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5 MVW in practice: IT-support for home care in Sweden

5 MVW in practice: IT-support for home care in Sweden

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This case especially focuses on why a system, that is very efficient and

appreciated in one setting, is not equally well functioning in another setting. We are here interested in analyzing the effects of introducing the

Permitto Care system in a new setting.

12.5.1 Intended use

The mobile IT-system Permitto Care gave its users, the home care nurses,

a tool to improve their internal communication. Through the system they

could easily get in contact with colleagues, ask questions and share their

knowledge. A main objective with the system was to facilitate for the users

to start their working day from home, in order to quicker reach the clients

and carry out the morning visits. The time needed for administration and

planning could be significantly reduced. The mobile system could further

make it possible to access and enter information about the care taker before

and after each home visit. The events and care activities performed could

be instantaneously documented.

12.5.2 The system implemented in another environment

The Permitto Care system is today also used in Hökarängen, a densely

populated suburb in the Stockholm area. At the time of this study, the ITsystem had been used for one and a half years. Results and conclusions of

an interview with representatives from the personnel about their experiences with Permitto Care are here presented.

Group characteristics

In Hökarängen the area to be serviced is relatively small and the home

health care personnel can reach their clients on foot. They visit the homes

of the care taker often three times per day. The home care district is divided into two areas, where each area is daily served by a team of 10-13

active home care nurses. Each day, the nurses visit about 10-15 clients

each. In total, the district serves about 150 clients. The number of personnel is slightly reduced on evenings and weekends.

Aspects of mobility

A normal working day starts with a short briefing in the home care organisation’s office, then follows the morning round to the clients, lunch brake,

the afternoon round and finally an informal meeting in the office and a

rounding up of the day. The personnel mostly perform their rounds alone,

but more demanding clients require a coordination allowing help from an

assisting colleague or from the separate home health care team.



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Communication and collaboration tools

During the home visits, a Nokia Communicator (9210i) running the Permitto Care system is carried along by the personnel. The Permitto Care

system provides its users with possibilities for communication and information support needed in the work activities, i.e.:

• Mobile communication with other care givers by text messages and

phone

• Access to individual care plans and detailed information about the clients

• Reading and writing care notes about individual clients

• Contact information about the clients and their relatives

• Planning and work schedules for the personnel

The interaction with the Permitto Care system is web-based and has two

web interfaces that differ in the layout. The first is for a web browser on a

stationary computer and the other one is for the web browser in the Nokia

Communicator. To reach data in the system the nurses have to log in with

a user name and a password. The interface on the stationary computer contains quite some functionality and is meant for administrative work, while

the mobile interface is designed for the operative work and is less detailed.

System data are up- and downloaded from a server and never stored locally on the client device for security reasons. Data in the system are sent

over an encrypted data connection.

12.5.3 Performance and outcomes

The system is well received by its users at the home health care service in

Hökarängen, and is considered relatively easy to learn and to operate. The

employees feel appreciated when they are offered a modern IT-system.

Appreciated features in the system are the main documentation function,

“the care taker record”. It makes it easy for the nurses to read and write

notes about the care taker they visit. The record keeping is carried out

much better with the new system compared to before.

The paper work has also been reduced to a great extent. Now everyone

can access information available in the system. By using the system, it is

possible for the home care nurses to reach information about the clients.

While on the move information about medicines, contact information of

their relatives or entry codes to the doors can be easily obtained. Savings

in time have also been achieved since the briefing meetings in the morning

can now be reduced from half an hour to five minutes.



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12.5.4 Unanticipated use of the system

The time it takes the system to create the network connection is quite long.

It entails the start of the web browser, to perform the user authorization

and to load the Permitto Care web pages is. To start-up and log into the

system, in order to write a record note for a certain care taker, takes an average user 2 minutes and 50 seconds.

If one home care nurse visits 15 clients a day, the time waiting for the

system would be 2 5/6 min × 15 = 42,5 minutes per day. If this is true for

the whole home care team of 10 care givers, working 5 days a week

(which is not really true when home health care personnel also works in

evenings and during the week ends), that makes 42,5 × 10 × 5 = 2125 / 60

≈ 35,5 hours per week – almost equal to a full time position!

Just a few days after the personnel at the home health care centre in

Hökarängen had started to use the Permitto Care system, it became clear

that to log into the system after each visit at a care taker took too much

time. The nurses created therefore new routines to use the system. They

now carry out just a few logins into the system during a day; in the beginning of the day, at lunch and at the end of the day, i.e. all occasions when

the users are meeting in the office. Once in the office it is more quiet and

easier to concentrate than when one is on the move. Help and support from

colleges is also within easy reach.

The mobile device, the Nokia Communicator, is still carried along on

the round to the clients but it is seldom used as a computer. As a mobile

phone, however, it is much appreciated and frequently used. Many employees prefer to use a desktop computer at the premises rather than their

mobile communicator.

The system’s long start up time has the following consequences:

• Users do not write their documentation for each visit at a care taker.

Thereby, the intended effects are lost, e.g. the benefits of a frequently

updated system, of information written into the system while it is still

fresh in the mind, of secure storage of information, and of backup advantages

• Information that is supposed to be documented during the visit to the

clients is instead remembered or briefly written on paper notes. The information is entered into the IT-system first when they reach the office.

Some users prefer using the stationary computer for entering the information into the system. A stationary computer has much more advantages than a small, mobile one; it is faster, easier to work with (with its

mouse and proper keyboard) and has a bigger screen that provides a bet-



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ter overview of the system. In this way, the mobile qualities of the Permitto Care system are seldom utilized

• When writing down things to remember, some users prefer to use paper

notes or the note-application in the Nokia Communicator, an application

that is not a part of the Permitto Care system. Both ways are much faster

• In the same way, entry codes to the client’s home are sometimes stored

by the nurses in the phones local note application. In this way the codes

are much faster available when needed

• While on the move nurses prefer to make phone calls back to the manager at the office in order to report important occurrences and get them

entered into the system

12.5.5 Conclusions and lessons learned

The Permitto Care system has, and has been rewarded for, a number of

good qualities, e.g. it is easy to learn, it provides the user with the correct

information and it is well adapted to the needs of the organisation. However, the system’s long connection time results in unintended use, and a

more or less total loss of intended efficiency. This becomes even clearer

when the system is studied in an environment where long travel distances

and solitary work is less apparent.

The slow network connection gives the users a general experience of the

system as slow and difficult to handle. As shown in this case, this results in

an unexpected way of using the system, caused by their intention to perform well. If the users find better, feasible, ways to achieve their goal

without using the system as intended, these ways will be used. In this case

the better way to work was e.g. not to use the system frequently as intended.

A professional user tries to perform a task in a quick and effective way,

without spending energy in preparing the tool for the task. Our conclusions

from this case confirm the notion that professionals will perform their task

even if this is hampered by an IT-system that does not fit the nature of

their work. In this case, a mobile solution was provided to support the

work of home care nurses but the specific nature of the work led to nonmobile use of the system. The case underlines again the great benefits of

early user involvement for the design and implementation of IT support

tools in organisational context. In order to benefit from mobile solutions a

careful analysis of the context of use proofs to be vital.



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12.6 Overall conclusion

On basis of our detailed case analysis we have illustrated the use of mobile

technology for work in different settings across four different countries.

Mobile work is often associated with the nomadic business traveller who

can have access to fancy back offices anywhere on the globe through an

array of lightweight and preferably integrated gadgets. The cases in this

chapter do not focus on this kind of mobile work but highlight the changing nature of the day-to-day activities of service engineers, home care

nurses, and customs controllers. The work of these employees was already

mobile even before the introduction of tablet PCs, PDAs, and communicators. However, the introduction of mobile solutions has changed the work

of mobile employees tremendously. For instance, in case of the service engineers in both Finland and Italy, employees do not start their working day

by going to the office but start their work when they enter their car and log

on to the central dispatch unit. In case of the custom controllers in The

Netherlands the mobile solution has changed their work day as the mobile

solution enables the execution of more unscheduled work than before. The

introduction of mobile solutions changes the organisation and the involvement of users is therefore of vital importance. The case of the home

care nurses in Sweden is an example of what happens when users are not

properly involved.

On basis of the cases the following benefits of mobile work come forward:

• Employees experience more efficiency due to less travelling from and to

the office

• Employees have much better access to information when outside of the

office and do not depend on phone calls to colleagues in the back office

• Employees experience that they have more possibilities to ask for the

help and advice of other colleagues on the job

The organisation benefits also in terms of more efficiency of the work

processes:

• Data can be stored in the local database directly from the field rather

than through additional data entry in the office

• Clients may be updated better, more easily, and more up to date information can be conveyed

• On the move employees can be tracked much easier and unscheduled

work can be allocated much better



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Overall the cases show a positive picture on the application of mobile

solutions in practice. Employees stress the benefits of their mobile work.

Possible barriers are of course a lack of user involvement as seen in the

case of Sweden, but as long as users are involved mobile virtual work is

perceived as a positive change. Potential barriers or possible downsides,

such as limitations of decision capabilities, a lack of employee autonomy

and stronger propensity for employee control did not feature so much in

the cases above. As these factors proof to have negative impacts on employee motivation, those remain a point of concern for the deployment of

mobile virtual work in practice.

The four cases described in this chapter show a mere refinement of an

already virtual work process through the use of more able tools. So far,

there are not many examples of companies that have started new activities

on basis of the possibilities that are offered by today’s mobile technologies. Further research in the area of MVW would enable such companies

to adapt their mobile work practices more carefully. Also, designers of

mobile solutions may benefit from the detailed lists of requirements which

come forward from the growing research into mobile work in practice. In

other words, it is necessary to identify the different enactments of the various mobile practices within different cultures and industries in order to

clarify the do’s and don’ts of MVW.



Acknowledgement

The authors thank Andrea Giacobbe and Silvia Massa for their work on the

Siram case and thank the EC-funded MOSAIC-project (FP6-2003-IST-2

004341) and the SALTSA Mobility Group for their ongoing support in this

project.



References

Kumar S, Zahn C (2003) Mobile communications: evolution and impact on business operations. Technovation 23(6):515–520

Perrow, C (1967) A framework for the comparative analysis of organizations.

American Sociological Review 32(2):194–208

Lilischkis S (2003) More yo-yos, pendulums and nomads: trends of mobile and

multi-location work in the information society. STAR issue report no. 36, Databank, Milano

Yin, R (1994) Case study research: design and methods. Sage Publications, London

Zilliox D (2002) Get-started guide to m-commerce and mobile technology.

American Management Association, New York



Part 3



Organisational Strategies



13 Knowledge Sharing in Mobile Work

Mariano Corso1, Antonella Martini2, Luisa Pellegrini2

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1



Department of Management Engineering, Polytechnic University of Milano, Italy

2

Faculty of Engineering, University of Pisa, Italy

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13.1 The KMS challenge in mobile context

Leveraging on people’s knowledge and creativity is a competitive must in

today’s business environment. The intensification of competition, however, forces companies to adopt new organisational models that seriously

challenge traditional approaches to managing knowledge. Hence, this

chapter answers the need of empirically grounded research to draw implications of the systems supporting Knowledge Management (KM) within

such new organizational models.

When analyzed in terms of how people are integrated and relate to the

rest of the organisation, many companies are characterized by two trends:

• Mobility and distribution of workforce: nowadays the concept itself of

the workplace is changing. People spend an increasing amount of their

working time outside the physical boundaries of their company, often in

mobility and interacting with customers or people from partner organizations (Laubacher and Malone 2003). Also when working inside the

company, people often change positions and work in multi-disciplinary

virtual teams. As a consequence, individuals have fewer and fewer opportunities for face to face interaction with their colleagues and can

hardly rely on their own experience

• Turnover and loose contractual links: provisional nature of employment, loose forms of contractual links to the company and high level of

turnover (Drucker 2002), while in many cases considered competitive

needs, make people’s stay with organizations temporary and partial,

thus creating barriers to the sharing of knowledge and expertise among

individuals

These two factors converge in what we call “Mobile Virtual Work”

(MVW). MVW is done by different people in ever changing situations

who need to collaborate and to be connected to shared resources in order to



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achieve their common goals. Being a “mobile virtual” (MV) worker is in

many cases a necessity rather than a choice that requires personal qualities

such as independence and entrepreneurship that were far less fundamental

in traditional organizations. As far as professional growth and access to

knowledge is concerned, MV workers cannot simply trust their company

HR development policies, but have to care, in first person, about creating

growth opportunities and building a network of relations that, in many

cases, transcend the boundaries of the company.

Nowadays, MV workers represent an increasingly more relevant share

of the total workforce (Drucker 2002; Laubacher and Malone 2003). Traditional management systems are not adequate, simply because they were

not designed to answer their needs. Many management systems should be

reviewed including rewarding training, and carrier paths, but the real essence of the change is probably related to Knowledge Management: when

dealing with MV workers, KM becomes a fundamental need rather than a

wish, for two reasons:

• MV workers knowledge and experience are becoming a fundamental asset for the company: only with a proper management of this knowledge,

in both tacit and explicit forms, the company can, at least partly, appropriate this knowledge

• A proper Knowledge Management System (KMS) can:

− reconnect MV workers to the professional and social network of

the company, preventing loss of knowledge

− provide them with opportunities for interaction and learning, thus

supporting their job and their professional growth, long term employability, ultimately improving job satisfaction and attractiveness

When dealing with this issue, the biggest opportunities, but at the same

time the biggest competitive challenges, are represented today by the

availability of new ICT-enabled services, and in particular web applications and mobile Value Added Services. At a rapidly decreasing cost, these

technologies are making it possible to overcome geographical, time and

organizational barriers to communication and knowledge transfer in dispersed networks.

Theory on how to successfully implement new ICTs to manage knowledge for MV workers, however, is still in its infancy, and only anecdotal

evidence about best practices is available today. The challenge for management theory is therefore clear: to provide empirically grounded and actionable knowledge for companies to design and implement new ICT enabled KM Systems able to extend the boundaries of their knowledge



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creation to their MV workers. Based on comparison among three case

studies, the chapter is a first attempt to draw implications on KMS requirements in mobile contexts.

The issue of managing knowledge of a dispersed workforce has already

been covered in economics and management literature mainly in connection with the problems of preserving intellectual capital and competence

from loss and spill over (Minkler 1993; Tsoukas 1996; Becker 2001;

Cramton 2001; Maskell 2001).

For example, Minkler (1993) focuses on firms that tried to assess the

importance of their dispersed knowledge; he emphasizes that some organizational innovations – employee participation, organization in cooperative

teams, just-in-time stock management systems, forms of labour protection

– are solutions that stem from firms’ awareness of the dispersion of their

knowledge assets.

The dispersion of knowledge exists in all organizations. However, in

traditional companies workers interact within the organizational physical

boundaries, thus facilitating exchanges. In fact, the level of knowledge

dispersion has progressively increased over the past few years, exceeding

previous boundaries. Various factors contribute to this trend: internalization of markets, companies are more widespread within areas and product

and service customization. In many cases, these factors induce firms to decrease the physical distance that separates them from their customers/suppliers, having some employees temporarily located in the customers’/suppliers’ offices. In this context, the main problem is to create a

technological and social infrastructure that allows knowledge and information transfer.

Different authors have pointed out that there are many relevant organizational and managerial effects resulting from the level of knowledge dispersion. Becker (2001) indicates three factors as the cause of organizational problems: large numbers, asymmetries and uncertainty. He also

identifies some strategies allowing a better use of dispersed knowledge:

• substitute knowledge with providing access to knowledge (individuals

have to remember where it can be found), the recovery takes place only

when it is necessary

• provide users with the capability of completing incomplete knowledge

• design institutions with appropriate coordination mechanisms

• decompose organizational units into smaller ones

• increase the information available to the decision-maker

Focusing on knowledge workers, Cramton (1997; 2001; 2002) identifies

the problems that can occur when MV people communicate and collabo-



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rate: 1) failures to communicate and retain contextual information regarding different members; 2) interference between unevenly distributed information and team-level collaboration, 3) differences in evaluating the

relevance of information, 4) differences in speed of access to information

and 5) difficulties in interpreting the meaning of silence/lack of communication. The main problems that may arise are: i) the propensity to ascribe

peoples’ behaviour or results to members instead of to the situation, ii) the

decrease in learning capacity, iii) the incapacity to reach other members’

expectations, and the damage of interpersonal reliance.

Many authors have analysed and proposed possible solutions to facilitate cooperation between mobile or geographically scattered workers or

virtual teams (Cramton 1997; 2001; Furst et al. 1999; Duarte and Snyder

1999; Lipnack and Stamps 1997).

Two aspects contribute to an effective management of distributed

knowledge: an efficient communication/interaction structure (Cohen and

Levinthal 1990) and a focused human resources management system

(Tsoukas 1996).

Communication can be enabled by creating information channels, which

are parts of the social capital and can have a technological or an organizational nature (Nahapiet and Ghoshal 1998; Gupta and Govindarajan 2000).

The introduction of job rotation is an example of an organizational solution, while intranet and corporate portals are technological tools facilitating the interaction among experts.

Many authors have focused their attention on the impact of KMS on

performances (Haanes and Lowendhal 1997; Petrash 1996; Roos et al.

1997; Schiuma and Marr 2001; Sveiby 1997). The impact on performances

is strongly related to the approach adopted in the KMS (Davenport and

Prusak 1998; Wiig 1997) and to the direct impacts on organizational behaviours in terms of knowledge creation, transfer and capitalization.

A fundamental assumption that is common to recent literature is that

coordination and decision making do not require knowledge centralization,

but rather should provide the access to knowledge (Nonaka 1990). Simple

access to knowledge still requires users to have both competency and capacity for understanding, assimilating and using retrieved knowledge. In

addition, users should also be able to correct possible mistakes (Collins

and Kusch 1998), adapt knowledge to the specific problem and complete

possible gaps (Nonaka and Takeuchi 1995).

More recently, the concept of communities of practice emerged as a key

issue. Communities of practice consist of people with a joint interest, mutual engagement and a shared repertoire; they develop spontaneously outside the formal organization, can span organizational boundaries, create

and are based on relationships (Wenger and Snyder 2000). The concept of



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