Many countries have formulated their eHealth visions and billions of dollars have been spent on supporting the eHealth development throughout the world. An important part of the development is the electronic patient record (EPR). To enable sharing and increase cooperation between care providers, most Swedish county councils have decided to use a region-wide EPR. The health professionals often experience numerous problems and consider the region-wide EPR to be too generic and require them to tailor their practices instead of the system evolving towards supporting their needs. The aim of the PhD research is to gain knowledge of adoption when deploying and using region-wide health IT systems. This is accomplished by studying, analysing and reflecting upon what region-wide health IT systems are and how professionals use them in their practice. In the research a grounded theory method has been used, which means that the empirical data, not theories and hypotheses, have driven the research process. The data-gathering methods have been interviews, observations, participating in meetings, questionnaires, seminars and conducting literature reviews. In order to be able to improve the adoption, a set of four key principles has been identified: (1) Evolving systems-Engaged users, (2) Treat IT deployment and usage as part of organisational development, (3) Identify, respect and support differences, and (4) Identify what must be customised and what can be centralised. These four principles challenge the traditional way of developing enterprise-wide IT and emphasise the importance that users must engage in the development, procurement and deployment process to identify their similar and unique needs and procedures. It is crucial that both the similarities and uniqueness are respected and supported. The similarities can be supported by a centralised, standardised solution, while uniqueness requires a customised solution. In order to accomplish that, the IT deployment and usage needs to be treated as an important part of the on-going organisational development, and the IT systems must evolve, i.e., be continuously developed in order to engage the users to participate.

Essa dissertação é formada por três artigos que versam sobre o Serviço de Atendimento Móvel de Urgência – SAMU, da Região Metropolitana de Porto Alegre. O primeiro artigo analisa a extensão na qual o SAMU opera como um sistema sociotécnico, considerando os 19 princípios propostos por Clegg (2000), tendo ficado claro que o sistema atende a 4, parcialmente a 3 e não atende a 12 deles. O segundo artigo foca o sistema de regulação do SAMU à luz dos quatro subsistemas do sistema sociotécnico: o pessoal, do projeto de trabalho, o tecnológico e do ambiente externo. O método utilizado para análise foi a Análise Macroergonômica do Trabalho – AMT (GUIMARÃES, 2010), que viabilizou a identificação de demanda ergonômica dos envolvidos no sistema, a partir de entrevistas e/ou questionários com 118 pessoas, sendo 41 trabalhadores da regulação e 77 das bases.Os resultados mostraram que os ítens de maior impacto para o desenvolvimento do serviço advém do ambiente externo, principalmente o despreparo da população para o uso do serviço (os trotes chegam a 69% das chamadas) e o risco de omissão de socorro. O terceiro artigo avalia o SAMU como um sistema complexo sob a ótica da Engenharia de Sistemas Cognitivos (ESC), que considera os fatores de coordenação, resiliência e “affordance” que emergem nas interações entre tecnologia e pessoas que compõem um sistema de trabalho. Concluiu-se que o SAMU possui diversas características de um sistema sociotécnico complexo, e que o sistema é descoordenado e clumssy, pois não possui artefatos e procedimentos de trabalho que agilizem o processo de trabalho. As características de resiliência são pró ativas e emergentes, pois os agentes diretos estão em constante adaptação para contornar os obstáculos encontrados no sistema de trabalho. Foram feitas algumas sugestões para melhoria do serviço, que poderão ser efetivadas a longo prazo, tendo em vista as dificuldades impostas pelo ambiente externo (legislação e questões políticas e sócio-culturais). / This dissertation consists of three articles that focus on the Mobile Emergency Service – SAMU of the Metropolitan Region of Porto Alegre. The first article examines the extent to which the SAMU operates as a sociotechnical system, considering the 19 principles proposed by Clegg (2000), it was clear that the system meets the 4, 3 and partially does not meet 12 of them. The second article focuses on the system of regulation of SAMU in the light of the four subsystems of the socio-technical system: staffing, project work, the technological and the external environment. The method of analysis was the Macroergonomic Work Analysis - MWA (GUIMARÃES, 2010), which enabled the identification of ergonomic demands of those involved in the system, based on interviews and / or questionnaires to 118 people, including 41 employees of regulation and 77 bases. The results showed that the items of greatest impact on service development comes from the external environment, especially the unpreparedness of the population using the service (hazing reach 69% of calls) and the risk of failure to save. The third article assesses the SAMU as a complex system from the perspective of Cognitive Systems Engineering (CSE), which considers the factors of coordination, resilience and "affordance" that emerge in the interactions between technology and people that make a system work. It was concluded that the SAMU has several characteristics of a complex socio-technical system and the system is patchy and clumssy as it has no artifacts and work processes that streamline the work process. The characteristics of resilience are clear, as the direct agents are constantly adapting to bypass the obstacles encountered in the work. There have been some suggestions for improving the service, which could take effect in the long term, in view of the difficulties imposed by the external environment (legislation and policy issues and socio-cultural).

Essa dissertação é formada por três artigos que versam sobre o Serviço de Atendimento Móvel de Urgência – SAMU, da Região Metropolitana de Porto Alegre. O primeiro artigo analisa a extensão na qual o SAMU opera como um sistema sociotécnico, considerando os 19 princípios propostos por Clegg (2000), tendo ficado claro que o sistema atende a 4, parcialmente a 3 e não atende a 12 deles. O segundo artigo foca o sistema de regulação do SAMU à luz dos quatro subsistemas do sistema sociotécnico: o pessoal, do projeto de trabalho, o tecnológico e do ambiente externo. O método utilizado para análise foi a Análise Macroergonômica do Trabalho – AMT (GUIMARÃES, 2010), que viabilizou a identificação de demanda ergonômica dos envolvidos no sistema, a partir de entrevistas e/ou questionários com 118 pessoas, sendo 41 trabalhadores da regulação e 77 das bases.Os resultados mostraram que os ítens de maior impacto para o desenvolvimento do serviço advém do ambiente externo, principalmente o despreparo da população para o uso do serviço (os trotes chegam a 69% das chamadas) e o risco de omissão de socorro. O terceiro artigo avalia o SAMU como um sistema complexo sob a ótica da Engenharia de Sistemas Cognitivos (ESC), que considera os fatores de coordenação, resiliência e “affordance” que emergem nas interações entre tecnologia e pessoas que compõem um sistema de trabalho. Concluiu-se que o SAMU possui diversas características de um sistema sociotécnico complexo, e que o sistema é descoordenado e clumssy, pois não possui artefatos e procedimentos de trabalho que agilizem o processo de trabalho. As características de resiliência são pró ativas e emergentes, pois os agentes diretos estão em constante adaptação para contornar os obstáculos encontrados no sistema de trabalho. Foram feitas algumas sugestões para melhoria do serviço, que poderão ser efetivadas a longo prazo, tendo em vista as dificuldades impostas pelo ambiente externo (legislação e questões políticas e sócio-culturais). / This dissertation consists of three articles that focus on the Mobile Emergency Service – SAMU of the Metropolitan Region of Porto Alegre. The first article examines the extent to which the SAMU operates as a sociotechnical system, considering the 19 principles proposed by Clegg (2000), it was clear that the system meets the 4, 3 and partially does not meet 12 of them. The second article focuses on the system of regulation of SAMU in the light of the four subsystems of the socio-technical system: staffing, project work, the technological and the external environment. The method of analysis was the Macroergonomic Work Analysis - MWA (GUIMARÃES, 2010), which enabled the identification of ergonomic demands of those involved in the system, based on interviews and / or questionnaires to 118 people, including 41 employees of regulation and 77 bases. The results showed that the items of greatest impact on service development comes from the external environment, especially the unpreparedness of the population using the service (hazing reach 69% of calls) and the risk of failure to save. The third article assesses the SAMU as a complex system from the perspective of Cognitive Systems Engineering (CSE), which considers the factors of coordination, resilience and "affordance" that emerge in the interactions between technology and people that make a system work. It was concluded that the SAMU has several characteristics of a complex socio-technical system and the system is patchy and clumssy as it has no artifacts and work processes that streamline the work process. The characteristics of resilience are clear, as the direct agents are constantly adapting to bypass the obstacles encountered in the work. There have been some suggestions for improving the service, which could take effect in the long term, in view of the difficulties imposed by the external environment (legislation and policy issues and socio-cultural).

abstract: This dissertation examines the nexus of three trends in electricity systems transformations underway worldwide—the scale-up of renewable energy, regionalization, and liberalization. Interdependent electricity systems are being envisioned that require partnership and integration across power disparities. This research explores how actors in the Mediterranean region envisioned a massive scale-up of renewable energy within a single electricity system and market across Europe, North Africa, and the Middle East. It asks: How are regional sociotechnical systems envisioned? What are the anticipated consequences of a system for a region with broad disparities and deep sociopolitical differences? What can be learned about energy justice by examining this vision at multiple scales? A sociotechnical systems framework is used to analyze energy transformations, interweaving the technical aspects with politics, societal effects, and political development issues. This research utilized mixed qualitative methods to analyze Mediterranean electricity transformations at multiple scales, including fieldwork in Morocco and Germany, document analysis, and event ethnography. Each scale—from a global history of concentrating solar power technologies to a small village in Morocco—provides a different lens on the sociotechnical system and its implications for justice. This study updates Thomas Hughes’ Networks of Power, the canonical history of the sociotechnical development of electricity systems, by adding new aspects to sociotechnical electricity systems theory. First, a visioning process now plays a crucial role in guiding innovation and has a lasting influence on the justice outcomes. Second, rather than simply providing people with heat and light, electrical power systems in the 21st century are called upon to address complex integrated solutions. Furthermore, building a sustainable energy system is now a retrofitting agenda, as system builders must graft new infrastructure on top of old systems. Third, the spatial and temporal aspects of sociotechnical energy systems should be amended to account for constructed geography and temporal complexity. Fourth, transnational electricity systems pose new challenges for politics and political development. Finally, this dissertation presents a normative framework for conceptualizing and evaluating energy justice. Multi-scalar, systems-level justice requires collating diverse ideas about energy justice, expanding upon them based on the empirical material, and evaluating them with this framework. / Dissertation/Thesis / Doctoral Dissertation Science and Technology Policy 2015

Cette thèse s’inscrit dans le cadre théorique très général de la conception des systèmessociotechniques complexes. Elle est appliquée au système de l'Appareil à Gouverner des sous-­‐marins. Elle traite, tout particulièrement, de l'étape d’allocation des fonctions entre l’homme et la machine.L’objectif des premiers travaux a été de tester un système automatisant la phase d’analyse de l’information mise à disposition du barreur. Deux expérimentations ont évalué les effets d’une interface "écologique" sur la performance, la charge de travail et la conscience de la situation de barreurs réalisant une tâche de pilotage sur simulateur.Une deuxième phase a consisté à définir différentes solutions d’allocation dynamique des fonctions entre l’homme et la machine dans le système de pilotage de sous-­‐marin. Une expérimentation a évalué l’apport d’une réallocation à la machine de la gestion du cap et/ ou de l'immersion, en fonction de la performance et de la charge de travail de l'opérateur.Les résultats de ces différentes études conduisent à proposer une démarche de conception d'un système sociotechnique qui reprend et enrichit le cadre du CWA (Cognitive Work Analysis) et à discuter du positionnement et de la formalisation del’allocation des fonctions dans le processus de conception des systèmes homme-­‐machine. / This thesis comes within the scope of sociotechnical systems design. It is applied to thesubmarine rudder control system. It focuses, in particular, on the stage of functions allocation between helmsman and machine.The objective of the first experiments was to test an "ecological" interface automating the function of information analysis. Two experiments evaluated its effects on performance, workload and situation awareness of helmsmen performing steering tasks.A second phase consisted in defining different proposals of dynamic allocations of functions between helmsman and machine. An experiment was carried out, in order to evaluate a solution of adaptive automation.The results of these studies lead to propose an approach for designing a socio-­‐technical system, which relies on and enhances the CWA (Cognitive Work Analysis) framework. They lead also to discuss place and formalisation of the functions allocation's stage into the process of sociotechnical systems' design.

Essa dissertação é formada por três artigos que versam sobre o Serviço de Atendimento Móvel de Urgência – SAMU, da Região Metropolitana de Porto Alegre. O primeiro artigo analisa a extensão na qual o SAMU opera como um sistema sociotécnico, considerando os 19 princípios propostos por Clegg (2000), tendo ficado claro que o sistema atende a 4, parcialmente a 3 e não atende a 12 deles. O segundo artigo foca o sistema de regulação do SAMU à luz dos quatro subsistemas do sistema sociotécnico: o pessoal, do projeto de trabalho, o tecnológico e do ambiente externo. O método utilizado para análise foi a Análise Macroergonômica do Trabalho – AMT (GUIMARÃES, 2010), que viabilizou a identificação de demanda ergonômica dos envolvidos no sistema, a partir de entrevistas e/ou questionários com 118 pessoas, sendo 41 trabalhadores da regulação e 77 das bases.Os resultados mostraram que os ítens de maior impacto para o desenvolvimento do serviço advém do ambiente externo, principalmente o despreparo da população para o uso do serviço (os trotes chegam a 69% das chamadas) e o risco de omissão de socorro. O terceiro artigo avalia o SAMU como um sistema complexo sob a ótica da Engenharia de Sistemas Cognitivos (ESC), que considera os fatores de coordenação, resiliência e “affordance” que emergem nas interações entre tecnologia e pessoas que compõem um sistema de trabalho. Concluiu-se que o SAMU possui diversas características de um sistema sociotécnico complexo, e que o sistema é descoordenado e clumssy, pois não possui artefatos e procedimentos de trabalho que agilizem o processo de trabalho. As características de resiliência são pró ativas e emergentes, pois os agentes diretos estão em constante adaptação para contornar os obstáculos encontrados no sistema de trabalho. Foram feitas algumas sugestões para melhoria do serviço, que poderão ser efetivadas a longo prazo, tendo em vista as dificuldades impostas pelo ambiente externo (legislação e questões políticas e sócio-culturais). / This dissertation consists of three articles that focus on the Mobile Emergency Service – SAMU of the Metropolitan Region of Porto Alegre. The first article examines the extent to which the SAMU operates as a sociotechnical system, considering the 19 principles proposed by Clegg (2000), it was clear that the system meets the 4, 3 and partially does not meet 12 of them. The second article focuses on the system of regulation of SAMU in the light of the four subsystems of the socio-technical system: staffing, project work, the technological and the external environment. The method of analysis was the Macroergonomic Work Analysis - MWA (GUIMARÃES, 2010), which enabled the identification of ergonomic demands of those involved in the system, based on interviews and / or questionnaires to 118 people, including 41 employees of regulation and 77 bases. The results showed that the items of greatest impact on service development comes from the external environment, especially the unpreparedness of the population using the service (hazing reach 69% of calls) and the risk of failure to save. The third article assesses the SAMU as a complex system from the perspective of Cognitive Systems Engineering (CSE), which considers the factors of coordination, resilience and "affordance" that emerge in the interactions between technology and people that make a system work. It was concluded that the SAMU has several characteristics of a complex socio-technical system and the system is patchy and clumssy as it has no artifacts and work processes that streamline the work process. The characteristics of resilience are clear, as the direct agents are constantly adapting to bypass the obstacles encountered in the work. There have been some suggestions for improving the service, which could take effect in the long term, in view of the difficulties imposed by the external environment (legislation and policy issues and socio-cultural).

abstract: To improve the resilience of complex, interdependent infrastructures, we need to better understand the institutions that manage infrastructures and the work that they do. This research demonstrates that a key aspect of infrastructure resilience is the adequate institutional management of infrastructures. This research analyzes the institutional dimension of infrastructure resilience using sociotechnical systems theory and, further, investigates the critical role of institutions for infrastructure resilience using a thorough analysis of water and energy systems in Arizona. Infrastructure is not static, but dynamic. Institutions play a significant role in designing, building, maintaining, and upgrading dynamic infrastructures. Institutions create the appearance of infrastructure stability while dynamically changing infrastructures over time, which is resilience work. The resilience work of different institutions and organizations sustains, recovers, adapts, reconfigures, and transforms the physical structure on short, medium, and long temporal scales. To better understand and analyze the dynamics of sociotechnical infrastructure resilience, this research examines several case studies. The first is the social and institutional arrangements for the allocation of resources from Hoover Dam. This research uses an institutional analysis framework and draws on the institutional landscape of water and energy systems in Arizona. In particular, this research illustrates how institutions contribute to differing resilience work at temporal scales while fabricating three types of institutional threads: lateral, vertical, and longitudinal threads. This research also highlights the importance of institutional interdependence as a critical challenge for improving infrastructure resilience. Institutional changes in one system can disrupt other systems’ performance. The research examines this through case studies that explore how changes to water governance impact the energy system in Arizona. Groundwater regulations affect the operation of thermoelectric power plants which withdraw groundwater for cooling. Generation turbines, droughts, and water governance are all intertwined via institutions in Arizona. This research, finally, expands and applies the interdependence perspective to a case study of forest management in Arizona. In a nutshell, the perilous combination of chronic droughts and the engineering resilience perspective jeopardizes urban water and energy systems. Wildfires caused by dense forests have legitimized an institutional transition, from thickening forests to thinning trees in Arizona. / Dissertation/Thesis / Doctoral Dissertation Environmental Social Science 2019

No description available.

This dissertation brings together the areas of safety science and operations management through a mixed-methods approach to investigate the complex relationships between two, often conflicting, organizational goals - efficiency and safety, in sociotechnical systems (STSs). This research mainly focuses on production pressure (PrP) which is considered as one of the main negative outcomes of overprioritizing the efficiency aspect of STSs. This work seeks to introduce novel methodologies for assessing PrP in real time for the purpose of mitigating its risks and unwanted consequences, particularly in safety critical environments such as traffic control centers (TCCs). Essay 1 concentrates on the theoretical underpinnings of PrP by systematically reviewing the existing literature to clarify and unify the concept under the context of safety science. It identifies key factors contributing to PrP, its negative effects on safety performance in various industries, and potential mitigation strategies. By doing so, this essay contributes to the field through laying the groundwork for more effective management strategies to improve workplace safety. Essay 2 addresses a significant gap identified in Essay 1 by developing a methodology based on Data Envelopment Analysis (DEA) for the ongoing measurement and monitoring of PrP. This innovative approach introduces a quantitative mechanism that juxtaposes efficiency and safety related outcomes of hourly performance in safety critical environments. This proposed method allows for a detailed analysis of performance dynamics within STSs. The practical application of this model is demonstrated through its implementation in the infrastructure management system of INFRABEL, the Belgian National Railroad Company. Essay 3 advances the conversation by tackling the predictive limitations of the DEA model established in Essay 2. It integrates Machine Learning (ML) techniques with DEA to develop an innovative method for forecasting near-future PrP levels for proactive management of safety risks. The major contribution of Essay 3 is the novel interface between ML and DEA that can improve decision-making capabilities of managers in safety-critical STSs through real-time monitoring and predictive analytics. Together, these studies contribute to the theoretical discussions around PrP and present practical solutions to longstanding challenges in safety science and operational management. / Doctor of Philosophy / In today's increasingly complex world, the systems that run our industries, from traffic control to healthcare, face a dilemmatic balance between pushing for higher productivity and ensuring safety. This dissertation explores the trade-offs between efficiency and safety which has become more pronounced with the advancement of technology. Traditional safety approaches which used to be effective in simpler systems, struggle in modern STSs where causes and effects are not linear but tangled in a web of unpredictable interactions. Production pressure (PrP), at the core of the mentioned balance, is the drive to maximize output and efficiency, often at the expense of safety. This pressure can lead to unintended and sometimes catastrophic outcomes in the long term, especially in environments where safety is critical, such as rail traffic control centers. Despite its vital impact, there has been a noticeable gap in understanding and managing PrP. In fact, existing safety frameworks are struggling to capture the dynamic nature of PrP, consequently, its real-time measurement and control remain difficult to achieve. This work, therefore, tries to broaden our understanding of PrP and to develop methods to monitor, measure, and predict it, to equip managers and policymakers with the tools to navigate the efficiency-safety dichotomy more effectively. Through a series of essays, this dissertation reviews the current state of knowledge on PrP to identify its sources and impacts and also innovates a novel approach to quantify PrP in real-time and predict its future trends.

Les travaux menés dans cette thèse CIFRE s’inscrivent dans le cadre d’une collaboration pérenne entre le CRAN et l'EDF R&D dont un des résultats majeurs a été le développement d'une méthodologie d’analyse de risques, appelée Analyse Intégrée des Risques (AiDR). Cette méthodologie traite des systèmes sociotechniques sous les angles technique, humain et organisationnel et dont les équipements sont soumis à des actions de maintenance et/ou de conduite. La thèse a pour objet ainsi de proposer une évolution du modèle dit de « barrière humaine » développé dans l'AiDR pour évaluer l'efficacité de ces actions humaines prises leur contexte organisationnel. Nos contributions majeures s'organisent autour de 3 axes : 1. Une amélioration de la structure préexistante du modèle de barrière humaine afin d’aboutir à un modèle basé sur des facteurs de forme appelés performance shaping factors (PSF) fournis par les méthodes d’Évaluation Probabiliste de la Fiabilité Humaine (EPFH) ;2. L’intégration de la résilience et la modélisation de l’interaction entre mécanismes résilients et pathogènes impactant l'efficacité des actions dans les relations causales probabilistes ;3. Un traitement global des jugements d’expert cohérent avec la structure mathématique du modèle proposé permettant d’estimer d’une manière objective les paramètres du modèle. Ce traitement se fonde sur la construction d’un questionnaire permettant de "guider" l’expert vers l’évaluation d’effets conjoints issus de l’interaction entre mécanismes pathogènes et résilients. L’ensemble des contributions proposées a été validé sur un cas d’application portant sur une barrière humaine mise en place dans un cas d’inondation externe d’une unité de production d’électricité d’EDF / The work carried out in this CIFRE PhD thesis is part of a long-term collaboration between CRAN and EDF R&D, one of the major results of which was the development of a risk analysis methodology called Integrated Risk Analysis (AiDR). This methodology deals with sociotechnical systems from technical, human and organizational points of view and whose equipment is subjected to maintenance and/or operation activities. This thesis aims to propose an evolution of the so-called "human barrier" model developed in the AiDR in order to evaluate the effectiveness of these human actions taken their organizational context. Our major contributions are organized around 3 axes: 1. Improvement of the pre-existing structure of the human barrier model to achieve a model based on performance shaping factors (PSF) provided by the Human Reliability Assessment (HRA) methods; 2. Integration of resilience and modeling of the interaction between resilient and pathogenic mechanisms impacting the effectiveness of activities in a probabilistic causal framework; 3. A global treatment of the expert judgments consistent with the mathematical structure of the proposed model in order to objectively estimate the parameters of the model. This treatment is based on a questionnaire to guide experts towards the evaluation of joint effects resulting from the interaction between pathogenic and resilient mechanisms. All of the proposed contributions have been validated on an application case involving a human barrier put in place during an external flooding occurring at an EDF power plant