Understanding how emerging technologies shape the future of work
This week, I interviewed Anastasia Sergeeva, an Assistant Professor at KIN with a background in business and healthcare management. Her research focuses on how new technology changes the roles of practitioners and the orchestration of their work in response to these new technologies. Her research spans topics of patient data and electronic health records to robotic surgery.
In our interview, we touch on topics including her journey to become an ethnographer of emerging technologies, counterintuitive insights coming out of her research on opening patient health records, what we can learn from looking at the distribution of bodily senses in surgical robot adoption, and her passion for reading history as a lens to contextualize and understand present developments.
Anastasia’s journey to find her home in ethnography and understand the changing nature of work
Shauna: Could you tell me about your research topics?
Anastasia: So, broadly I am interested in how work is changing with the introduction of novel technologies. And I’m specifically attracted to health settings and any new tools that change how people perform their work. I think a healthcare context is such a rich example of what you could also see in other settings. And anything that is labelled as disruptive or dramatic enough to promise a big impact on patient health or health work attracts my attention.
Shauna: What brought you to KIN, Center for Digital Innovation?
Anastasia: After my master’s, I worked at a hospital in a management role for a few years. I was involved in many tasks from managing the front-desk and call-center to business development; it was a medium-size private medical clinic, a hospital really, with an ICU and operating theatres. Part of what I was doing was implementing electronic patient records, and I experienced first-hand how hard it was to drive this implementation. I remember that I was really pushing for digitization: “we cannot keep using paper,” “let’s do this, it will solve so many problems”. It was just so intuitive to me that we had to digitize. But it didn’t really work, at least not the way I hoped…
At some point, I decided to go back to school and do a PhD. I was just really curious to read everything I could about why it’s so difficult to digitize. But, what I read was not representative of how I saw things are done at work. For example, the idea of physicians’ resistance was very commonly described, but did not resonate with me. The portrayal of technology as the ultimate good and physicians as the ultimate traditionalists resisting change; it felt like force-fitting some agenda onto reality.
I always felt very uncomfortable with all those theories. Eventually I came to believe that the reason was due to the method or basic assumptions. Most of those descriptions rely on surveys or macroeconomic econometric calculations or regression models. It is the gold standard of the scientific method in our field, but this way you never really get a picture of reality. There’s so much complexity to what is really going on. But, if you use a survey, you need to formulate your hypothesis upfront so you end up aiming to measure “resistance” without questioning whether it is the right thing to measure in the first place. This way you never get to the bottom of the problem. I wanted to do things differently and eventually found my home in what is called ethnography. So, this is how and why I eventually ended up here, at Vrije Universiteit.
I met Marleen and we talked about my interests and background and it seemed most natural that I would do research in some healthcare setting, given my experience. After some searching, I found a pilot project for myself, where I had a chance to observe how mobile devices were introduced in a hospital and how they were used by nurses. After that, I heard that the same hospital was introducing a surgical robot, and I became fascinated with finding out what would happen once the teams really started working with the robot. From there on, it sort of grew further and broader. Then the hospital also introduced a patient portal for patients to be able to read what is written in their records, to open up data, so that’s one of my projects currently. So you could say that every time a new digital tool or innovation is introduced, I jump on it.
Paradoxically, opening up patient data can empower physicians rather than patients
Shauna: What are some counterintuitive insights or findings coming out of your research around patient data?
Anastasia: You should never just open up patient data. It’s a terrible idea. I often hear some big visions that “health should become the next mobile banking”. That every patient should have everything on their phone and Whatsapp with their physician.
But what we see is that the whole idea behind the patient empowerment environment or the whole push towards owning your data is based on the assumptions that it makes patients more informed and in charge. That we shouldn’t have passive sick people who don’t know what to do.
Well, very often it’s not happening. On the one hand, if you just blindly “open the data” in the same format as you have it inside the hospital, patients don’t get more “informed”, because the data they get is medical data. It’s not translated, it is created for a different purpose and different audience and it’s just very overwhelming. So the idea of data being neutral and consumable by everybody in the same objective and universal manner is just so silly.
We studied a case where a hospital opened up patient data. We went in and looked at how patients use that data. And we also observed consultations between patients and physicians, and what happens to that relationship. Patients don’t get more informed, they get more worried, overwhelmed, or in awe of the medical expertise. That dynamic creates reinforcing loops where physicians become even more powerful.
Robotic surgery is changing the definition of a surgeon and who can be a surgeon
Shauna: So, you have been studying the da Vinci robot for some years now from an embodiment perspective, a perspective that focuses on perceptive and sensory capabilities for performing work. In fact, you just published a paper about it, Losing Touch. Could you tell me something interesting coming out of that research around how the role of surgeons is changing?
Anastasia: So much of surgeons’ work is about their skill in working with tissue and knowing anatomy and organs by touch and using their hands…Surgery is about embodiment, about having dexterity, being flexible, but it’s also about being able to endure long hours of heavy work, being able not to vomit when you see a cadaver, all those things. It is about basically training your whole body in many ways to become a surgeon.
People very often talk about human senses as if they are universal. The idea of “muscle memory” for example, is quite generic, it is a universal human capability. But the surgeons I have studied don’t have universal senses, they spent five or more years training their senses so that their senses become different from mine, they can discriminate between things I would not be able to recognize and they can do things with their hands and eyes that I would not be able to do.
What we see is that technology is changing that completely. Now, you don’t have to be skilled in those ways, you don’t have to endure eight hours of standing in one position, cutting into someone. Interestingly, you might not have to be a man to be a surgeon! So, it’s completely different. It reshapes the whole person needed. The robotic technology takes over these bodily capabilities. You don’t have to have golden hands anymore. Not only a skilled, strong, macho, very concentrated person who can suppress their instinct to vomit, can be a surgeon.
Shauna: How did the surgeons feel about that?
Anastasia: They love it. In some circles where people study technology or even robotics, you often hear interest in adoption, for example, “how do we increase the adoption of Da Vinci?” In this case, this was not really an issue, at least not in that group that I studied, because it augmented so much. The robot made it so easy, it was so attractive and so intuitive, and the only important burden was how to redistribute the senses that were lost, thus tasks that could no longer be performed by the surgeon to other team members. How do you make sure that the senses that the surgeon does not have, that are blocked, are taken over by someone else?
As a society, we over value cognitive work, forgetting our bodies to our detriment
Shauna: Are there any other industries where this is happening, where tools are reshaping the content and form of work?
Anastasia: Basically all types of work where people have to do anything with their hands or use their bodies in a skillful way, I would say most of the jobs really, but you could think of artists, restorers, craftsmen, and architects. Architects are now, for example, using virtual reality (VR) applications and head-mounted VR glasses to visualize how their designs will look, to perceive scale and depth, and to discuss with their team or with their clients.
Shauna: How does the embodiment perspective help us understand this transition?
Anastasia: The problem is that we have a society with such a cognitive orientation, too much focus on what we think is real “knowledge work” or “thinking for a living”. That’s why we don’t have many papers on embodiment because we think we do all our work with our brains. We’re obsessed with our brains and we forget the body. I even think that the whole movement of yoga or mindfulness actually appeared in order to repair that unbalance and bring more awareness to the body.
Shauna: Are you reading anything outside of work that you can recommend?
Anastasia: I’m re-reading We, by Yevgeny Zamyatin. It was written in the 1920s, but I find it very fascinating how much of it is still reflective of today’s beliefs in “progress”, ideas of objective, scientific reasoning, and our fascination with science and data. It has been my favorite since high-school, but I now keep rediscovering its relevance. He shows that our beliefs in progress haven’t changed much since the 1920s.
History is my hobby. I like to read about our relationship to tools and nature, and how the nature of the materiality of our existence has shaped our social life. I think we ignore history to such a terrible extent…In my teaching, I always like to give historical context to students. In my current course on innovation, I said to my students, “you’re all fascinated by innovation now, but until at least the 19th century it was a forbidden word. People hated innovation”. I feel it’s so important to teach history and read about this. Very often, we don’t have time to reflect on lessons we learnt from the past, especially in a business environment.
Stay tuned! We’ll be featuring a followup post on Anastasia’s work on the da Vinci robot linked to her recently published journal article, Losing Touch. Follow our Medium channel and sign up to our newsletter to find out more.
Author: Shauna Jin
The KIN Center for Digital Innovation is part of the School of Business and Economics (SBE) at the Vrije Universiteit Amsterdam (VU).
Our research focuses on the development, use, implications and business value of digital innovations. We are a multi-disciplinary group of researchers with academic backgrounds in business administration, sociology, communication science, anthropology, philosophy, engineering, industrial design, and computer science.