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Observational Study
.2014 May-Jun;21(3):414-22.
doi: 10.1136/amiajnl-2012-001520. Epub 2013 Sep 4.

Communication spaces

Observational Study

Communication spaces

Enrico Coiera. J Am Med Inform Assoc.2014 May-Jun.

Abstract

Background and objective: Annotations to physical workspaces such as signs and notes are ubiquitous. When densely annotated, work areas become communication spaces. This study aims to characterize the types and purpose of such annotations.

Methods: A qualitative observational study was undertaken in two wards and the radiology department of a 440-bed metropolitan teaching hospital. Images were purposefully sampled; 39 were analyzed after excluding inferior images.

Results: Annotation functions included signaling identity, location, capability, status, availability, and operation. They encoded data, rules or procedural descriptions. Most aggregated into groups that either created a workflow by referencing each other, supported a common workflow without reference to each other, or were heterogeneous, referring to many workflows. Higher-level assemblies of such groupings were also observed.

Discussion: Annotations make visible the gap between work done and the capability of a space to support work. Annotations are repairs of an environment, improving fitness for purpose, fixing inadequacy in design, or meeting emergent needs. Annotations thus record the missing information needed to undertake tasks, typically added post-implemented. Measuring annotation levels post-implementation could help assess the fit of technology to task. Physical and digital spaces could meet broader user needs by formally supporting user customization, 'programming through annotation'. Augmented reality systems could also directly support annotation, addressing existing information gaps, and enhancing work with context sensitive annotation.

Conclusions: Communication spaces offer a model of how work unfolds. Annotations make visible local adaptation that makes technology fit for purpose post-implementation and suggest an important role for annotatable information systems and digital augmentation of the physical environment.

Keywords: annotation; augmented reality; clinical information system; human-computer interaction; situated cognition; task-technology fit.

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Figures

Figure 1
Figure 1
Annotations on a door form a tightly coupled set that supports infection control on entry and exit through the door.
Figure 2
Figure 2
Annotation assemblies are distinguishable by the degree to which they refer to the elements of the space within which they are found, and the degree to which they refer to external workflows. Some communication spaces are composites, assembled out of a number of discrete subassemblies.
Figure 3
Figure 3
Annotations in the space surrounding hospital computer workstations contain information to assist in operating the clinical software. Clockwise from left: (1) a list of software icons and their associated functions on the wall next to a computer screen; (2) a note on top of a screen reminding users to ‘Protect your security’, followed by the icons to ‘Change user’ or ‘Exit’; (3) paper sheets on a wall behind a workstation with detailed instructions: ‘Electronic Medical Record–what you need to know’, eg ‘Allergies Recording’ followed by detailed instructions.
Figure 4
Figure 4
Annotations on a medication trolley: (1) the trolley carries sheets to be used in special circumstances, eg : the ‘Chart in Pharmacy’ paper sheet which acts as a placeholder for a patient chart whilst it is off ward; drug trays are annotated with handwritten labels: (2) patient bed numbers for patients receiving medications that are special orders from Pharmacy (eg ‘Bed 5+6’); and (3) common medications stored on the ward are organized by general class (eg ‘Antibiotics’, ‘Analgesia’, ‘Cardiac Meds’).
Figure 5
Figure 5
A noticeboard in a common ward clerking area aggregates a heterogeneous set of annotations all referencing different processes external to the space. Clockwise from top left: (1) a hand annotated paper sheet with a table of patient bed by hour of the day, indicating the observations taken by a nurse; (2) one of three sheets describing ‘Falls prevention strategies’ for the hospital; (3) typed sheet with times and procedures for clinical nursing handover in the ward; (4) a district wide newsletter describing patient safety procedures, eg ‘Time Out’.
Figure 6
Figure 6
This communication space in a hospital ward clerking area is a composite of several distinct spaces: (1) a noticeboard (figure 5); (2) a filing area; (3) a computer workstation (figure 3, left-hand side); and (4) a workbench.
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References

    1. Coiera E. When conversation is better than computation. J Am Med Inform Assoc 2000;7:277–86 - PMC - PubMed
    1. Coiera E. Interaction design theory. Int J Med Inform 2003;69:205–22 - PubMed
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    1. Littlejohn SW, Foss KA. Theories of human communication. 9th edn Wadsworth, 2007
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