Cognitive Artifacts in Complex Work - Ambient Intelligence for Scientific Discovery - page 159

elaborate procedures such as institutional review board applications that require
researchers to perform substantial administrative work beyond actual research.
This research study in acute care cognition [23] was conducted over nine
months at a major urban teaching hospital using an ethnomethodological ap-
proach. The researcher performed interviews with 25 nurses and coordinators and
40 anesthesiologists/certified registered nurse anesthetists (CRNA) and anesthe-
sia coordinators at the coordinator station in an operating room (OR) suite. He
reviewed the structure and variations of roughly 15 daily availabilities, master
schedules and OR Graphs over three months. He also made video recordings
of three anesthesia coordinators while each developed a schedule of outpatient
clinic assignments.
Two themes guided this research into practitioner cognition. The first was the
effort to understand the work domain as a complex, high hazard, time-pressured,
interrupt-driven environment. The second was the effort to understand how prac-
titioners manage their work domain using strategies such as anticipation, hedging
and husbanding resources, and making trade-offs.
Surgical and critical care is too complex to understand by simply observing
what happens. So much information is embedded in this environment that the
investigator needs some additional means to understand it. Cognitive artifacts
are that means. Artifacts embody the nature of the technical work that is neces-
sary to plan and manage anesthesia assignments. Artifacts represent the struc-
ture and boundaries of the work domain. This research used four observation
and cognitive systems engineering methods [33] to understand how acute care
team members learn, remember, and make decisions about anesthesia resource
allocation.
Artifact Analysis. Xiao et al [34] describes how practitioners develop artifacts
such as white marker boards on their own. Observing the way that such artifacts
are organized and used enables the researcher to identify critical features of the
domain and work situation. This is because cognitive artifacts typically are used
to support important, dicult activities. The work that the artifact is designed
to support can also be improved by making a better artifact. Better information
design or improved use of information technology can make technical work more
enjoyable, more ecient, and more reliable.
Direct Observation. The researcher watched how clinicians acted, interacted,
and used cognitive artifacts to coordinate work. Understanding emerged from
the researcher's own observations and interviews in the real world. Neither labo-
ratory study, simulation, nor reading, could discover the richness of team activity
in the context that observation captures.
Interviews. Discussions with practitioners can be in-depth, structured sessions,
or informal, spur-of-the-moment queries. Questions can be designed to elicit
critical information. Follow-up queries were used to seek further information
beyond the initial answers that subjects gave. Information from interviews helped
to understand the reasons behind observed behaviors and to discover more about
the context for opinions and actions than the other methods revealed.