ABSTRACT
The synthesis of cognitive system functions in the ICU was built around the
practitioner term bumpable, and it reveals much about discovering patterns in JCSs
at work. To tell the story of the critical incident and put it in context, the account of
how ICUs function is full of details, described in domain terms. But the selection
of what details to notice and how to group them into a coherent description
presupposes a sensitivity to model the ICU as a Joint Cognitive System (JCS) and
to recognize what ICUs adapt around, e.g., bounceback, bedcrunches. The incident
and the larger account of ICUs illustrates Ashby’s Law of Requisite Variety in
action (JCS-Foundations, p. 40). Note that adaptations often become routinized as a standard part of a task or a
role, so that, on the surface, it is difficult to see how these routines are adaptive and
to what they have adapted (cf., the Law of Fluency, p. 20). Similarly, the
adaptations as exercised in everyday practice are not necessarily noteworthy to the
practitioners themselves. Their ability to tell people directly about these processes
is limited, since there is usually a significant gap between what people say they do
and what they are observed to do unless special procedures are used. The synthesis
of cognitive system functions identifies what behavior is adapted to; yet some of
these factors dominate the account of how the JCS works well out of proportion to
their frequency of occurrence. This means that discovery is aided by looking at
situations that are near the margins of practice and when resource saturation is threatened (attention, workload, etc.). These are the circumstances when one can
see how the system stretches to accommodate new demands, and the sources of
resilience that usually bridge gaps.
