Exploring Macrocognitive Healthcare Work: Discovering Seeds for Design Guidelines for Clinical Decision Support

Modern healthcare can be described as a macrocognitive work system. In such systems, people seek to adapt to complexity through functions such as sensemaking, coordinating, and re-planning. Technologies can augment human cognitive abilities for managing attention, recalling information, projecting trajectories, and achieving common ground. The ideal healthcare system would integrate technologies in ways that maximize the ability of humans to adapt to complexity through coordinating and synchronizing activities, and help people anticipate surprise and error ‐ while preserving the clinical experience among clinicians and patients. This paper reports on our effort to explore the macrocognitive work undertaken at a major healthcare network in the United States. Our team conducted 60 cognitive interviews across seven facilities, covering inpatient, outpatient and community-based settings. We report on our approach based in methods of Cognitive Task Analysis. The approach was simultaneously structured and adaptable, and was therefore well suited for exploratory data collection, as it permitted adjustments to the data collection strategy across a wide spectrum of performers, experience-levels, and work contexts. We review our data collection, analysis and representation methodology, and the seeds for design guidelines for clinical decision support that resulted from the effort.