Models of rationality for engineering: the case for human-centred systems design

The deterministic rationality of engineering and the mindset which goes with it do not equip engineers to cope with human aspects of their work, and may lead to technically-centred design which is not fit for purpose. This is exemplified by conventional knowledge-based systems (KBS) which have been recognised as ineffective in meeting the needs of real work systems because they do not cater for the situated, distributed nature of naturalistic decision making in co-operative work settings. Nevertheless, in the domain of maternity care the technology has been shown to have the potential to improve decision making in life-critical situations. If their potential is to be realised then the design of KBS in this domain needs to address issues of interacting with the work of clinical teams. This paper describes the adoption of user-centred methods, including activity theory and ethnography within a case study perspective, by a multi-disciplinary development team. Their combined use in a pilot study of an existing KBS was effective in enabling the team achieve a shared understanding of the complex work system of delivery wards and to be able to postulate new roles for a KBS under development to make it an effective clinical tool. The paper makes a case for changes to the roles for which KBS are designed and concludes with an analysis of the benefits of employing user-centred methods as part of the methodology of engineering design.