Penelope M. Sanderson

Interruptions in healthcare: Theoretical views

BACKGROUND Researchers in healthcare have begun to investigate interruptions extensively, given evidence for the adverse effects of work interruptions in other domains and given the highly interruptive hospital environment. In this paper, we reviewed literature on interruptions in critical care and medication dispensing settings in search of evidence for a relationship between interruptions and adverse events. METHODS The literature search included the databases MEDLINE, CINAHL+Pre CINHAL, Health Sources: Nursing Academic Edition, EMBASE, PsycINFO, ISI Web of Science and Ergonomics Abstracts. The paper titles and abstracts were subsequently reviewed. After the initial search, we reviewed paper titles and abstracts to define the subset for review. RESULTS We currently lack evidence in healthcare of the extent to which interruptions lead to adverse effects. The lack of evidence may be due to the descriptive rather than causal nature of most studies, the lack of theory motivating investigations of the relationship, the fact that healthcare is a complex and varied domain, and inadequate conceptualizations of accident aetiology. We identify two recent accident theories in which the relationship between activity and medical errors is complex, indicating that even when it is sought, causal evidence is hard to find. DISCUSSION Future research on interruptions in healthcare settings should focus on the following. First, prospective memory research and distributed cognition can provide a theoretical background for understanding the impact of interruptions and so could provide guidance for future empirical research on interruptions and the planning of actions in healthcare. Second, studying how interruptions are successfully rather than unsuccessfully overcome may better help us understand their effects. Third, because interruptions almost always have positive and adverse effects, more appropriate dependent variables could be chosen.

The human planning and scheduling role in advanced manufacturing systems: an emerging human factors domain

Advanced manufacturing technology is quickly displacing humans from the factory floor, but relatively little is known about how much responsibility humans should retain over plant operation. Scheduling operations are particularly critical to maintaining overall manufacturing system performance, and many researchers argue that humans should be retained in the control loop for this task. This paper critically reviews work done over the last 25 years on human scheduling abilities. The increasing amount of empirical work on human scheduling ability is widely dispersed, and many researchers are not aware of one anothers work. Current work on manufacturing scheduling, field studies, and laboratory work on human scheduling abilities are reviewed. Methodological and conceptual problems are highlighted. The intention is to provide a sounder basis for future research on the human scheduling role by providing knowledge of what has been examined in the past and an awareness of the important issues for the future

Designing teams for first-of-a-kind, complex systems using the initial phases of cognitive work analysis: case study.

We present a technique for team design based on cognitive work analysis (CWA). We first develop a rationale for this technique by discussing the limitations of conventional approaches for team design in light of the special characteristics of first-of-a-kind, complex systems. We then introduce the CWA-based technique for team design and provide a case study of how we used this technique to design a team for a first-of-a-kind, complex military system during the early stages of its development. In addition to illustrating the CWA-based technique by example, the case study allows us to evaluate the technique. This case study demonstrates that the CWA-based technique for team design is both feasible and useful, although empirical validation of the technique is still necessary. Applications of this work include the design of teams for first-of-a-kind, complex systems in military, medical, and industrial domains.

Evaluating Design Proposals for Complex Systems with Work Domain Analysis

In this paper we propose a new framework for evaluating designs based on work domain analysis, the first phase of cognitive work analysis. We develop a rationale for a new approach to evaluation by describing the unique characteristics of complex systems and by showing that systems engineering techniques only partially accommodate these characteristics. We then present work domain analysis as a complementary framework for evaluation. We explain this technique by example by showing how the Australian Defence Force used work domain analysis to evaluate design proposals for a new system called Airborne Early Warning and Control. This case study also demonstrates that work domain analysis is a useful and feasible approach that complements standard techniques for evaluation and that promotes a central role for human factors professionals early in the system design and development process. Actual or potential applications of this research include the evaluation of designs for complex systems.

Designing for attention with sound: Challenges and extensions to ecological interface design

Objective: We explore whether ecological interface design (EID) principles can be applied to the design of an auditory display for anesthesia monitoring. Background: EID examples focus almost exclusively on visual displays. In the anesthesia work environment, however, auditory displays may provide better individual and team awareness of patient state. Method: Using a work domain analysis of physiological monitoring in anesthesia, we identify information to display. Using the skills, rules, and knowledge distinction we identify cognitive control needed. Using semantic mapping we map physiological variables and constraints to auditory dimensions. Results: EID principles do not address when information should be displayed and to whom. An attentional mapping stage helps to specify answers to these questions so that a workable auditory display for anesthesia monitoring is achieved. Conclusion: EID principles of representing work domain functional structure and minimizing resource-demanding cognitive control are necessary but insufficient to specify requirements for an effective auditory display. Also needed are analyses of control tasks, strategies, and the social organization of work. Such analyses are an integral part of the broader cognitive work analysis framework from which EID emerged. Application: Actual or potential uses of this research include the design of displays that support continuous peripheral awareness in collaborative multimodal work environments.

Emergent features in visual display design for two types of failure detection tasks

Visual display design for dynamic systems may be helped by exploiting emergent features that allow subjects to easily distinguish different states of the system. Three different types of displays were compared—two object displays and one separated display—each in a version that had a salient emergent feature that distinguished normal and failed states and in a version that did not have such an emergent feature. Subjects monitored for global and local failures simultaneously, which presented demands similar to integrated and separated tasks, respectively. Displays with salient emergent features supported superior global failure detection and may also have helped local failure detection. An object display with a salient emergent feature supported both types of failures better than or at least as well as the other displays. This advantage was attributed to the fact that the display had a salient emergent feature rather than to the fact that it was an object display. This research shows that emergent features can be effectively exploited to support tasks involving both integration of information and attention to individual data sources.

Sonification Supports Eyes-Free Respiratory Monitoring and Task Time-Sharing

Three experiments explored the effectiveness of continuous auditory displays, or sonifications, for conveying information about a simulated anesthetized patients respiration. Experiment 1 established an effective respiratory sonification. Experiment 2 showed an effect of expertise in the use of respiratory sonification and revealed that some apparent differences in sonification effectiveness could be accounted for by response bias. Experiment 3 showed that sonification helps anesthesiologists to maintain high levels of awareness of the simulated patients state while performing other tasks more effectively than when relying upon visual monitoring of the simulated patient state. Overall, sonification of patient physiology beyond traditional pulse oximetry appears to be a viable and useful adjunct to visual monitors. Actual and potential applications of this research include monitoring in a wide variety of busy critical care contexts.

Work Domain Analysis for Training-System Definition and Acquisition

Training-needs analysis is critical for defining and procuring effective training systems. However, traditional approaches to training-needs analysis are not suitable for capturing the demands of highly automated and computerized work domains. In this article, we propose that work domain analysis can identify the functional structure of a work domain that must be captured in a training system, so that workers can be trained to deal with unpredictable contingencies that cannot be handled by computer systems. To illustrate this argument, we outline a work domain analysis of a fighter aircraft that defines its functional structure in terms of its training objectives, measures of performance, basic training functions, physical functionality, and physical context. The functional structure or training needs identified by work domain analysis can then be used as a basis for developing functional specifications for training systems, specifically its design objectives, data collection capabilities, scenario genera...

Ecological Interface Design for Pasteurizer II: A Process Description of Semantic Mapping

Ecological interface design (EID) is proving to be a promising approach to the design of interfaces for complex dynamic systems. Although the principles of EID and examples of its effective use are widely available, few readily available examples exist of how the individual displays that constitute an ecological interface are developed. This paper presents the semantic mapping process within EID in the context of prior theoretical work in this area. The semantic mapping process that was used in developing an ecological interface for the Pasteurizer II microworld is outlined, and the results of an evaluation of the ecological interface against a more conventional interface are briefly presented. Subjective reports indicate features of the ecological interface that made it particularly valuable for participants. Finally, we outline the steps of an analytic process for using EID. The findings presented here can be applied in the design of ecological interfaces or of configural displays for dynamic processes.

Are Melodic Medical Equipment Alarms Easily Learned

BACKGROUND:We tested melodic auditory alarms recommended in the IEC 60601-1-8 standard for medical electrical equipment for ease of learning and discrimination, and for effectiveness during a timeshared task. METHODS:Twenty-two critical care nurses learned the IEC 60601-1-8 melodic alarms over two training sessions more than a week apart, with or without mnemonics suggested in the standard. Subsequently, the nurses identified alarms arriving at quasi random intervals while performing a timeshared arithmetic task. RESULTS:Only one nurse (4.5%) identified the alarms with 100% accuracy after two training sessions. Mnemonics did not improve overall alarm identification accuracy (mnemonic = 56%, nonmnemonic = 55%) but led to a narrower range of confusions between alarms. Nurses responded faster (P < 0.0001) and more accurately (P = 0.032) to medium priority than high priority alarms, despite rating high priority alarms as sounding more urgent (P < 0.0001). Nurses with at least 1 yr of formal musical training identified the alarms much more accurately (musical training = 73%, no musical training = 38%, P < 0.0001), perceived a greater distinction between high and medium priority alarms (P = 0.002), and found identifying the alarms easier overall (P = 0.023). During the timeshared task, nurses’ responses were slower (P = 0.002) and became less accurate (P = 0.02). CONCLUSIONS:The slow rate of learning and persistent confusions suggest that the IEC 60601-1-8 melodic alarms should be redesigned before they are adopted for clinical practice.