activity theory and documentation design

8/8/2019 Activity Theory and Documentation Design

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Hierarchical structure of activity: Activities are composedof goal-directed actions. These actions are performedconsciously. Actions, however, consist of non-consciousoperations.

Object-orientedness: Objective and socially or culturallydefined properties. Our way of doing work is grounded in apraxis, which shared by our co-workers and determined bytradition. The way artifact is used and the division of laborinfluences the design."

Mediation: Human activity is mediated by tools andlanguage. The artifacts as such are not the object of ouractivities, but appear as socio-cultural entities.

Continuous Development: Both the tools used and theactivity itself are constantly reshaped.

Distinction between internal and external activities. Traditional cognitive psychology focuses on what is denotedinternal activities in Activity theory, but it is emphasizedthat these mental processes cannot be properly understoodwhen separate from external activities, that is the

interaction with the outside world.Activity theory excels at examining and pulling apart thecomplexities of an activity, especially the tensions among thecomponents of that activity. That might have implications for howwe write documentation, what we document, and what media,style, and tone we choose. It also may lead toward packagingcomplex decision making (e.g. forms, database fields), usingdifferent technologies to deliver information (e.g. PDAs, tablets),or thinking about how to deliver information where people need it(e.g. telemedicine).

Kofod-Petersen and Cassens (2006) then explain the hierarchicalstructure of activity, which has the following levels:

Activity: Composed of different actions that are related toeach other by belonging to the same activity. For example,


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an individual activity could be traveling to a conference.Individual activities can also be a part of collectiveactivities, such as attending a meeting with co-workers.

Actions: Are composed of different operations that can bedefined as automatic tasks. For example, a person wouldpresent a confirmation at the front desk upon checking in tothe hotel.

Operations: Actions that are performed non-consciously,such as writing your name on a sign in sheet, or taking outyour keys to start a car.

Marlin M. Cluts (2003) said that activities are influenced by

motives while actions are influenced by goals and operations byconditions. This hierarchy becomes useful in analyzing peoplesbehavior. What is interesting is that people become frustrateddepending on whether goals or motives change. Activity theoryallows for dynamic expansion and contradictions arise in the formof problems, breakdowns, and misfits. The expanded model of activity theory shows that humans do their work in a social andcultural environment. This adds the community component andmediators such as rules and the division of labor as depicted inthe chart below (Kofod-Petersen and Cassens 2006).


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What we should know about activity theory is that we shouldstudy the whole system not just the artifacts. However, it isimportant to recognize the three type of artifacts associated withactivity theory such as tools (mediate the relationship between

subject and object), rules (mediate the relationship betweensubject and community), and division of labor (mediates therelationship between community and object) (Cluts 2003). Let uslook at an example and see how all three artifacts play animportant role in software development. I will use my company asan example. My company develops nursing software. We havethree programmers on our team. They can be labeled as subjectsin the development process. They form a community togetherwith the stakeholders or in our case the counties who use oursoftware. We also have a Training and Implementation team whoworks with programmers by providing software documentationand conducting training for the client. Therefore, we worktogether in a division of labor as we have different duties andresponsibilities. The recently added billing feature that wasintegrated into the software is considered the object . Theprogrammers agreed to follow a set of rules provided by uppermanagement to comply with the software standards. The rulesare to code the billing portion so that it is compatible with theState regulations. Our developers are using tools (or mediatingartifacts) for design, programming tools such as Ruby on Rails (anopen source programming app), and documentation that I writefor the software.

Activity theory also includes changing contexts in breakdownsituations. Numerous times, I heard our programmer say that theRuby on Rails application stopped working and is generatingerrors while in the middle of compiling the code. It is now apriority to get the compiler working again in order to continueprogramming the software. The programmers focus has beenshifted from development to troubleshooting of the compiler. Ourtechnical support team had to jump in and help troubleshoot theissue, which then becomes a community activity, or a change inthe community. The ability of activity theory to identify


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breakdown situations makes it possible for the system designerto identify these possible shifts in situation and model theanticipated behavior of the system (Kofod-Petersen and Cassens2006, 11).

How Activity Theory is Applied to Computer-basedSystem Design

Now that we have grasped the concept and looked at thedefinition of activity theory, I would like to move on and look athow activity theory is applied in computer-based system designs.According to J.E. Bardram (2009), people organize and think of their work in terms of activities that are carried out in pursuit of

some overall objective, often in collaboration with others. Once aperson moves away from desktop and into a non-office likeenvironment such as a hospital, it becomes challenging tomanage their activities because they are now multitasking whichis combined with mobility, collaboration, and urgency. Bardram(2009) defines mobility as having clinicians moving constantlybetween physical and social environments and using differentcomputational devices to perform their tasks. The clinicians areusing a shared PC instead of their own personal computers to

enter patient information. The term collaboration refers to thefact that clinicians need to remain aware of others work and beable to coordinate and communicate easily with colleagues (p.10:2). Finally, urgency of clinical work means that the overheadsinvolved in accessing medical information, including manualreconfiguration due to interruptions, mobility, or collaboration,must be kept to an absolute minimum, since delays may have adirect impact on the well-being of a patient (p. 10:2).

The clinicians main objective is to collaborate and problem-solveto achieve the overall objective and that is to provide the bestcare and treatment for patients. After talking to a few registerednurses (RNs), its apparent that they relate their work in terms of specific work activities, each with a specific objective in mind.

This objective relates to the treatment of patients, but can alsorelate to teaching and research. It is important to note that


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activity theory does not view an activity as tied to one specificindividual (Bardram 2009). Human activity is always collectiveand oriented towards an objective that exists outside theindividual (Bardram 2009). Such collaboration is achieved by

distributing the actions within a given activity among differentactors (Bardram 2009).

There is a wide range of computer systems and applications thatsupport the activities of patient treatment. While these systemsoffer support for various clinical work, clinicians still complainabout the lack of integration. The system may support a set of particular tasks that are carried out by the staff, but it is difficultto support them with the overall activities in treating their

patients. For this kind of integration to happen, the servers anddatabases need to be incorporated using a middleware approach.The aim of activity-based computing is to help users manage thecomplex set of actions, tools, materials, resources, and peopleinvolved in an activity by introducing an explicit representation of the activity into the computer system (Bardram 2009, 10:8). Theauthor defines activity-based computing as a computinginfrastructure, which supports users to create, save, manage,suspend, resume, move, share, and discover computational

activities (p. 10:10). He has identified five core principles foractivity-based computing:

Activity-Centered Resource Aggregation: This simply meansthat activity-based computing needs to support relevantresources and services and all materials related totreatment of patients. For example, accessing patientelectronic records, lab results, and medical images (e.g. x-rays). These services and resources may come from many

different sources but all are part of a single activity. Activity Suspension and Resumption: Clinicians perform a

multitude of tasks and constantly switch from one activityto another. In addition, because of the nature of their work,they are constantly interrupted (e.g. someone calls them,pages them). The clinicians are involved in more than one


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activity at a time and are responsible for different actionswithin each of the activities. Once the activity is suspended,its state is saved. Once the clinician resumes they are ableto resume their activity and pick up where they left off.

Activity Roaming: This refers to transferring activities fromone computing environment such as a desktop PC or alaptop to a Tablet PC or another hand-held device. Thisallows the clinician to pause their activity on one device andresume it on another. The system must therefore be ableto automatically bring up all the applications and resourcesassociated with the activity, thereby relieving users frommanually restoring all the resources and views associated

with the on-going activity. Activity Sharing: An activity is seen as inherently shared

by a set of participants, who can resume and suspend theactivityasynchronously as well as synchronouslyandwork inside it.

Activity Awareness: Denotes the principle that thecomputer system maintains information about the usersreal-world activities. This awareness is used to give the usereasy access to appropriate resources and tools.

Task Analysis in Computer-based System DesignWhen building new software, there are a few things thatdesigners must keep in mind. The first thing they need to do istask analysis, that is, how they see the system would be used.Lets say that my company decided to create new nursingsoftware called XYZ1. There are a few criteria that designers

should consider (1) Potential uses of XYZ1 (2) Expected benefits(3) User interface requirements of XYZ1, and (4) Data interfacerequirements of XYZ1.

1. Potential uses of XYZ1: The programmers will need to firstcome up with ways that the nurses and doctors will use theapplication. Will the software allow them to input patient


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data? Will it store images such as x-rays, or will it help withbilling and coding?

2. Expected benefits of XYZ1: How will the clinicians benefitfrom having this type of application? They will input patientrecords into the computer instead of using paper, and willbe able to chart the information easily. This will prevent thecurrent method of paper-based records in getting lost orbeing misread.

3. User interface requirements of XYZ1: What do the cliniciansexpect to see in the interface of the software? Should thesoftware interface be similar to other programs such asMicrosoft Word, Internet Explorer, so that users are familiarwith the layout? Should the buttons be located at the top of the screen or at the bottom?

4. Data interface requirement of XYZ1: They can look atdifferent ways to integrate email, or excel spreadsheets intothe software. Also, look at portability across differentoperating systems and platforms.

Some of the questions that they would look at would be:

Does XYZ1 facilitate the achievement of user goals?

How well does XYZ1 fit into the present work environmentof the users?

What training demands are made by XYZ1?

How does XYZ1 affect development of an organization?

In order to achieve the best design, my company would need to

collaborate with clinicians and have their input and participationin the design process. There was a case study done by Kyhlbckand Sutter 2004 on who is involved in the human-computerinteraction design. The case study was about the development of a digital wound care documentation computer system. In the latenineties, a few nurses attended a university distance course on


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wound care treatment. One of the nurses brought her experienceinto the hospital and shared her knowledge with the rest of thestaff. Her colleagues were better-educated thanks to herinstruction. A result of the nurses work was the design of a three-

page wound documentation form. The form was soon adopted bythe municipal elder care. Influenced by the successful work of the hospital nurse, the municipal nurses adopted her specificthree-page paper form. At a low technology level the nursesthemselves design their own artifacts in choosing what haveproved to be useful for them (Kyhlbck and Sutter 2004). Overtime, rules on wound cleaning and treatment have changedwhich in turn would change the artifacts in use. In 2003, severalmunicipal nurses participated in the design of a computersystem, a process that resulted in a software prototype. Theyworked with a team of software designers and developers, andtogether they designed a digital wound care documentationsystem named Helar.

The software design has become much more than just a list of functional specs, it has to be worked in a way where practitionersand designers interact. The cultural-historical activity theorybridges the gap between the problem and the way to design an

appropriate computer/software solution. If the practitionersgeneral design work is recognized, the artifacts in the presentdomain will be utilized in the software process as an essentialresource for transforming initial ideas into a future product(Kyhlback and Sutter 2004, 78).

Can Activity theory Framework Be Applied to MedicalSoftware Documentation?

Perhaps the greatest research that was done on activity theoryand how it relates to the real world is how its being used forcomputer-based system design. The articles that I found all dealwith bridging a gap between the application design and the user.

The main question that arises is can activity theory framework beapplied to documentation design? Should we include our usersopinions when designing documentation?


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transformed during development of the activity. If the nurse wereto move on to her next task, which is to use a user guide forentering patients billing information into our application, heractivity would change, and we would say that she is entering

billing information now because activities are distinguished fromeach other according to their objects. Transforming the objectinto an outcome motivates the existence of an activity (Kuutti,1996, 27). For the nurse to become more skilled in runningreports or entering billing information, operations must bedeveloped so that her actions of performing these tasks becomemore fluid. At first, the nurse will use the documentation to followa step-by-step procedure of executing her task of running reportsfor example, but after a while, this conscious action transformsinto an operation. She will no longer need to plan her actions, heractions will become automatic. As the nurse continues to runreports in the system, she will start to come up with her ownways of doing it. She will find a way to do shortcuts, or figure outan easier way to change the fields to be included on the reports.She might also find a way to not only run the reports but toexport them and archive them on the computer a newoperation is formed as the nurses skills increase. It is importantto remember that activities are always changing and developing.

As Kari Kutti said, because activities are not isolated units butare more like nodes in crossing hierarchies and networks, theyare influenced by other activities and other changes in theirenvironment (34). Meaning, external influences change theactivity causing an imbalance called contradictions. This is wherethe elements of the activity is broken down, or problem andmisfits arise. Even though that might have a negativeconnotation to it, it is actually not a bad thing. This allows forfurther development, in our case making our softwaredocumentation better for the clinicians. When the online help forour nursing application was not enough, my team decided tocreate user guides in addition to the online help. When nurseswere unable to print step-by-step instructions using theembedded online help, they were aggravated. So my team


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decided that it was time to give the clinicians additionalresources and thus the user guides were created.

A lot of research articles concentrate on explaining how to useactivity theory framework to create computer-based systemdesigns. What I would like to see is how the same framework canbe used for documentation design, specifically for medicalsoftware documentation. We can think of activity theory as a wayof getting a system-level view of an activity so that we can mapout the points at which information is blocked and specificallythe innovations people have put together to get the informationunblocked. Once we map out the system, we can begin to designthe best interventions in our case, the best documentation,

delivered to the right people in the right form at the right time.Marlin M. Cluts (2003) lists a few research questions that applytowards the use and evolution of artifacts in the design of computer systems. But how about using the same questions fordocumentation design? Some of the questions we might askwould be:

1. How are artifacts shared? How will the nurses use ourdocumentation to perform tasks, and how will they share

them with other nurses and doctors who are in their medicalcommunity.

2. How is the perceived use or credibility of artifactsdetermined? What makes the clinicians trust that ourdocumentation is accurate? Do they trust it because theysee others using it?

3. How are the relationships among workers affected by theuse of the artifacts? Are nurses/doctors reluctant to asktheir co-workers questions even though they are followingour documentation, or do they share their concerns withtheir team?

So the next question arises, is there set of methods that we canuse to apply activity theory to create a research study for


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medical documentation design? In his book Tracing genresthrough organizations: a sociocultural approach to informationdesign Clay Spinuzzi talks about fieldwork-to-formalizationmethod. Which include examples of contextual

design, application design, client-led design, and user-centeredinformation design. The fieldwork-to-formalization methods aremeant to guide system design through the stages of gatheringdata from customers, modeling and interpreting that information,and designing and implementing system based on thatinformation (Spinuzzi 2003, 11). These are the methods thatSpinuzzi talks about in his book.

Gathering Field Data this is where a facilitator would visit

the site and talk with individual workers or a group, lookingfor the type of artifacts used at the location, and obseringpeople work (informally). In my case, I would visit a statecounty (or an agency as we call them at my job) to speakwith the registered nurses on staff and ask them what theirbusiness objectives are, do they want to be moreproductive, do they want to improve customer satisfaction,etc. I would also look for any distractions or problems thatmight potentially disrupt their work flow.

Building Formalizations After the fieldwork comes theformalizationsthe models, categorical descriptions, andsequential descriptionsthat can be used to communicatefindings to software developers and to describe and designfuture system (Spinuzzi 2003, 17). Our goal is toconcentrate on the specific aspects of the work the nursesperform that can potentially affect the documentationredesign. We want an overall summary of the

formalizations so that we can find a pattern on the issues of the work structure.

Certainly these methods sometimes entail examining userinnovations, collecting feedback, and even collaborating withusers to redesign artifacts. But in the end, the goal is totransform a messy set of ad hoc, unofficial solutions into a single,


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neat, coherent, officlalandstatic generalized solutions(Spinuzzi 2003, 22).

Another concept that Spinuzzi introduced in the book is genretracing. Genre tracing provides a way to highlight usersexperiences with official and unofficial genres and to comparethem across communities or workplaces (Spinuzzi 2003, 22).

Through genre tracing, we examine how people inteact withcommunities and solve problems. Genre tracing examines howworkers figure out a way to workaround an issue themselves bydeveloping unofficial genres and innovations. Genre tracing istime-consuming just as ethnographic research,ehtnomethodological research, and fieldwork-to-formalization

methods can be. Thus, its recommended to use genre tracing ineither a major design or a redesign of a project. Genre tracinginvolves three levels of scope: (1) the macroscopic level of activity also called a contextual layer, that show the big pictureand investigates the meaning of the activity, (2) the mesoscopiclevel of action is that of goal-directed actionthe tasks in whichpeople are consciously egaged (33), in other words its howindividuals perform routine tasks with specific tools, and (3) themicroscopic level of operation or moment by moment operations

that respond to conditions. Spinuzzi says that often informationdesigners focus on one of the levels while ignoring the other two.

Genre tracing attempts to integrate levels of scope by tracing asociocultural unit of analysisgenreacross the three levels(Spinuzzi 2003, 51). Spinuzzi lists the following data collectionand data analysis methods.

Data collection the data collection is approached throughan integrated-scope examination of genres. Its a way of searching for destabilization at each level of activity andseeing how it affects other levels.

Macroscopic Data Collection involves collecting data toshow the big picture.


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Mesoscopic Data Collection looks at how users actionshelp accomplish bigger activities. The goal-directed actionsare usually executed within minutes or hours.

At the end of the book, Spinuzzi talks about and gives examplesof "open systems" approach to information design. "The point isnot to rescue workers with a better designed system," as somepractitioners of user-centered design would emphasize, "but toprovide a base for workers to build on" (204). Open systems allowworkers to modify, extend, and customize a centrally designedcore in ways they deem important; their innovations becomeimportant parts of the system" (211). Spinuzzi implies thattechnical communicators need to see how various forms of information fit within asphere of activity, and observes that we should carefully examinehow genreshowever they are identified or definedaffect eachother and are shaped by human activity (Willerton 2004, 559).


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ConclusionIn activity theory, it is important to theorize reflection,imagination, and intention as the center of human cognitiveprocesses; whether we use the activity theory framework todesign a top of the line computer program or create softwaremanuals and user guides. Activity theory helps us betterunderstand how people act with technology. They are able tocommit certain acts with certain technologies, whether it is emailto communicate with their families or an iPod for listening tomusic. Activity theory lets us distinguish between things andpeople, which allow us to further discuss human intentions. When

we write documentation, we need to know who will use it, and if itwill be used in conjunction with other resources be it another toolor a person. One of the things in Platos theory that we shouldthink about is his emphasis on knowing the person to whom youare speaking and the approach that will work to convey truth tothat individual. This fits well with documentation design, youhave to know who your audience is, and if possible get your usersinvolved in the process of documentation design. Ultimately, theyare the ones who will use your documentation. The most difficult

part for technical communicators is figuring out what ouraudience/users needs to know or do. In my example, the nurseneeds to know how to print reports and add patient informationinto the system. We also need to enable the users (or in our casenurses) to do so, usually in a mediated fashion by includingmotivation, knowledge, and the need to accomplish a task,whether a simple or a complex one.


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activity theory and documentation design

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