ABSTRACT
Despite the complexity of sociotechnical systems such as health care, the critical embedded element-human beings-is often minimized or ignored during the design phases of improvement efforts. The human is frequently considered only after an implementation has not gone well, while the relationships of workers to one another within the work system are rarely acknowledged. This stance is based on outdated assumptions that workers perform in “unsystematic and irrational ways” and that designers are “clumsy or even
CONTENTS
Why Look at Work? ............................................................................................ 153 Work Systems in Health Care ............................................................................ 154 Setting the Stage: Overview of the Surgical Work Environment ................. 155
Team Work within the Cardiac Surgery Microsystem .............................. 159 Methods for Enhanced Information Exchange during Cardiac Surgery: Implementing to Complement Existing Work ................................................ 160 Design and Implementation of a Preoperative Briefing ................................ 161
Motivation ....................................................................................................... 161 Method ............................................................................................................. 162 Developing a Prototype of a Preoperative Briefing Tool/Model ............ 163 Dissemination and Sustainment .................................................................. 166
Design and Implementation of a Surgeon- Perfusionist Communication Protocol ................................................................................... 167
Motivation ....................................................................................................... 168 Method ............................................................................................................. 169 Dissemination and Sustainment .................................................................. 172
Conclusion ........................................................................................................... 172 References ............................................................................................................. 173
stupid” (Vicente 1999, p. xi). Cognitive work analysis (CWA) examines existing work systems and develops recommendations for designing for effective human involvement in the origination and nature of work. CWA views individuals embedded within a work system as “actors” rather than “users,” thus including the human as an influential member of each work system (Vicente 1999). Rasmussen and Vicente describe CWA as a method for truly understanding the influence of the work system and the relationship of its components (i.e., tools, technology, tasks, organization, people, environment, training, etc.) on work performance. Vicente et al. charge that researchers have failed to acknowledge that the system actually shapes worker behaviors, and as such, departures from expected behavior are generally the result of workers being clever, rational, and, more importantly, competent in their current work setting. These features of the “human factor” are imperative for the continuation and optimization of work in any complex system and, as such, must be designed for and optimized within their work system.
