SPECIAL SECTION: Adapting to New Technology in the Operating Room

Abstract

The effects of new technology on human performance in domains such as anesthesiology, commercial aviation, and nuclear power operations remain controversial. To study the impact of new technology on skilled practitioner performance, we observed the introduction of a new, highly integrated, microprocessor-based physiological monitoring system for use in cardiac anesthesia. The new computer system differed from its predecessors in method of display, human interface, level of integration, and automation of functions. A process-tracing technique was used to examine physician-computer interaction in the context of 22 anesthesia procedures for cardiothoracic surgery, most of which involved cardiopulmonary bypass. Practitioners experienced a series of problems with the new computer system. Computer system characteristics relative to the specific context of cardiac surgery created new cognitive and physical burdens that tended to congregate at times of high demand, the characteristic feature of clumsy automation. Practitioners as individuals and as a group tried to overcome these problems by adapting the computer system (system tailoring) and their behavior (task tailoring) as they learned about the interaction between characteristics of the new system and characteristics of their field of practice.

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References

Billings, C. (1991). Human-centered aircraft automation: A concept and guidelines (NASA Tech. Memorandum 103885). Springfield, VA: National Technical Information Service.

Cook, R. I. , Woods, D. D. , Howie, M. B. , Horrow, J. C. , & Gaba, D. M. (1992). Unintentional delivery of vasoactive drugs with an electromechanical infusion device. Journal of Cardiothoracic and Vascular Anesthesia 6, 238–244.

Flores, F. , Graves, M. , Hartfield, B. , & Winograd, T. (1988). Computer systems and the design of organizational interaction. ACM Transactions on Office Information Systems, 6, 153–172.

Hutchins, E. (1995). Cognition in the wild.. Cambridge: MIT Press.

Malin, J. T. , Schreckenghost, D. L. , Woods, D. D. , Potter, S. S. , Johannesen, L. , Holloway, M. , & Forbus, K. (1991). Making intelligent systems team players: Case studies and design issues, Volume I: Human-computer interaction design (NASA Tech. Memorandum 104738). Springfield, VA: National Technical Information Service.

Norman, D. A (1988). The psychology of everyday things.. New York: Basic Books.

Rasmussen, J. (1986). Information processing and human-computer interaction: An approach to cognitive engineering.. New York: Elsevier.

Reason, J. (1990). Human error.. Cambridge, England: Cambridge University Press.

Rochlin, G. I. , La Porte, T. R. , & Roberts, K. H. (1987). The self-designing high-reliability organization: Aircraft carrier flight operations at sea. Naval War College Review, 40(4), 76–90.

10.

Sarter, N. B. , & Woods, D. D. (1995). How in the world did we ever get into that mode? Mode error and awareness in supervisory control. Human Factors, 37, 5–19.

11.

Suchman, L. (1987). Plans and situated actions: The problem of human-machine communication.. Cambridge, England: Cambridge University Press.

12.

Wiener, E. L. (1985). Beyond the sterile cockpit. Human Factors, 37, 75–90.

13.

Wiener, E. L. (1989). Human factors of advanced technology ("glass cockpit") transport aircraft (NASA Tech. Report 117528). Springfield, VA: National Technical Information Service.

14.

Woods, D. D. (1986). Paradigms for intelligent decision support. In E. Hollnagel , G. Mancini , & D. D. Woods , (Eds.), Intelligent decision support in process environments (pp. 153–173. New York: Springer-Verlag.

15.

Woods, D. D. (1988). Coping with complexity: The psychology of human behavio. in complex systems. In L. Goodstein , H. Andersen , & S. Olsen , (Eds.), Tasks, errors, and mental models (pp. 128–148. Bristol, PA: Taylor & Francis.

16.

Woods, D. D. (1993). Process tracing methods for the study of cognition outside the experimental psychology laboratory. In G. Klein , R. Calderwood , & J. Orasanu , (Eds.), Decision making in action: Models and methods (pp. 228–251. Norwood, NJ: Ablex.

17.

Woods, D. D. , Cook, R. I. , & Billings, C. (1995). The impact of technology on physician cognition and performance. Journal of Clinical Monitoring, 11, 5–8.

18.

Woods, D. D. , Johannesen, L. J. , Cook, R. I. , & Sarter, N. B. (1994). Behind human error: Cognitive systems, computers, and hindsight. Wright-Patterson Air Force Base, OH: Crew Systems Ergonomics Information Analysis Center (CSERIAC).

19.

Richard I. Cook is assistant professor in the Department of Anesthesia and Critical Care at the University of Chicago and director of the Cognitive Technologies Laboratory. He received his M.D. from the University of Cincinnati in 1986 and is a board-certified anesthesiologist.

20.

David D. Woods is associate professor at the Ohio State University (with appointments in industrial and systems engineering, anesthesiology, and industrial design) and codirector of the Cognitive Systems Engineering Laboratory. He received his Ph.D. in cognitive psychology from Purdue University in 1979.