Computer Supported Collaboration in Mixed Homecare

Abstract

In today's world, which is characterized by an ageing society and an increasing need for care, new concepts of care organization and cooperation are needed. The successful collaboration in networks of professional providers and informal caregivers will be decisive for the care of the individual. Information and communication technologies (ICT) may facilitate the collaboration within these networks. While ICT has long been part of regular business practice, the healthcare sector and especially the homecare sector are lagging far behind digitization. The reasons for this are manifold and have not yet been satisfactorily clarified, although for this a variety of interdisciplinary projects have been funded in recent years. The heterogeneity of mixed homecare networks as well as different perspectives of informal and professional caregivers complicate the design and successful implementation of CSCW tools. Questions about the ability to change of care networks with established technical arrangements, the importance of network effects, and the effects of the technology acceptance of the individual on the adoption of the whole network remain open. The EIKI research project is therefore investigating how care networks are composed and what influence the implementation of collaboration software has on the cooperation in homecare networks.

Full text

Renyi, M., Kunze, C., Gaugisch, P., Teuteberg, F. (2019): Computer Supported Collaboration in
Mixed Homecare. Position Paper for the Workshop Who Cares? Exploring the Concept of Care
Networks for Designing Healthcare Technologies at the 16th European Conference on Computer-
Supported Cooperative Work: The International Venue on Practice-centred Computing and the
Design of Cooperation Technologies
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Computer Supported Collaboration in
Mixed Homecare
Madeleine Renyi1,3, Christophe Kunze1, Petra Gaugisch2 and Frank
Teuteberg3
1Furtwangen University, Furtwangen, Germany
2Fraunhofer IAO, Stuttgart, Germany
3Osnabrück University, Osnabrück, Germany
Contact Author: madeleine.renyi@hs-furtwangen.de
Abstract. In today's world, which is characterized by an ageing society and an increasing
need for care, new concepts of care organization and cooperation are needed. The
successful collaboration in networks of professional providers and informal caregivers will
be decisive for the care of the individual. Information and communication technologies
(ICT) may facilitate the collaboration within these networks. While ICT has long been part
of regular business practice, the healthcare sector and especially the homecare sector
are lagging far behind digitization. The reasons for this are manifold and have not yet
been satisfactorily clarified, although for this a variety of interdisciplinary projects have
been funded in recent years. The heterogeneity of mixed homecare networks as well as
different perspectives of informal and professional caregivers complicate the design and
successful implementation of CSCW tools. Questions about the ability to change of care
networks with established technical arrangements, the importance of network effects, and
the effects of the technology acceptance of the individual on the adoption of the whole
network remain open. The EIKI research project is therefore investigating how care
networks are composed and what influence the implementation of collaboration software
has on the cooperation in homecare networks.

2
Introduction
For most people, the family is still the most important mainstay of their lives,
which they in return support with the greatest of strength. In today's world, which
is characterized by increasing (female) employment (Neubert et al. 2018) and
large geographical distance between relatives, it is often difficult to cope with this
challenge. The family loses its potential to care until old age (Bianchi 2014). This
poses enormous challenges for society. New concepts of care organization and
cooperation are needed. Particularly in view of the current demographic
development and the expected shortage of skilled workers in the nursing sector, it
is neither possible to care for the ageing population through purely professional
care structures nor is it desired by a large number of senior citizens (c.f.
(Lindwedel-Reime 2018; Peek et al. 2014; Piau et al. 2014; Vannieuwenborg et
al. 2016)). In the future, homecare will therefore depend to a large extent on a
successful care mix, i.e. a combination of informal (family or neighborhood) help
and professional care (Bäuerle and Scherzer 2009; Görres et al. 2016; Jacobs et al.
2016) (compare Figure 1).
Figure 1: network around a person in need of care
The communication in and coordination of such a care mix however is not easy
and thus, amongst others, the lack of transparency about responsibilities in the
network, poor accessibility of actors and the lack of knowledge exchange pose
major problems. Here, the targeted use of information systems (IS) could, offer
help (Bosch and Kanis 2016; Bratteteig and Wagner 2013; Camarinha-Matos and
Afsarmanesh 2002; Renyi et al. 2018).

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Collaboration in Homecare – Experiences
Since Irene Greif and Paul Cashman coined the term CSCW in a workshop at
Endicott House (MA) in 1984 (Grudin 1994), the use of ICT to support
collaboration has become routine in many industries. Modern software tools for
planning and documenting work got common practice in the professional sector
with the aim to support group processes, to increase effectiveness and efficiency
and to promote the exchange and production of knowledge in groups. However,
especially in the informal and private sectors the potential of computer-supported
collaborative work (CSCW) is far from exhausted and partly hardly accepted
(Pinelle and Gutwin 2005; Renyi et al. 2019).
The understanding of the heterogeneity of these networks (number of actors,
role of those in need of care, distinction between nursing and caring relatives,
remote caregivers, other informally caring / engaged), gained through quantitative
and qualitative studies (c.f. (Renyi et al. 2018, 2019)), led to the insight that the
structure of the network has effects on the requirements for CSCW solutions. In
contrast to other fields of application, CSCW for mixed homecare is not only
about a productivity solution and the optimization of care organization. Related to
the concept of caring communities (Klie 2015), it is also (or even first) about
promotion of a common identity, sense of solidarity, and formation of
communities of responsibility.
This objective must then also be reflected in collaboration solutions
1
. The use
of such tools however goes hand in hand with possible risks of technical
coordination (e.g. diffusion of responsibility, feeling of obligation, etc.). Not only
during the design of such applications, but also during the implementation in the
field, sometimes contradicting requirements must, therefore, be met. The different
perspectives and viewpoints of informal and professional caregivers complicates
this even more.
Conclusion
Essentially for the everyday usage, the need for clear communication rules and
guidelines for using such tools got apparent.
Still open is the question of the meaning of care-specific solutions compared to
general collaboration tools (e.g. messengers, shared calendars, task lists). Is the
new development of care-specific applications necessary at all or would an
increase in the level of awareness for, training of and consulting for general
collaboration tools be conducive to the same goal?
1
c.f. the research prototype ‘Zirkel’ (https://play.google.com/store/apps/details?id=de.hsfurtwangen.circle)
discussed in (Renyi et al. 2018)

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Also, still unclear are the ability to change of care networks with established
technical arrangements, the importance of network effects (“It’s only effective if
everyone participates!?”), and the effects of the acceptance of the individual on
the adoption of the whole network.
A lack of transparency about tasks and roles in care arrangements repeatedly
leads to tensions. However, it is unclear whether an increase in transparency can
eliminate the differences in the understanding of roles and contribute to care at
eye level. Long-term studies with large numbers of participants are still lacking.
Data privacy issues considerably hinder the adoption of cross-professional
usage of collaboration tools. While informal and semi-professional caregivers use
messengers like WhatsApp in an everyday manner, and even sometimes seem to
lack a feeling for data worthy of protection, professionals categorically reject
software with a certain suspicion of data privacy issues. Design implications how
to bridge this gap are needed.
Future work
Further attempts to answer the above questions are, amongst others, conducted in
the research project EIKI
2
. The research project investigates social-space-oriented
approaches to support collaboration for mixed homecare. The analysis and
categorization of care networks is understood as essential for the successful
implementation of technology for care collaboration.
Following a mixed method approach, the authors conduct a series of
interviews, workshops and surveys on the way there. Comparing this knowledge
to experiences of prior projects will hopefully result in a better understanding of
care networks, their attitude towards technology and the role technology can play
in ensuring successful care.
Acknowledgments
The mentioned project EIKI is supported by the Ministry of Social Affairs and Integration Baden-
Württemberg.
References
Bäuerle, D., and Scherzer, U. 2009. Zukunft Quartier – Lebensräume Zum Älterwerden.
Themenheft 1: Hilfe-Mix – Ältere Menschen in Balance Zwischen Selbsthilfe Und
2
http://projekt-eiki.de/

5
(Professioneller) Unterstützung, Gütersloh: Netzwerk: Soziales neu gestalten, p. 70.
(http://www.netzwerk-song.de/fileadmin/user_upload/Themenheft1.pdf).
Bianchi, S. M. 2014. “A Demographic Perspective on Family Change,” J Fam Theory Rev. (6:1),
pp. 35–44. (https://doi.org/10.1017/S0950268814002131.Tuberculosis).
Bosch, L. B. J., and Kanis, M. 2016. “Design Opportunities for Supporting Informal Caregivers,”
in Proceedings of the 2016 CHI Conference Extended Abstracts on Human Factors in
Computing Systems - CHI EA ’16, New York: ACM Press, pp. 2790–2797.
(https://doi.org/10.1145/2851581.2892354).
Bratteteig, T., and Wagner, I. 2013. “Moving Healthcare to the Home: The Work to Make
Homecare Work,” in Proceedings of the 13th European Conference on Computer Supported
Cooperative Work, O. W. Bertelsen, L. Ciolf, iMaria A. Grasso, and G. A. Papadopoulos
(eds.), pp. 21–25. (https://doi.org/10.1007/978-1-4471-5346-7).
Camarinha-Matos, L. M., and Afsarmanesh, H. 2002. “Design of a Virtual Community
Infrastructure for Elderly Care,” in Collaborative Business Ecosystems and Virtual
Enterprises (Vol. 85), L. M. Camarinha-Matos (ed.), Springer, Boston, MA, pp. 439–450.
(https://doi.org/10.1007/978-0-387-35585-6).
Görres, S., Seibert, K., and Stiefler, S. 2016. “Perspektiven Zum Pflegerischen Versorgungsmix,”
in Pflege-Report 2016 (Vol. 2), Stuttgart: Schattauer GmbH, pp. 3–14.
Grudin, J. 1994. “Computer-Supported Cooperative Work: Its History and Participation,”
Computer (27:4), pp. 19–26.
Jacobs, M., Van Tilburg, T., Groenewegen, P., and Broese Van Groenou, M. 2016. “Linkages
between Informal and Formal Care-Givers in Home-Care Networks of Frail Older Adults,”
Ageing and Society (36:8), pp. 1604–1624. (https://doi.org/10.1017/S0144686X15000598).
Klie, T. 2015. “On the Way to a Caring Community?,” in Compassionate Communities: Case
Studies from Britain and Europe, K. Wegleitner, K. Heimerl, and A. Kellehear (eds.),
Abingdon-on-Thames: Routledge, pp. 198–209. (https://doi.org/10.4324/9781315735801-
14).
Lindwedel-Reime, U. 2018. “Weg Vom Hilfsarbeiter-Image. Eine Einschätzung Zum

6
Pflegenotstand in Deutschland.,” 365 Tage Fürs Leben (6). (http://www.bundesverband-
kinderhospiz.de/bv-shop/bücher-und-magazine/magazin-365-ausgabe-4-149-detail).
Neubert, L., König, H. H., and Brettschneider, C. 2018. “Seeking the Balance between Caregiving
in Dementia, Family and Employment: Study Protocol for a Mixed Methods Study in
Northern Germany,” BMJ Open (8:2), pp. 1–9. (https://doi.org/10.1136/bmjopen-2017-
019444).
Peek, S. T. M., Wouters, E. J. M., van Hoof, J., Luijkx, K. G., Boeije, H. R., and Vrijhoef, H. J.
M. 2014. “Factors Influencing Acceptance of Technology for Aging in Place: A Systematic
Review,” International Journal of Medical Informatics (83:4), pp. 235–248.
(https://doi.org/10.1016/j.ijmedinf.2014.01.004).
Piau, A., Campo, E., Rumeau, P., Vellas, B., and Nourhashemi, F. 2014. “Aging Society and
Gerontechnology: A Solution for an Independent Living?,” Journal of Nutrition, Health and
Aging (18:1), pp. 97–112. (https://doi.org/10.1007/s12603-013-0356-5).
Pinelle, D., and Gutwin, C. 2005. “A Groupware Design Framework for Loosely Coupled
Workgroups,” in ECSCW 2005, Berlin/Heidelberg: Springer-Verlag, pp. 65–82.
(https://doi.org/10.1007/1-4020-4023-7_4).
Renyi, M., Rosner, M., Teuteberg, F., and Kunze, C. 2019. “Collaboration in Mixed Homecare –
A Study of Care Actors ’ Acceptance towards Supportive Groupware,” in (Accepted for
Publication) BIS 2019.
Renyi, M., Teuteberg, F., and Kunze, C. 2018. “ICT-Based Support for the Collaboration of
Formal and Informal Caregivers – A User-Centered Design Study,” in Business Information
Systems. BIS 2018. Lecture Notes in Business Information Processing, Vol 320., P. A.
Abramowicz W. (ed.), Cham: Springer, pp. 400–411. (https://doi.org/10.1007/978-3-319-
93931-5_29).
Vannieuwenborg, F., Van der Auwermeulen, T., Van Ooteghem, J., Jacobs, A., Verbrugge, S., and
Colle, D. 2016. “Evaluating the Economic Impact of Smart Care Platforms: Qualitative and
Quantitative Results of a Case Study,” JMIR Medical Informatics (4:4), p. e33.
(https://doi.org/10.2196/medinform.5012).