Academic journal article Human Factors

Adapting to New Technology in the Operating Room

Academic journal article Human Factors

Adapting to New Technology in the Operating Room

Article excerpt


Increased computational and graphic capabilities have fueled attempts to automate more of the human operator's role in complex fields of practice such as aircraft flight decks (Billings, 1991), air traffic control, space vehicle systems management (Malin et al., 1991), and surgical operating rooms. Examining new technology introduction has revealed that this change produces complex effects. It does not simply substitute one medium for another (e.g., computerbased for paper; programmed digital for hardwired analog; automatic for manual) while preserving the old ways of doing things. Rather, technological change is an intervention in an ongoing field of activity that produces a complex set of organizational and cognitive reverberations (Flores, Graves, Hartfield, & Winograd, 1988). Changing the extent and type of automation transforms systems, often in unforeseen ways and with unanticipated consequences. Moreover, people who use new computer systems participate in the process of integrating the technology into complex fields of practice, often in ways that are surprising to designers.

Although people usually focus on the possibilities new technology affords, studies have shown that computer systems can create new burdens and complexities for those responsible for operating high-consequence systems (Billings, 1991; Norman, 1988; Woods, Cook, & Billings, 1995). New technology may decrease the operator's physical workload while increasing cognitive workload, especially during critical periods in which cognitive workload is already high - a condition Wiener called clumsy automation (Wiener, 1989). Clumsy automation is a form of poor coordination between human and machine in the control of dynamic processes. Here the benefits from new technology accrue during workload troughs, whereas costs and burdens imposed by the technology (e.g., new tasks, knowledge requirements, communication burdens, attentional demands) occur during periods of peak workload (Sarter & Woods, 1995). Significantly, this can create opportunities for new kinds of system failure that did not exist in older, simpler systems (Woods, Johannesen, Cook, & Sarter, 1994).

We report the results from one study of the impact of technology change on practitioners - those people who do cognitive work to monitor, diagnose, and manage complex systems. In this case the practitioners are anesthesiologists specializing in anesthesia for cardiac surgery.

The computer system studied was a new, highly integrated, microprocessor-based physiological monitoring system, one of several introduced during the past decade. The system integrates the functions of discrete devices, each of which displayed and controlled a single sensor system. The result is a single CRT display with multiple windows and a large space of menu-based options for maneuvering among different representations, options, and special features. In short, this is the kind of computerization that is regarded as a means for improving human performance in medicine and in other fields of practice.

In this study we examined prospectively the effect of this technology change on practitioners. We observed them while they learned to use the new technology as it entered the work environment. We used the resulting data to refine a cognitive task analysis (Rasmussen, 1986) for cardiac anesthesia. The data show how new features and capabilities of the computer system affect cognitive tasks and create new burdens and complexities. The data show that the practitioners are not passive recipients of technology but, rather, active agents who tailor technology to their needs.


The computer system studied was an integrated physiological monitoring system that combines the functions of several different devices within a single computer shell. Changing to the new system involves changes in method of display (all data display occurs through a windowed color CRT), human interface (a menu-based interaction via touch screen), level of integration (all data are centralized in a single viewing mechanism), and automation of functions (aids for computing numerical indices that can be derived from primary, sensed data). …

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