Yan Xiao - Profile on Academia.edu (original) (raw)
Papers by Yan Xiao
Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 1995
One of the goals of naturalistic studies of human decision making is to reveal the cognitive load... more One of the goals of naturalistic studies of human decision making is to reveal the cognitive loads or task difficulties imposed on the decision maker in real work environments. Fixation errors or cognitive lockups have been reported as a unique type of performance failure in dynamic work environments, and are thus particularly valuable to the understanding of the challenges and difficulties confronting practitioners in dynamic environments. In this paper, we present the analysis of fixation errors during real-life trauma patient resuscitation. The analysis elicits two factors, both rooted in the inherent complexity of the domain, that contributed to the occurrence of fixation errors: unreliable monitoring devices and delayed feedback. The former induces the behavior of preferring confirmatory information, partly for redundancy checks. The latter may create a false sense of system stability and divert attention away from the correct diagnosis.
Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 2001
This paper reports findings on some of the practices adopted by teams based on interviews and obs... more This paper reports findings on some of the practices adopted by teams based on interviews and observations of teams working in trauma resuscitation. This study was conducted at a level I trauma center over a period of six months. Although analysis of interview transcripts is on-going, these practices can be tentatively organized into several general themes: learning and trusting other roles, sharing responsibilities, ensuring team awareness, and being adaptive. In particular, even though membership of teams in trauma resuscitation is fluid and dynamic, by sharing the overall responsibilities for the well-being of the patient, the teams are able to resist many failure factors.
SMC'03 Conference Proceedings. 2003 IEEE International Conference on Systems, Man and Cybernetics. Conference Theme - System Security and Assurance (Cat. No.03CH37483)
Healthcare environment is a prime example of collaborative work, in which work is organized both ... more Healthcare environment is a prime example of collaborative work, in which work is organized both at the macro-level over days and weeks as well as microlevel over hours and minutes. Coordination is carried out jointly by those who often share the ultimate goal of providing best care to the patient while at the same time have different perspectives. Additionally, uncertainty and contingencies often arise to disrupt the best plans. Based on the phenomenology observed in coordination for day of surgery management, we illustrate strategies employed by healthcare workers to enhance operational robustness and reliability. Based on the insight learned, a videobased toolset was developed and deployed in a Level-I trauma center to enhance distributed monitoring. Initial trials showed that the toolset was highly received.
ECSCW 2001
Distributed cognition as an approach to collaborative work holds that a work unit is cognitive sy... more Distributed cognition as an approach to collaborative work holds that a work unit is cognitive system in which cognitive activities are carried out jointly by workers with the use of tools. This approach has several direct implications to the study of collaborative work In this paper, we analysed staff interactions with a large display board in a Level I trauma centre operating room unit. Coordination needs are exacerbated by the unpredictability of incoming emergency surgery patients admitted to the trauma centre as well as other contingencies (such as changes in scheduled surgery cases or staffing) The public display board has evolved into a key component for supporting collaborative work. The physical and perceptual properties of the board are exploited by the clinicians to support rapid paced, highly dynamic work. The canvas-like appearances of the display board, combined with magnetic objects attached to the board, afford its users to taylor the board as an effective coordinative tool and to invent new ways of representing information Based on the concept of display-based cognition, our analysis illustrates the role of public displays in facilitating negotiation of scheduling, joint planning, and augmenting inter-personal communication.
Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 1998
This paper describes a study of team coordination and its breakdowns in a complex and dynamic wor... more This paper describes a study of team coordination and its breakdowns in a complex and dynamic work environment. Sixteen videotaped cases of real-life trauma patient resuscitation in a trauma center's patient admitting areas were analyzed. The findings from the study suggest that highly skilled work teams used a variety of ways to coordinate, many of which were non-verbal and implicit. Breakdowns in coordination occurred in several stressful situations, and the lack of explicit, verbal communications could be a major contributing factor. The paper characterizes the situations where coordination breakdowns were observed, and recommends that the team training be targeted at those situations where verbal communications are essential yet team coordination is prone to breakdowns.
Proceeding of the twenty-sixth annual CHI conference extended abstracts on Human factors in computing systems - CHI '08, 2008
This paper presents an ongoing observational study to explore a "front-stage-back-stage" model of... more This paper presents an ongoing observational study to explore a "front-stage-back-stage" model of information processes during group discussions (multidisciplinary rounds) in the pediatric intensive care unit (PICU) of a large urban medical center. Participants were observed to collaborate on "front-stage" processes of presentations, discussion, and treatment planning, while in parallel they performed tightly-coupled "backstage" information activities. The front-stage and backstage information processes were interdependent to address the need for fluid, high time-pressured discourse with potential life-and-death consequences. We believe the front-stage-back-stage model adds to our understanding of collaborative information exchange and holds implications for computer supported cooperative work (CSCW) systems. For example, computing support may increase the efficiency and reliability of information transfer by enhancing the ability to "choreograph" front-stage and back-stage information processes during critical discourse such as medical rounds.
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, Jan 11, 2007
Multi-disciplinary rounds are a forum for communication and sense-making, and they play a critica... more Multi-disciplinary rounds are a forum for communication and sense-making, and they play a critical role in intensive care to ensure care coordination across specialties and providers. Increased availability of clinical information through computers has made it possible to provide support during rounds. We conducted an observation study to determine ways in which computers may be used during rounds, when users are under time pressure in accessing and manipulating clinical data. A total of fifteen hours of rounds in a pediatric intensive care unit for 47 patients were observed. Factors influencing information transfer during rounds were characterized in three areas: physical, social and cognitive, and supporting artifacts. Based on these factors we developed a set of design guidelines for computerized supporting tools. An example guideline suggests digital capture of handwritten notes. These guidelines developed may help guide future systems development, thus leveraging the power of c...
Quality and Safety in Health Care, 2008
Background: Consistent compliance with evidencebased guidelines is challenging yet critical to pa... more Background: Consistent compliance with evidencebased guidelines is challenging yet critical to patient safety. We conducted a qualitative study to explore the underlying causes for non-compliance with evidencebased guidelines aimed at preventing four types of healthcare-associated infections in the surgical intensive care unit (SICU) setting. Methods: Twenty semistructured interviews were conducted with attending physicians (3), residents (2), nurses (6), quality improvement coordinators (3), infection control practitioners (2), respiratory therapists (2) and pharmacists (2) in two SICUs. Using a grounded theory approach, we performed thematic analyses of the interviews. Results: The concept of systems ambiguity to explain noncompliance with evidence-based guidelines emerged from the data. Ambiguities hindering consistent compliance were related to tasks, responsibilities, methods, expectations and exceptions. Strategies reported to reduce ambiguity included clarification of expectations from care providers with respect to guideline compliance through education, use of visual cues to indicate the status of patients with respect to a particular guideline, development of tools that provide an overview of information critical for guideline compliance, use of standardised orders, clarification of roles of care providers and use of decision-support tools. Conclusions: The concept of systems ambiguity is useful to understand causes of non-compliance with evidencebased guidelines aimed at reducing healthcare-associated infections. Multi-faceted interventions are needed to reduce different ambiguity types, hence to improve guideline compliance.
Journal of the American Medical Informatics Association, 2002
Journal of Stroke and Cerebrovascular Diseases, 2000
TeleBAT is our application of an integrated mobile telecommunications system (MTS) to the clinica... more TeleBAT is our application of an integrated mobile telecommunications system (MTS) to the clinical problem of acute stroke. Although efforts are ongoing to educate patients to seek emergency treatment at the first signs of stroke, we sought to shorten time to treatment once the patient is known to the emergency medical system. Ambulance paramedics acquire valuable assessment data about a stroke patient en route to a medical center. We tested the feasibility of using wireless digital cellular communication to provide a stroke neurologist with real-time visual access to the neurological examination of patients conducted during transport to our stroke treatment center. Audio and visual information, and patients vital signs were transmitted from our interfacility ambulance. The MTS was designed to be userfriendly and includes turnkey operation inside the ambulance and flexible access through a internet browser by the clinicians in the hospital. With 4 simultaneous cellular phone connections, each with a bandwidth of 9.6 kilobytes per second, the throughput was a 320• image every 2 seconds. The image quality requirement was determined through empirical testing by using a videotaped National Institutes of Health Stroke Scale examination. A framework to assess adequacy was developed and defined as the ability of the clinician to make an identical clinical judgment when visual access to the patient was provided by either audio-visual transmission or by face-to-face examination. We have shown mobile telemedicine linking prehospital providers with a stroke center neurologist and thus have come one step closer to transforming the prehospital phase of transport to a prehospital phase of treatment.
Human Factors: The Journal of the Human Factors and Ergonomics Society, 2000
In their search for generalizable behavioral patterns and design principles, cognitive field rese... more In their search for generalizable behavioral patterns and design principles, cognitive field researchers should reflect on the epistemological limitations of empirical studies. In this paper we describe a framework for epistemological analysis that can help serve this purpose and discuss its application to two prototypical cases of cognitive engineering research: laboratory experiments and field studies. The framework examines two, often implicit, processes in empirical research: the abstraction from empirical data and the substantiation of theoretical constructs and principles. By explicitly considering these two processes in several systematic steps, we can gain appreciation for the epistemological contribution of empirical studies to cognitive engineering research. The framework and its application also provide guidance to such important issues as generalizability of results and external validity. Possible applications of this research include providing guidance to researchers an...
Cognition, Technology & Work, 2007
Coordinating activities in many settings can require people to manage conflict, potential and act... more Coordinating activities in many settings can require people to manage conflict, potential and actual. Conflict arises from resource limitations, high-stakes consequences, uncertainty, goal conflict among stakeholders and hierarchical organizational structures. To understand coordination in such systems, we conducted a field study of management of surgical oper-ating rooms. While coordinating interdependencies, such as progress monitoring, scheduling and rescheduling, and prodding, coordinators managed a set of complicated conflicts. They did so opportunistically, to resolve and to prevent conflict. Additionally, coordinators were concerned with perceived fairness. These findings indicate that, in the design of ICT to support coordination, we should examine not only the mechanical articulation of activities and efficient prioritization of resources, but also means to support companion social processes.
Cognition, Technology & Work, 2007
Safe and efficient surgical operations depend on a work environment larger than the individual op... more Safe and efficient surgical operations depend on a work environment larger than the individual operating room (OR) and on communications at different levels of the hospital organization. Extensive communication is needed before and during surgery to ensure that surgical rooms, equipment, and supplies; patients; surgeons; supporting personnel; and accompanying documentation are all ready at the appropriate times. In this article, we compile the results of three of our studies of communication activities outside ORs, with the goal of identifying opportunities and challenges in the workflow of surgery. The first study demonstrates the amount of communication work performed by OR coordinators. The second study demonstrates the potential functions of a whiteboard in communication. The third study describes an organizational learning strategy of proactive event reporting. We apply computersupported cooperative work and organizational learning concepts to the findings and suggest ways in which information technology may improve surgical workflow.
This article describes challenges in the design and development of a decision support system for ... more This article describes challenges in the design and development of a decision support system for trauma patient resuscitation that is used to encourage consistency and reduce error rates. The Trauma Reception and Resuscitation Project links real-time, computer-generated prompts from best practice algorithms via visual and auditory displays. Its functionality is now being tested. Evaluation of this decision support approach can employ patient chart review or observation, but we describe an approach that measures the process of care by video audit. Key process problems in trauma management (e.g., errors of omission, commission, and misprioritization) are identified. The video record provides a framework for learning and feedback. Future testing and development of this system will include a randomized clinical trial and technology enhancement.
JONA: The Journal of Nursing Administration, 2004
Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 1996
Increasingly telecommunication systems have become an integral part of many professions. However,... more Increasingly telecommunication systems have become an integral part of many professions. However, little empirical data and guidelines exist for designing telecommunication systems to facilitate decision makers in cooperative efforts in dynamic task environments. A preliminary experiment was conducted in which the subjects (all experienced in the domain concerned) were presented with video-tapes of previously recorded real-life trauma patient resuscitation. The experiment examined the subjects' ability to understand the status of the patient and resuscitation efforts shown in the video. The experiment was to simulate remote diagnosis tasks in which experts provide consultation through video linkage. The subjects were found to have a number of difficulties in achieving a full understanding. Hypotheses about the reasons that could explain these difficulties are proposed and they include (1) background noise, viewing range restriction, and insecure viewing access to remote sites (2...
Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 1996
The use of simulators for skill evaluation is common in a number of fields, but the effect that v... more The use of simulators for skill evaluation is common in a number of fields, but the effect that various characteristics of simulators have on subject performance is not fully understood. Ten experienced trauma anesthesiologist participated in a full mission simulation of a real video taped trauma case management. This case contained critical events that require the participants to use clinical examinations and familiar and unfamiliar equipment contained in the simulator. Participants' performance differed from both the performance in the real case and ideal performance. The unfamiliarity with one complex piece of the equipment (ventilator function and controls) caused 4 out of 10 participants to be unable to finish the simulation. Surprisingly, unfamiliarity with another piece of equipment (new to all participants) did not have any dramatic impact. Anesthesia simulators have been successfully used in training anesthesiologists, but the demands of evaluation of clinical skills di...
Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 1995
Case rounds are a prominent and important means of training in medical domains. As part of a fiel... more Case rounds are a prominent and important means of training in medical domains. As part of a field study of anesthesiologists’ problem solving activities, we audiotaped the discussion of 10 cases spreading over 4 case rounds. This paper describes the method used in data collection and analysis, followed by the major findings of the study. The study identified three types of skills transferred in case rounds: procedural knowledge, sensitivity to precursors of potential problems, and the ability to prepare for contingencies. The study also showed the potential of case rounds in studying cognitive activities in naturalistic settings.
Dynamic Delegation: Shared, Hierarchical, and Deindividualized Leadership in Extreme Action Teams
Administrative Science Quarterly, 2006
This paper examines the leadership of extreme action teams—teams whose highly skilled members coo... more This paper examines the leadership of extreme action teams—teams whose highly skilled members cooperate to perform urgent, unpredictable, interdependent, and highly consequential tasks while simultaneously coping with frequent changes in team composition and training their teams' novice members. Our qualitative investigation of the leadership of extreme action medical teams in an emergency trauma center revealed a hierarchical, deindividualized system of shared leadership. At the heart of this system is dynamic delegation: senior leaders' rapid and repeated delegation of the active leadership role to and withdrawal of the active leadership role from more junior leaders of the team. Our findings suggest that dynamic delegation enhances extreme action teams' ability to perform reliably while also building their novice team members' skills. We highlight the contingencies that guide senior leaders' delegation and withdrawal of the active leadership role, as well as t...
Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 1995
One of the goals of naturalistic studies of human decision making is to reveal the cognitive load... more One of the goals of naturalistic studies of human decision making is to reveal the cognitive loads or task difficulties imposed on the decision maker in real work environments. Fixation errors or cognitive lockups have been reported as a unique type of performance failure in dynamic work environments, and are thus particularly valuable to the understanding of the challenges and difficulties confronting practitioners in dynamic environments. In this paper, we present the analysis of fixation errors during real-life trauma patient resuscitation. The analysis elicits two factors, both rooted in the inherent complexity of the domain, that contributed to the occurrence of fixation errors: unreliable monitoring devices and delayed feedback. The former induces the behavior of preferring confirmatory information, partly for redundancy checks. The latter may create a false sense of system stability and divert attention away from the correct diagnosis.
Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 2001
This paper reports findings on some of the practices adopted by teams based on interviews and obs... more This paper reports findings on some of the practices adopted by teams based on interviews and observations of teams working in trauma resuscitation. This study was conducted at a level I trauma center over a period of six months. Although analysis of interview transcripts is on-going, these practices can be tentatively organized into several general themes: learning and trusting other roles, sharing responsibilities, ensuring team awareness, and being adaptive. In particular, even though membership of teams in trauma resuscitation is fluid and dynamic, by sharing the overall responsibilities for the well-being of the patient, the teams are able to resist many failure factors.
SMC'03 Conference Proceedings. 2003 IEEE International Conference on Systems, Man and Cybernetics. Conference Theme - System Security and Assurance (Cat. No.03CH37483)
Healthcare environment is a prime example of collaborative work, in which work is organized both ... more Healthcare environment is a prime example of collaborative work, in which work is organized both at the macro-level over days and weeks as well as microlevel over hours and minutes. Coordination is carried out jointly by those who often share the ultimate goal of providing best care to the patient while at the same time have different perspectives. Additionally, uncertainty and contingencies often arise to disrupt the best plans. Based on the phenomenology observed in coordination for day of surgery management, we illustrate strategies employed by healthcare workers to enhance operational robustness and reliability. Based on the insight learned, a videobased toolset was developed and deployed in a Level-I trauma center to enhance distributed monitoring. Initial trials showed that the toolset was highly received.
ECSCW 2001
Distributed cognition as an approach to collaborative work holds that a work unit is cognitive sy... more Distributed cognition as an approach to collaborative work holds that a work unit is cognitive system in which cognitive activities are carried out jointly by workers with the use of tools. This approach has several direct implications to the study of collaborative work In this paper, we analysed staff interactions with a large display board in a Level I trauma centre operating room unit. Coordination needs are exacerbated by the unpredictability of incoming emergency surgery patients admitted to the trauma centre as well as other contingencies (such as changes in scheduled surgery cases or staffing) The public display board has evolved into a key component for supporting collaborative work. The physical and perceptual properties of the board are exploited by the clinicians to support rapid paced, highly dynamic work. The canvas-like appearances of the display board, combined with magnetic objects attached to the board, afford its users to taylor the board as an effective coordinative tool and to invent new ways of representing information Based on the concept of display-based cognition, our analysis illustrates the role of public displays in facilitating negotiation of scheduling, joint planning, and augmenting inter-personal communication.
Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 1998
This paper describes a study of team coordination and its breakdowns in a complex and dynamic wor... more This paper describes a study of team coordination and its breakdowns in a complex and dynamic work environment. Sixteen videotaped cases of real-life trauma patient resuscitation in a trauma center's patient admitting areas were analyzed. The findings from the study suggest that highly skilled work teams used a variety of ways to coordinate, many of which were non-verbal and implicit. Breakdowns in coordination occurred in several stressful situations, and the lack of explicit, verbal communications could be a major contributing factor. The paper characterizes the situations where coordination breakdowns were observed, and recommends that the team training be targeted at those situations where verbal communications are essential yet team coordination is prone to breakdowns.
Proceeding of the twenty-sixth annual CHI conference extended abstracts on Human factors in computing systems - CHI '08, 2008
This paper presents an ongoing observational study to explore a "front-stage-back-stage" model of... more This paper presents an ongoing observational study to explore a "front-stage-back-stage" model of information processes during group discussions (multidisciplinary rounds) in the pediatric intensive care unit (PICU) of a large urban medical center. Participants were observed to collaborate on "front-stage" processes of presentations, discussion, and treatment planning, while in parallel they performed tightly-coupled "backstage" information activities. The front-stage and backstage information processes were interdependent to address the need for fluid, high time-pressured discourse with potential life-and-death consequences. We believe the front-stage-back-stage model adds to our understanding of collaborative information exchange and holds implications for computer supported cooperative work (CSCW) systems. For example, computing support may increase the efficiency and reliability of information transfer by enhancing the ability to "choreograph" front-stage and back-stage information processes during critical discourse such as medical rounds.
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, Jan 11, 2007
Multi-disciplinary rounds are a forum for communication and sense-making, and they play a critica... more Multi-disciplinary rounds are a forum for communication and sense-making, and they play a critical role in intensive care to ensure care coordination across specialties and providers. Increased availability of clinical information through computers has made it possible to provide support during rounds. We conducted an observation study to determine ways in which computers may be used during rounds, when users are under time pressure in accessing and manipulating clinical data. A total of fifteen hours of rounds in a pediatric intensive care unit for 47 patients were observed. Factors influencing information transfer during rounds were characterized in three areas: physical, social and cognitive, and supporting artifacts. Based on these factors we developed a set of design guidelines for computerized supporting tools. An example guideline suggests digital capture of handwritten notes. These guidelines developed may help guide future systems development, thus leveraging the power of c...
Quality and Safety in Health Care, 2008
Background: Consistent compliance with evidencebased guidelines is challenging yet critical to pa... more Background: Consistent compliance with evidencebased guidelines is challenging yet critical to patient safety. We conducted a qualitative study to explore the underlying causes for non-compliance with evidencebased guidelines aimed at preventing four types of healthcare-associated infections in the surgical intensive care unit (SICU) setting. Methods: Twenty semistructured interviews were conducted with attending physicians (3), residents (2), nurses (6), quality improvement coordinators (3), infection control practitioners (2), respiratory therapists (2) and pharmacists (2) in two SICUs. Using a grounded theory approach, we performed thematic analyses of the interviews. Results: The concept of systems ambiguity to explain noncompliance with evidence-based guidelines emerged from the data. Ambiguities hindering consistent compliance were related to tasks, responsibilities, methods, expectations and exceptions. Strategies reported to reduce ambiguity included clarification of expectations from care providers with respect to guideline compliance through education, use of visual cues to indicate the status of patients with respect to a particular guideline, development of tools that provide an overview of information critical for guideline compliance, use of standardised orders, clarification of roles of care providers and use of decision-support tools. Conclusions: The concept of systems ambiguity is useful to understand causes of non-compliance with evidencebased guidelines aimed at reducing healthcare-associated infections. Multi-faceted interventions are needed to reduce different ambiguity types, hence to improve guideline compliance.
Journal of the American Medical Informatics Association, 2002
Journal of Stroke and Cerebrovascular Diseases, 2000
TeleBAT is our application of an integrated mobile telecommunications system (MTS) to the clinica... more TeleBAT is our application of an integrated mobile telecommunications system (MTS) to the clinical problem of acute stroke. Although efforts are ongoing to educate patients to seek emergency treatment at the first signs of stroke, we sought to shorten time to treatment once the patient is known to the emergency medical system. Ambulance paramedics acquire valuable assessment data about a stroke patient en route to a medical center. We tested the feasibility of using wireless digital cellular communication to provide a stroke neurologist with real-time visual access to the neurological examination of patients conducted during transport to our stroke treatment center. Audio and visual information, and patients vital signs were transmitted from our interfacility ambulance. The MTS was designed to be userfriendly and includes turnkey operation inside the ambulance and flexible access through a internet browser by the clinicians in the hospital. With 4 simultaneous cellular phone connections, each with a bandwidth of 9.6 kilobytes per second, the throughput was a 320• image every 2 seconds. The image quality requirement was determined through empirical testing by using a videotaped National Institutes of Health Stroke Scale examination. A framework to assess adequacy was developed and defined as the ability of the clinician to make an identical clinical judgment when visual access to the patient was provided by either audio-visual transmission or by face-to-face examination. We have shown mobile telemedicine linking prehospital providers with a stroke center neurologist and thus have come one step closer to transforming the prehospital phase of transport to a prehospital phase of treatment.
Human Factors: The Journal of the Human Factors and Ergonomics Society, 2000
In their search for generalizable behavioral patterns and design principles, cognitive field rese... more In their search for generalizable behavioral patterns and design principles, cognitive field researchers should reflect on the epistemological limitations of empirical studies. In this paper we describe a framework for epistemological analysis that can help serve this purpose and discuss its application to two prototypical cases of cognitive engineering research: laboratory experiments and field studies. The framework examines two, often implicit, processes in empirical research: the abstraction from empirical data and the substantiation of theoretical constructs and principles. By explicitly considering these two processes in several systematic steps, we can gain appreciation for the epistemological contribution of empirical studies to cognitive engineering research. The framework and its application also provide guidance to such important issues as generalizability of results and external validity. Possible applications of this research include providing guidance to researchers an...
Cognition, Technology & Work, 2007
Coordinating activities in many settings can require people to manage conflict, potential and act... more Coordinating activities in many settings can require people to manage conflict, potential and actual. Conflict arises from resource limitations, high-stakes consequences, uncertainty, goal conflict among stakeholders and hierarchical organizational structures. To understand coordination in such systems, we conducted a field study of management of surgical oper-ating rooms. While coordinating interdependencies, such as progress monitoring, scheduling and rescheduling, and prodding, coordinators managed a set of complicated conflicts. They did so opportunistically, to resolve and to prevent conflict. Additionally, coordinators were concerned with perceived fairness. These findings indicate that, in the design of ICT to support coordination, we should examine not only the mechanical articulation of activities and efficient prioritization of resources, but also means to support companion social processes.
Cognition, Technology & Work, 2007
Safe and efficient surgical operations depend on a work environment larger than the individual op... more Safe and efficient surgical operations depend on a work environment larger than the individual operating room (OR) and on communications at different levels of the hospital organization. Extensive communication is needed before and during surgery to ensure that surgical rooms, equipment, and supplies; patients; surgeons; supporting personnel; and accompanying documentation are all ready at the appropriate times. In this article, we compile the results of three of our studies of communication activities outside ORs, with the goal of identifying opportunities and challenges in the workflow of surgery. The first study demonstrates the amount of communication work performed by OR coordinators. The second study demonstrates the potential functions of a whiteboard in communication. The third study describes an organizational learning strategy of proactive event reporting. We apply computersupported cooperative work and organizational learning concepts to the findings and suggest ways in which information technology may improve surgical workflow.
This article describes challenges in the design and development of a decision support system for ... more This article describes challenges in the design and development of a decision support system for trauma patient resuscitation that is used to encourage consistency and reduce error rates. The Trauma Reception and Resuscitation Project links real-time, computer-generated prompts from best practice algorithms via visual and auditory displays. Its functionality is now being tested. Evaluation of this decision support approach can employ patient chart review or observation, but we describe an approach that measures the process of care by video audit. Key process problems in trauma management (e.g., errors of omission, commission, and misprioritization) are identified. The video record provides a framework for learning and feedback. Future testing and development of this system will include a randomized clinical trial and technology enhancement.
JONA: The Journal of Nursing Administration, 2004
Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 1996
Increasingly telecommunication systems have become an integral part of many professions. However,... more Increasingly telecommunication systems have become an integral part of many professions. However, little empirical data and guidelines exist for designing telecommunication systems to facilitate decision makers in cooperative efforts in dynamic task environments. A preliminary experiment was conducted in which the subjects (all experienced in the domain concerned) were presented with video-tapes of previously recorded real-life trauma patient resuscitation. The experiment examined the subjects' ability to understand the status of the patient and resuscitation efforts shown in the video. The experiment was to simulate remote diagnosis tasks in which experts provide consultation through video linkage. The subjects were found to have a number of difficulties in achieving a full understanding. Hypotheses about the reasons that could explain these difficulties are proposed and they include (1) background noise, viewing range restriction, and insecure viewing access to remote sites (2...
Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 1996
The use of simulators for skill evaluation is common in a number of fields, but the effect that v... more The use of simulators for skill evaluation is common in a number of fields, but the effect that various characteristics of simulators have on subject performance is not fully understood. Ten experienced trauma anesthesiologist participated in a full mission simulation of a real video taped trauma case management. This case contained critical events that require the participants to use clinical examinations and familiar and unfamiliar equipment contained in the simulator. Participants' performance differed from both the performance in the real case and ideal performance. The unfamiliarity with one complex piece of the equipment (ventilator function and controls) caused 4 out of 10 participants to be unable to finish the simulation. Surprisingly, unfamiliarity with another piece of equipment (new to all participants) did not have any dramatic impact. Anesthesia simulators have been successfully used in training anesthesiologists, but the demands of evaluation of clinical skills di...
Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 1995
Case rounds are a prominent and important means of training in medical domains. As part of a fiel... more Case rounds are a prominent and important means of training in medical domains. As part of a field study of anesthesiologists’ problem solving activities, we audiotaped the discussion of 10 cases spreading over 4 case rounds. This paper describes the method used in data collection and analysis, followed by the major findings of the study. The study identified three types of skills transferred in case rounds: procedural knowledge, sensitivity to precursors of potential problems, and the ability to prepare for contingencies. The study also showed the potential of case rounds in studying cognitive activities in naturalistic settings.
Dynamic Delegation: Shared, Hierarchical, and Deindividualized Leadership in Extreme Action Teams
Administrative Science Quarterly, 2006
This paper examines the leadership of extreme action teams—teams whose highly skilled members coo... more This paper examines the leadership of extreme action teams—teams whose highly skilled members cooperate to perform urgent, unpredictable, interdependent, and highly consequential tasks while simultaneously coping with frequent changes in team composition and training their teams' novice members. Our qualitative investigation of the leadership of extreme action medical teams in an emergency trauma center revealed a hierarchical, deindividualized system of shared leadership. At the heart of this system is dynamic delegation: senior leaders' rapid and repeated delegation of the active leadership role to and withdrawal of the active leadership role from more junior leaders of the team. Our findings suggest that dynamic delegation enhances extreme action teams' ability to perform reliably while also building their novice team members' skills. We highlight the contingencies that guide senior leaders' delegation and withdrawal of the active leadership role, as well as t...