the analysis in this paper has been carried out by re-reading the interviews
and observations to search for themes concerning places and technologies, and
how these potentially shape each other. The paper is an explorative study, indicat-
ing some preliminary findings regarding how place shapes the use of technology, and
how technology shapes the experience of place, in this setting. The analysis is still
premature and additional data is needed to further explore the subject.
4 Shaping of Technology and Place in Fosen
The places identified in this setting are the classroom (used for transmitting video
conferences), the physicians’ offices/meeting rooms (used for attending video con-
ferences), the workplace (municipal health care and nursing homes), the home,
and the region of Fosen. The main technologies in use are computers, video confer-
ences and an internet-based discussion forum. The analysis should be read as early
suggestions on how place and technology shape each other in this setting.
4.1 How Technologies Change Places
The technologies in this study change places, either by adding new dimensions to
them, transforming their use or transforming what places mean to people. The first
example is the classroom. The classroom is an ordinary classroom in a school in one
of the local communities in Fosen. The lectures transmitted through video conference
are being transmitted from this room, with a teacher and with course participants pre-
sent in the room during the entire lecture. The other participants are placed in differ-
ent locations throughout the region, meeting up in groups in their local community to
‘watch and listen to’ the lecture, with the possibility of asking questions at certain
times during and after the lecture. As the lecture is being transmitted from the class-
room, the participants here have been told to be silent, so that the lecture is not dis-
turbed and the other participants in the other locations can hear the teacher. Nor-
mally, the classroom would be a place for activity and dialogue, where participants
could comment and ask questions, and where the teacher could adapt his/her teach-
ing to the activity in the group. However, because of the video conference, the
classroom is changed, and becomes a place for being silent and passive.
The other locations are mostly physicians’ offices or meeting rooms. They have
video conference equipment because of clinical contact with the regional hospital in
video conferences at certain times. These rooms are originally designed for other
purposes, for clinical work with patients, and so now also have to be organised for
video conference lectures for small groups.
Furthermore, technologies also change the workplace. The workplace becomes a
place for learning. The course participants are allowed to work with the course
for two hours during work hours. Sometimes they do this together: they sit down in
The Shaping of Technology and Place 13
front of the computer in the workplace to discuss and work on their group assign-
ment. This makes their participation in the course visible to their co-workers, and the
course participants express how their co-workers become curious and ask them ques-
tions about what they learn in the course, leading to discussions on work practice and
routines in the workplace.
The course participants also work (a lot) with their group assignments from the
home. The two hours during work hours are not enough, and they study by themselves
after work in the home and take part in discussions in the internet-based discussion
forum. Thus, the home is redefined/reconfigured [1,14], becoming more than a sanc-
tuary. The home also becomes a place for learning and a place where one is ex-
pected to carry out course assignments.
The technologies also change participants’ experiences of the region they live in;
their ‘sense of place’. They get access to competence development and networks
across geographical distances, and express how this changes their experience of
how ‘remotely’ they live. They articulate that they now have more opportunities.
4.2 How Places Change Technologies
Places change technologies in several ways in this study: they have implications for
how the technologies are being perceived, experienced and used. The first example
concerns the use of video conferences. Video conference technologies are often pre-
sented as advanced technologies, used in specially designed and equipped rooms in
many large organisations. These organisations invest a significant amount of re-
sources in the technology itself and in training employees. When video conferences
are used in Fosen (and often elsewhere in healthcare settings), with simple equip-
ment and unstable connections, and where the (inexperienced) participants are
crammed together in a small physicians’ office, video conferencing is a very dif-
ferent technology. Video conferencing can be seen as one type of technology that
can be easily implemented in different settings, but when place is included in the
analysis, this view is nuanced. It points to how the ‘same’ technology holds dif-
ferent meanings in different places [1] and, in fact, becomes a different technology
in a different place.
The internet-based discussion forum was intended to function as an informal,
‘oral’ setting where participants were supposed to discuss topics and assignments,
almost as if in a face-to-face situation. However, the forum was mostly used at
home, a setting that implied that use of the forum competed with many other activi-
ties (taking care of kids, doing house work, etc.). For the participants in the course,
this meant that it was difficult to maintain a coherent discussion. They express that
they could post something one day and then they would have to wait days for a re-
sponse, or that they would ‘come back’ after Christmas holidays (when they would
not prioritise using the forum, instead focusing on family activities) and have many
postings from others to which to respond. Thus, the place (the home setting) chang-
es the discussion forum to something more like an email inbox, where the partici-
pants can check and respond when they are able to, and where you cannot expect an
immediate response.
14 Håland
5 Conclusion
Following Oudshoorn [1] and Langstrup [14] and others, I argue that the notion of
place should be included when discussing technology and health, thus welcoming
more place-sensitive analyses. There is an increasing range of places where healthcare
is provided, often combined with the introduction of new technologies (such as tel-
ecare technologies), which underlines the need to investigate the importance of place
[11]. Andrews [11] argues that healthcare becomes spatially dispersed and diverse,
and that user experiences become similarly diverse and potentially space-specific.
This means that we need to know more of how patients and health personnel experi-
ence technology and place. Further research should explore the complex interplay
between technology, place and health to develop insights into how technology and
place both constrain and enable human activity.
Acknowledgments The course ‘Ageing on the Internet’ was developed by the Nor-
wegian Centre for Integrated Care and Telemedicine. The research project evaluating
the course was owned by Fosen DMS and administered by Studio Apertura at NTNU
Samfunnsforskning AS. The project was conducted by the Department of Adult
Learning and Counselling and the Norwegian Centre for Electronic Patient Records,
NTNU. The project was funded by The Norwegian Directorate for Health. I would
like to thank the people in Fosen for welcoming me and for participating in the inter-
views.
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