Finally the day had come to defend my PhD thesis. Contrary to what I expected, I slept quite well and arrived at KTH university around nine o’clock. There I met with my supervisor Jan Gulliksen and had the opportunity to have a chat with the opponent David G. Hendry and two of the three committee members: Geraldine Fitzpatrick and Gunnar Ellingsen. This was really nice and I felt that this also calmed my nerves a bit – or at least distracted me in a nice way.

Morning Seminars

There is this nice tradition at KTH that on the day of the defence, members of the committee give a talk about their own work. Geraldine Fitzpatrick started the seminars with her talk on Participatory Design in a ‘path to market’: Tensions in a quadruple helix collaboration. She presented a research project that can be considered as successful considering what was described and specified in the funding application. I found it very interesting to learn about difficulties to carry out those milestones in practice and the lessons learned related to different processes and workflows of researchers and industry partners. Human-centred design aims to understand what people really need in their daily life and what helps them to accomplish certain things. So what do you do if the outcome of your project (as written in the research application) is an app or some other kind of technology and you learn during your research that this is acutally not what those people need? I think this is super interesting and also a valuable outcome, but will probably not satisfy the funding body. Based on their experience, Geraldine Fitzpatrick and Lone Malmborg presented their reflections for projects and also funding bodies at NordiCHI and you can read more about it in their article here.

Gunnar Ellingsen from UIT – The Arctic University of Norway in Tromsø – presented the case of Preparing for the implementation of the Epic EPR in Norway drawing on experiences from Denmark. He presented some lessons learned from an implementation at Herlev/Gentofte Hospitel (HGH) in Denmark and some early findings from the setting in Norway. There were many questions and an interesting discussions following his presentation, for example, what are the experiences from nurses? How to deal with controversial statements of people when reporting back on the research study?

The final presentation was given by David G. Hendry who introduced Educational Case Studies in Tech Policy. I found his pedagogic approach very interesting! At their university they give students a case study which they have to work on in only two hours and in which they address questions such as: who are the direct and indirect stakeholders; what values might they hold and what values might be implicated in the target technology; what value tensions might emerge; what policy elements exist in the sociotechnical context and so on. Using those case studies in his teaching, he aims to develop students’ appreciation for how technology and policy go hand in hand.

I so very much enjoyed the presentations and couldn’t help but think: Wow – these people are on MY committee!

Presentation by the Opponent: David G. Hendry

After lunch, the official defence started off with David presenting my work. This might seem unusual to many, as often the PhD student presents the work she or he has done. At KTH usually the opponent presents the work and I really love that idea. Not that I don’t like to talk about my research – I like that a lot – but I was really happy that I didn’t have to present myself. This actually helped me NOT to freak out the days before the defence. Otherwise, I would have spent so much time preparing and rehearsing the presentation (kind of a perfectionist in that respect) and by that I would have become much more nervous. Instead, I spent a wonderful day with my family in Stockholm which also distracted me from pondering about the important next day. I wasn’t sure how an opponent would think about it, but David reassured me that he really enjoyed getting to know my work and to think with my ideas.

His presentation was just fabulous and I really enjoyed listening to his take on my work. Of course, I have my own ideas on what my contributions are, what went well, and where I could improve. But listening to David’s views related to my contributions and his appreciations almost made me wonder: Is he really talking about me? Maybe the impostor syndrome was hitting me at that moment… Thanks to my sister taking pictures of every slide, I can outline his view on contributions and his appreciations here:

David outlined what he viewed as contributions of my work in three aspects: theory, method, and practice.

Theory. Case study and new ideas for investigating complex stakeholder roles and relationships, combining empirical, conceptual, and technical investigations

Method. Extension of Technology Frames for representing values and value tensions

Practice. Superb foundation for human-centered design or value sensitive design projects in:

  • Doctor-patient relationship
  • New empirical work
  • Improved technical design

He then presented his appreciations:

Important and ambitious work for human well-being

Very careful approach to the data, attending to its limitations

Deeply and consistently interactional stance throught research

Extremely clear interpretive moves • well-organized thesis • excellent writing

Discussion

After the presentation, the discussion started with David as opponent asking questions. The initial question was related to scoping the problem space and the decisions made related to the research questions and the conducted studies (e.g., focusing on physicians and patients and not including, for example, insurance companies, county councils, etc.) We also talked about the doctor-patient relationship and the models described in the literature that I refer to in my thesis. Related to this, David mentioned the philosopher Ivan Illich who wrote “Medical Nemesis: The Expropriation of Health”, which went right on my ToRead list 😉 . We also discussed the methods used, the limitations and how I addressed those; my commitments and how I approached the qualitative data; my interpretation of the survey data and my arguments related to whether PAEHR is harmful or not. For example, we asked in the survey whether patients read something that made them upset (which is something healthcare professionals were concernded about). In relation to this, David made a good point wondering how often patients leave an doctor’s appointment being upset. This reminded me also about the discussion of anxiety-creation (which I wrote about here) and that patients may be anxious anyway (for example because they have to wait for results) and not necessarily because of reading their records. The discussion with David took a bit over half an hour and afterwards the three committee members took over asking more questions. These questions related to the concept of power in healthcare related to patient empowerment; how my own background influenced the different phases of my research; particularities of the interview and survey study; various literature on values used in the background and analysis of my thesis; the rich diversity of PAEHR use; how I came to my conclusions. Finally, the audience were invited to ask further questions, some of which were related to patient safety, risks, and data integrity.

Deliberations and the Verdict

After the opponent, the committee, and the audience had asked their questions, the chair Henrik Artman closed the defence and we left the room. University had set up some snacks and non-alcoholic cava and I had bought some sparkling wine to have a toast with. Opponent, committee, supervisors, and the chair went into a separate room to discuss whether I had passed my defence or not. Sometimes the discussions can take quite a while, but thankfully in my case it took them only about 10 minutes. Geraldine Fitzpatrick was the one informing me about the decision and happily told me that it was unanimous and that I passed. She added that everyone was impressed with my work; with the consistency in the way I responded to questions and in the discussion; with the consistency in they way I presented the work itself in my writing; and that often in defences the discussion is needed to fill in the holes, because something is missing, but that this wasn’t the case here… Geraldine closed by congratulating me and she was the first who then officially called me “Dr. Grünloh!”

The official protocol she gave me was taken away directly by my main supervisor, given that this has to be handed in to the administration. Henrik Artman, who was the chairman of the dissertation, congratulated me also in his role as the head of department and gave me a new piece of paper in a golden picture frame. It was the written congratulation by the head of the school.

It was such an exciting day! We had a toast right there and then, I got very nice presents from my family and friends, everyone had so many kind words for me and my work, it was quite overwhelming. Gerolf, a colleague in the HTO group, made the lovely little trailer1 you can see on top of this page, where he included some of the appreciations and contributions outlined by David.

The Dinner

To round up this great day and an exciting PhD journey, I wanted to invite family and friends for dinner. It was a bit tricky to organise a venue to celebrate after the defence, but in the end it was just perfect. We went to Wirströms, a place that I really hold dear, given that we went there many times during my PhD when I visited KTH. So it was kind of a full circle that the after-defence dinner took place there. The room was a bit small for the 32 people who came, but also quite cozy. Two of my supervisors gave really lovely speeches and given that I was standing after I thanked them for their words, I tried twice to also say a few words – but I couldn’t. There I was, surrounded by all the lovely people who made this amazing and exciting PhD journey not only possible but also so much fun. When I looked at their smiling faces, every attempt to say “Thank you” ended up with a cracking voice, so I gave up 🙂 But I am sure, they knew what I wanted to say. And if not, here is a digest:

THANK YOU SO  MUCH! You are awesome and I couldn’t have done it without you!

Footnotes

  1. published with permission of the creator Gerolf Nauwerck and the people appearing in the clip.
, ,
My PhD thesis: Published and Printed
Erwartungen und Erfahrungen mit für Patienten zugängliche elektronischen Gesundheitsakten (Kurzfassung meiner Dissertation)

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