Effective information support tools are challenging to design for fast-paced, information rich, and difficult to predict circumstances, particularly when information is fragmented and sources are dispersed. To explore, we conducted a field study on handover and the associated information work, which included 40 visits and 75 hours of observation and interviews with doctors in a metropolitan emergency department (ED). Beyond information exchange, we found that handovers highlight doctors' proactive approach by anticipating information needs, managing uncertainties arising from dynamic information, and developing patient care plans through multiple contingencies. Expanding on the idea of handover as a multifaceted process rather than a single event, we reinforce existing calls for greater flexibility emphasising that the ascertainment of pertinent information is an ongoing, adaptive process. This work demonstrates that deciding what constitutes relevant information is a priori indeterminate when designing information systems and support tools in environments such as EDs. We propose the preservation of specific ‘relativities’ of information—such as uncertainty, particularity, incompleteness, and temporality—in designing information support tools for dynamic, critical and multi-disciplinary work environments.

There is interest in how clinicians can achieve good awareness of their patients’ wellbeing in a way that is not provided by conventional alarms. Earcons (short abstract sound motifs) provide an alternative. In three experiments we explored how effectively normal and abnormal levels of a patient's heart rate (HR), arterial oxygen saturation (SpO2) and blood pressure (BP) could be conveyed using two different earcon designs: overlapping (individual earcons for each vital sign played at the same time) or serial (individual earcons played one after the other). HR was mapped to the tremolo (sound vibration) rate in short bursts of white noise, SpO2 was mapped to the relative pitch of a tone, and BP was mapped to the range of an upward or downward sweep of pitch (chirp) of a tone. Experiment 1 compared how well non-clinician participants could identify HR and SpO2 using overlapping and serial mappings and found no difference in accuracy either for mapping or across vital signs. Experiment 2 added the BP vital sign, and compared overlapping and serial mappings. Identification accuracy was better with the serial mapping than with the overlapping mapping, and better for HR than for either SpO2 or BP. Experiment 3 replicated Experiment 2 but added conditions in which participants were cued to report a single vital sign in order to check whether memory limits or output interference were constraining the ability to report vital signs. When the cue appeared after the earcons were played, approximating a classic partial report paradigm, there was no improvement in identification accuracy, suggesting that earcon interpretability rather than memory load or output interference was constraining responses. However, when the cue appeared before the earcons were played, identification improved, suggesting that focused attention aided interpretation of the earcons. Although design modifications are needed, the results suggest that three vital signs may best be displayed in serial presentation for clinicians to maintain awareness of a patient's wellbeing in a convenient eyes-free manner.

Supervising anesthesiologists oversee junior anesthesiologists in several operating rooms to instruct and provide advice, and hence ensure high patient safety. Supervisors benefit from good situation awareness but accessing information about multiple patients can be challenging. In a user-centered design process, we have developed an interface concept for a head-worn display (HWD) to support multi-patient monitoring. The design includes data about the patients’ physiology, vital status, vital trends, and medications. We conducted an exploratory evaluation of a prototype in a high-fidelity medical simulation with six supervising anesthesiologists. Our results show that the supervisors’ situation awareness of all simulated operations improved because participants noticed and responded to multiple events over the course of the scenario. However, the supervisors reported increased mental workload due to the constant availability of patient data. We discuss insights about the HWD display, the design process, and the experience and views of staff on using the HWD.

Head-worn displays (HWDs) offer their users high mobility, hands-free operation, and “see-what-I-see” features. In the prehospital environment, emergency medical services (EMS) staff could benefit from the unique characteristics of HWDs. We conducted a field study to analyze work practices of EMS staff and the potential of HWDs to support their activities. Based on our observations and the comments of EMS staff, we propose three use cases for HWDs in the prehospital environment. They are (1) enhanced communication between different care providers, (2) hands-free access to clinical monitoring and imaging, (3) and improved realism of training scenarios. We conclude with a set of design considerations and suggest that for the successful implementation of HWDs in EMS environments, researchers, designers, and clinical stakeholders should consider the harsh outdoor environment in which HWDs will be used, the extensive workload of staff, the complex collaboration performed, privacy requirements, and the high variability of work.

Quick service restaurants (QSRs) are high tempo work environments that require collaboration and communication between crew. In a number of respects, head-worn displays (HWDs) might seem a promising technology to support QSR crew, but on close inspection they raise challenging issues for design. We conducted fieldwork studies at two large QSRs to understand how work is organised, how existing systems are used, and how information is displayed to and communicated between crew. We observed the crew working both routinely and with improvisation, collaboratively and individually, physically and digitally. From our analysis of the field study, we identify tentative use cases for HWDs, but with these also design tensions-that is, opportunities coupled with challenges that appear difficult to circumvent even with modest design proposals. These tensions would require careful consideration if HWDs were to be deployed in in QSRs, given that HWDs are ubiquitous, potentially private, digital, mobile, and able to collect behavioural data.

We describe a work domain analysis of a hydropower plant that operates in the two independent markets, the electricity market and the irrigation market. Based on the results of a work domain analysis, the authors develop configural displays that represent abstract functions of the hydropower system and that are intended as part of an ecological interface. The displays developed cover three critical segments of hydropower system operations: real time power supply operations, water storage management, and electricity trading. We provide detailed descriptions of the displays and of the expected improvements in control quality caused by the each of the displays.

We discuss the phenomenon of system tailoring in the context of data from an observational study of anaesthesia. We found that anaesthetists tailor their monitoring equipment so that the auditory alarms are more informative. However, the occurrence of tailoring by anaesthetists in the operating theatre was infrequent, even though the flexibility to tailor exists on many of the patient monitoring systems used in the study. We present an influence diagram to explain how alarm tailoring can increase situation awareness in the operating theatre but why factors inhibiting tailoring prevent widespread use. Extending the influence diagram, we discuss ways that more informative displays could achieve the results sought by anaesthetists when they tailor their alarm systems. In particular, we argue that we should improve our designs rather than simply provide more flexible tailoring systems, because users often find tailoring a complex task. We conclude that properly designed auditory displays may benefit anaesthetists in achieving greater patient situation awareness and that designers should consider carefully how factors promoting and inhibiting tailoring will affect the end-users' likelihood of conducting tailoring.

A series of experiments using a paradigm called PLAULT, where subjects have to discover the structure of a logical network, is reported. The links in the network are invisible, and subjects have to infer where they are by examining the status of the logic gates under a variety of conditions. Three experiments explore the interaction of features of the task, such as its spatial and graphical complexity, with the cognitive limitations of the learner. A combination of these features predicts which parts of a network subjects can and cannot learn, when knowledge is tested by requiring subjects to draw diagrams of the supposed network structure. These task features also predict efficiency of transfer to a fault diagnosis task. The experiments demonstrate the predictive power that can be gained by identifying task features that are likely to prevent thorough learning of a system. These results are also important for understanding the dissociation of the ability to perform routine tasks and the ability to respond to abnormal events.>

An experiment to examine how a troubleshooter's mental model of a logic network might prejudice his or her ability to diagnose previously unseen faults is discussed. Subjects first inferred the structure of a logic network by viewing it in different states. Most subjects ended up with mental models of the network that were almost, but not completely, correct. Then, in a fault diagnosis phase, subjects diagnosed faults placed in the network by the experimenter. Faults involved the addition of new links or the deletion of existing links. In generating faults for subjects, two factors were varied in a 2*2 design: whether a subject believed a link existed or not and whether that belief was true or false. The ability to detect the symptoms of a fault was not always a guarantee of correct fault diagnosis. Subjects had difficulty diagnosing faults to do with links they believed did not exist, and they found it impossible to diagnose faults that influenced parts of the network about which they had false beliefs.>

Presents a review of some of the areas to which supervisory control theory has been applied and indicate some of the ideas which have as yet not been followed up but which were introduced by Sheridan and his students. Topics covered include: modeling manual and supervisory control tasks; supervisory control of deep-ocean vehicles; technology problems and technology solutions; human integration in a complex world; supervisory control in distributed decision-making; and human supervisor control models in advanced manufacturing systems.>

In some fault-diagnosis situations, troubleshooters may misunderstand system structure and functioning. An experiment examined how a troubleshooter's mental model of a logic network might prejudice the ability to diagnose previously unseen faults. In the knowledge acquisition phase, subjects inferred the structure of a logic network by viewing it in different states. Most subjects ended up with slightly inaccurate mental models of the network. In the fault-diagnosis phase, subjects were required to diagnose novel faults placed in the network. Two factors were varied in a 2*2 design: whether a subject believed a link existed or not, and whether the belief was true or false. Faults involved the addition of new links or the deletion of existing links. Subjects had difficulty diagnosing faults that involved links they believed did not exist and faults that influenced parts of the network about which they had false beliefs, and it was harder for subjects to see that something was wrong with the network if the fault involved a network link they believed not to exist. However, the ability to see the symptoms of the fault was not always a guarantee of correct fault diagnosis.>