Cognitive Artifacts in Complex Work - Ambient Intelligence for Scientific Discovery - page 158

Fig. 1. Hard Copy of the Master Schedule.

clinicians identify technical work issues as merely “the way we do things around
here.” Yet the details of technical work are not trivial. Technical work is in-
timately related to clinical care and it exerts real influences on decisions that
are made [25]. Practitioners have created cognitive artifacts in order to assist
the technical work of scheduling and managing anesthesia resources. The mas-
ter schedule (Fig. 1) is the primary artifact that a coordinator creates the day
before procedures and embodies all of the assignment information that matters
in this work setting. It is one of many artifacts that are created in order to re-
duce uncertainty to a minimum, which is essential to effectively manage resource
allocation in this variable, ever-changing, contingent, high risk setting.
Berg [3] and Heath and Luff [9] describe the failure of computer-supported
information systems that were intended to support sharp end cognitive work.
Those failures were due in large part to the system developers' poor grasp of
the actual nature of work at the sharp end. Those who would develop ambient
information systems for health care need to understand what they intend to
support. The following section describes a research approach to accomplish that.

3.1 Research Method

Research into cognitive activity in surgical and critical care is dicult for a
number of reasons. Care settings, patient populations and system constraints
vary widely. Practitioners often suffer from poor insight into how their work is
organized. Information and interaction at the sharp end is dense and complex.
In addition, technical work is poorly recognized as an aspect of medical care.
Recent initiatives to protect care provider and patient privacy have resulted in