Adapting equipment to the healthcare workforce

Socio-technical systems design was originally conceived by Fred Emery and Eric Trist. It is an approach to understanding the system around technology which forms part of our focus on front end research – i.e. the process where we create solutions that will naturally resonate with people.

Socio-technical systems theory puts forward an alternative to autocracy in the workplace (and in the design of technology) and provides a framework that allows us to understand how organisations adapt to external forces and take responsibility for productivity and wellbeing. Such theories allow us to develop a theoretically grounded user-centric approach to design. For example, socio-technical systems theory recognises a need for a continuous redesign to occur based on the knowledge of those who are working within a system alongside an agile, adaptive and iterative approach. To illustrate the socio-technical approach – think back to the 1950s.

At this point, the UK coal mining industry was promoting efficiency through the adoption of new technology. Technology was designed away from the coal face (quite literally) and researchers from the Tavistock Institute in London were charged with studying why some of the newly introduced technology was not producing the intended result.

Coal mining was a dangerous profession and at the time the coal miners were venting their frustrations at what they saw as an impossible situation given the complexity and unpredictability of underground mining, the nature of the equipment that was provided and match with their existing working methods. It followed that safety issues resulted and in some mines there was a reduction in productivity and increase in accidents following the introduction of technology.

From the point of view of organisational design, there was an important observation that was noted by the Tavistock researchers. In some mines, these problems did not occur. These were reported as being the mines where management respected the workers and asked them for input into the design of technology. This created a central part of socio-technical systems theory – work systems can and should be devised to allow employees to have greater control over technology – working together to fine-tune a system rather than being instructed or “handed down” a mandated way of doing things.

Over recent years we see similar things happening in hospitals where staff find the need to adapt/improvise/invent technology (see for example link). We have seen this on a number of occasions and more recently in the case of personal protective equipment. Understanding this process is important – as per accounts of productive socio-technical systems, people find their own ways of working in order to promote efficiency and address shortcomings. These workaround/adaptations/improvisations are not only necessary but tell us a lot about the reality of the situation. For example, why do people find the need to adapt to equipment? Has the right equipment been provided? Does it match with their work? Do they feel in control? We need to understand the process of “mutual adaption between tool and context” as findings impact don’t just impact on safety – they impact on wellbeing and productivity.

Based on our experience in medical device design it can make more sense for medical devices to be treated as social objects rather than physical ones. The process of adaptation and improvisation implies a form of ownership and empowerment. Such adaptive behaviours come with both risks and benefits, but they are a necessary component of a successful working environment.