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“An information ecology [is] a system of people, practices, values, and technologies in a particular local environment” (Nardi & O'Day, 1999, p. 49). In this case study, the local environment is the highly specialized neurosurgical operating room. Its people are the doctors, nurses, technicians, med students, and staff that are required for a complex neurosurgical procedure. The practices are the specialized tasks performed by each important member of the team from the circulating nurse to the neurosurgeon; each member’s job is critical to the function of the operating room. “[It] is a complex system of parts and relationships” (p. 50).

The values held by the people in this information ecology revolved first and foremost around quality of care provided to the patient, and the success of each delicate procedure. Patient care was paramount to all other concerns. However, also highly valued because of its important ties to efficient, careful, quality care was open communication among team members. Finally, while many technologies are involved in a highly specialized neurological procedure, the one focused on in this case study was the audiovisual equipment installed for use by the neurophysiologists. It was, in fact, the installation and use of this a/v equipment that lead to the dysfunction in the operating room’s information ecology. Unfortunately in this case, technology overshadowed the importance of the human interaction involved within the ecology, which caused inevitable dysfunction, because as Nardi and O’Day point out “In information ecologies, the spotlight is not on technology, but on human activities that are served by technology” (p. 49).

“Change in an ecology is systemic. When one element is changed, effects can be felt throughout the whole system” (p. 51). In this case study, the change made was the introduction of new technology to a comfortably functioning operating room. Called neurophysiological monitoring, this technology is cutting edge and highly valued among the elite and scarce neurophysiologists working in hospitals today. As its name suggests, the purpose of the audio-visual technology is to monitor the neurophysiological condition of a patient undergoing brain surgery. It is to be used by the neurophysiologists. As Nardi and O’Day explain, “The name of a technology identifies what it means to the people who use it...it positions the technology more directly under the control of its users” (p. 54). “Under the control of its users” is a very important qualifier here. Clearly, the name, the identity of this technology, suggests its users are strictly neurophysiologists, not neurosurgeons, not anesthesiologists, not surgical nurses, or technicians. The technology belongs to and is controlled by only one member of this ecology. “In a healthy information ecology, [all] work together in a complementary way” (p. 51). How can all relationships remain intact, and all members of the ecology work together in such a way, if only one member of the system is controlling a major technology involved and affecting all members of the system? Relationships cannot remain intact in these circumstances; the ecology breaks down.

The very identity of the technology indicates to whom it will be most useful, and by whom it will be most utilized. This distinction of use indicates the habitation (p. 55) of the technology. “The habitation of a technology is its location within a network of relationships. To whom does it belong? To what and to whom is it connected? Through what relations? The habitation of a technology is its set of family ties in the local information ecology” (p. 55). This technology’s habitation was intrusive to the tight-knit family ties built on trust and communication already established in this operating room.

If the monitoring system can potentially save a patient and at the very least elevate the quality of care during a brain surgery, how can its worth be questioned? How can any members of the team take issue with its use? Perhaps because, as Nardi and O’Day state, “As users of tools, [the neurophysiologists] are responsible for integrating them into settings of use in such a way that they make sense for [all members of the team]” (p. 55). The neurophysiologists did not do this. They failed to recognize the system’s keystone species. “An ecology is marked by the presence of certain keystone species whose presence is crucial to the survival of the ecology itself.” In this case, the keystone species would have been, and should have been a mediator, or a mediating body. Unfortunately, as is often the case, “When we add new technologies to our own information ecologies, we sometimes try to work in the absence of essential keystone species” (p. 53). The neurophysiologists discovered a technology that would assist them in their role in a surgery, installed the supportive technology, and utilized it, unbeknownst and certainly without the approval of the other integral team members.

Our web illustrates the dysfunction that occurs in this specific information ecology as a result of the neurophysiologists’ failure to recognize that the other members of the system, the ecology, had vital viewpoints, concerns, and agendas. Further it shows the disruption of the values system of the members of the operating team. The team is a system. If all parts are not working together, the system breaks down, just as it did in this hospital.

One of the most significant contributors to the breakdown of this particular informational ecology is the lack of awareness by those who make decisions of the values held by the other participants. By failing to recognize, acknowledge, and integrate the values of the nurses, neurosurgeons, and other operating room personnel into the implementation of the new recording technology, the neurophysiologists insured that their vision of the technology would be implemented, but also that the informational ecological system would disintegrate, an unexpected consequence. The neurophysiologists valued efficiency and quality of care above, and to the exclusion of, all else. Although the other stakeholders also valued these ideals, to varying degrees, they also had other values that informed their attitudes and actions. For many of the other stakeholders, the value of open communication and the privacy of job performance caused them to question the new technology and the true motives of those who pushed for implementation. One theme that emerged numerous times was the value of the nurturing and confidential nature of the OR as a classroom for interns and residents. Surprisingly, this value was also overlooked by the neurophysiologists, who presumably had benefited from that same environment as they developed their own skills as interns. In essence, the decision-making stakeholders narrowly viewed the technology as a tool, rather than understanding it as a system or an ecology. If they had considered this technology more appropriately as a system and ecology, then the values of the others would have been included in the decision-making process. The end result of implementing the monitoring system may still have occurred, but it would have been framed by all of the necessary concerns and a collaborative effort to prioritize and address the varied values of the stakeholders.

As a result of the lack of values awareness within the information ecology, the integration of the audio and visual monitoring system had many unintended consequence including a dysfunction in the operation of the information ecology. The purpose of the equipment was to help the neurophysiologists by giving them the ability to do some of their work away from the operating room. Through the broadcast of audio and visual information as well as quantitative data from the operating room, the neurophysiologists would be able to tell if a patient needed assistance. This broadcast provided the neurophysiologists with a picture of what was going on during the surgery, the audio of the neurologist talking through the procedure, and important data. The hope was that by using this technology the neurophysiologists could be available when needed only and be able to help numerous patients at a time. The result, however, was dysfunction in the normal operations of the information ecology.

Each member of the ecology, based on their pre-implementation practices and values, reacted differently to the introduction of the new technology. The neurologists used this technology to help in collaboration with the team outside of the operating room. This group based on their value of efficiency and collaboration found the technology helpful, although as a group, the neurologists were unhappy with the control of being able to choose which procedures would be recorded and broadcast. The anesthesiologists found the transmittance of audio from inside the operating room to be debilitating. They saw the technology as a hindrance for communication in the operating room as they no longer felt comfortable conversing freely. At the same time, though, they recognized that with careful and public safeguards to privacy, such as indicator lights on the a/v equipment, their own services could be better provided to more patients at one time. The nurses also felt the the new technology was intrusive. Students and residents were impacted as they felt more nervous during their learning experiences as they knew audio and visual of their work was being broadcast and watched by others. Lastly, the other operating room staff felt confined by the equipment and were wary of the communication they had with the other staff in the room. The unintended consequences of less communication between operating room staff, and the intensified nervousness of students and residents could have been prevented had the decision makers considered all those involved when making their decision. In addition, these worries and issues may have been addressed prior to implementation had the decision makers been aware of the others values.

Nardi, B.A. & O'Day, V. 1999. Information ecologies: using technology with heart. Cambridge, MA: MIT.