Cognitive Artifacts in Complex Work - Ambient Intelligence for Scientific Discovery - page 157

that information. As an exploratory process, life sciences share little need for
monitoring and scheduling critical events. Instead, experimental work requires
review of information and event over long durations and dynamic updates of
emergent data that inform ongoing processes.
While both domains use the latest operational equipment, they lag in sup-
port for information technology systems. Life sciences quickly adopted experi-
mental systems, biological databases and visualization. Their use of information
resources is surprisingly traditional, with a continuing reliance on the traditional
printed article. Acute care relies on information to provide patient care and coor-
dinate the resources that are required to provide it. As important as information
is in healthcare, computer support has been largely devoted to the blunt (man-
agement) side of the organization for purposes such as billing. The acute care
case is presented first to illustrate the use of cognitive artifacts in a complex
communicative process.
3 Cognitive Work in Acute Care: Scheduling
Health care organizations include tightly constrained teams of service providers
who perform complex procedures that routinely have significant consequences.
At the sharp end of health care, these practitioners apply expertise through ac-
tions in order to produce results [6]. The circumstances for adverse outcomes are
embedded in the conditions and constraints in the workplace. Those conditions
can result from many influences including management (blunt end) policy and
practice [29].
The site where this research was conducted handles roughly 50 to 80 proce-
dures every day in 24 operating rooms (OR). Some of these are brief and take 30
minutes while others last most of the day. Some are routine and their duration
can be predicted reliably, while others are complex and less predictable. Some
procedures will go on as scheduled, while others will be delayed and canceled.
There is always the possibility of an emergent need for an OR and staff to per-
form a procedure. The coordinator's responsibility is to manage staff activities
to accommodate these demands eciently [23].
The work of health care practitioners includes diagnostic and therapeutic
interventions that enable a practitioner to influence the patient's future course.
This work is supported by a large body of knowledge, a tradition of training,
and many artifacts. Practitioner work is not simply about clinical details. It also
includes what has been termed technical work [5]. Each individual procedure
depends on the timely synchronization of people, equipment, tools and facilities.
The collective management of that process throughout an entire day for the
entire suite of operating rooms also requires coordination.
Technical work coordination involves many practical but essential activities
that are needed to carry out clinical care: resource availability assessment, re-
source allocation, anticipation, prediction, trade-off decisions, speculation, and
negotiation among others [5]. Many practitioners consider this type of activity
to be the “background noise” of the workplace. When asked about such issues,