Abstract
Clinical work is accomplished by complex, highly distributed, joint cognitive systems, and involves high levels of uncertainty and ambiguity. Hospital emergency departments (EDs) in particular must adapt to uncertainty, ambiguity and change on a variety of different temporal scales. Many of these adaptations are unofficial, in part because they cannot be specified in advance and because the official models of healthcare work do not include or acknowledge them. This paper presents two case studies of reactive adaptation within the ED setting and uses these to explore their implications for cognitive engineering and design.









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Armstrong-Coben A (2009) The computer will see you now. New York Times
Bainbridge L (1987) Ironies of automation: increasing levels of automation can increase, rather than decrease, the problems of supporting the human operator. In: Rasmussen J, Duncan K, Leplat J (eds) New technology and human error. Wiley, Chichester, pp 276–283
Berg M (1999) Accumulating and coordinating: occasions for information technologies in medical work. Comput Support Coop Work 8(4):373–401
Berg M, Winthereik BR (2004) Waiting for Godot: episodes from the history of patient records. In: Berg M (ed) Health information management: integrating information technology in health care work. Routledge, London, pp 11–44
Cohen MD, March JG, Olsen JP (1972) A garbage can model of organizational choice. Admin Sci Q 17(1):1–25
Garfinkel H (1967) “Good” organizational reasons for “bad” clinic records Studies in ethnomethodology. Blackwell Publishing Ltd, Cambridge, pp 186–207
Hayes RH, Wheelwright SC (1979) Link manufacturing process and product life cycle. Harv Bus Rev 57:133–140 (January–February)
Jensen J (2004) United hospital increases capacity usage, efficiency with patient-flow management system. J Healthc Inf Manag 18(3):26–31
Kohli S, Waldron J, Feng K, Katis P, Jakubowski G, Davies D, Kohm C (2004) Utilizing the electronic emergency whiteboard to track and manage emergency patients. Paper presented at the Medinfo, San Francisco, CA, 7–11 Sept 2004
Mendonca EA, Chen ES, Stetson PD, McKnight LK, Lei J, Cimino JJ (2004) Approach to mobile information and communication for health care. Int J Med Inf 73(7–8):631–638
Pennathur PR, Bisantz AM, Fairbanks RJ, Perry SJ, Zwemer FL, Wears R. L (2008) Cognitive artifacts in transition: an analysis of information content changes between manual and electronic patient tracking systems. Paper presented at the human factors and ergonomics society 52nd annual meeting. New York, NY, USA
Perry SJ, Wears RL (2009) Coping with chaos: coordination of work in healthcare. In: Mosier K, Fischer U (eds), Experts in complex situations: transforming information into knowledge. Taylor & Francis, New York, pp 55–68
Roth E, Multer J, Scott R (2009) Understanding and contributing to resilient work systems. In: Nemeth CP, Hollnagel E, Dekker SWA (eds) Resilience engineering perspectives: preparation and restoration, vol 2. Aldershot, Farnham, pp 215–234
Saleem JJ, Russ AL, Justice CF, Hagg H, Woodbridge PA, Doebbeling BN (2008) Paper use with the electronic medical record: an important supplement or negative circumvention. Paper presented at the Human Factors and Ergonomics Society 52nd annual meeting. From http://www.ingentaconnect.com/content/hfes/hfproc/2008/00000052/00000012/art00002
Timmermans S, Berg M (2003) The gold standard: the challenge of evidence-based medicine and standardization in health care. Temple University Press, Philadelphia
Vicente KJ (1999) Cognitive work analysis. Lawrence Erlbaum Associates, Mahwah
Wears RL (2008) The chart is dead–long live the chart. Ann Emerg Med 52(4):390–391
Wears RL, Perry SJ (2006a) Free fall—a case study of resilience, its degradation, and recovery, in an emergency department. Paper presented at the 2nd international symposium on resilience engineering, Juan-les-Pins, France. http://www.resilience-engineering.org/REPapers/Wears_et_al.pdf
Wears RL, Perry SJ (2006b) Shadows and ghosts: the role of hidden information in a US healthcare setting. Paper presented at the International Ergonomics Association 2006 congress. Maastricht, Netherlands
Wears RL, Perry SJ (2008) Semper gumby sub rosa: adaptability in a healthcare setting. Paper presented at the 52nd Human Factors and Ergonomics Society, New York, NY, USA
Wears RL, Perry SJ, Wilson S, Galliers J, Fone J (2007) Emergency department status boards: user-evolved artefacts for inter- and intra-group coordination. Cognit Technol Work 9(3):163–170
Woods DD, Hollnagel E (2006) Joint cognitive systems: patterns in cognitive systems engineering. CRC Press/Taylor & Francis Group, Boca Raton
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Perry, S.J., Wears, R.L. Underground adaptations: case studies from health care. Cogn Tech Work 14, 253–260 (2012). https://doi.org/10.1007/s10111-011-0207-2
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DOI: https://doi.org/10.1007/s10111-011-0207-2