Cognitive Behavior and Clinical Workflows

Abstract

The efficacy and safety of advanced contemporary patient care is contingent on effective collaboration of expert clinicians, professionals and a large support workforce whose communication and data sharing is supported by networks of robust, interoperable information technology. Their intricate work coordination often spans institutional and professional boundaries, individual and collective responsibility, and private and public sets of procedural constraints and dependencies that comprise the exceptionally complex organizational structure of healthcare. Complex work environments engender and foster non-linear, dynamic workflows that are difficult to model and where outcomes are sometimes impossible to consistently predict. Theories from communications sciences, psychology, sociology, management, organizational behavior and human factors research, and derived in part empirically from HIT evaluation and implementation studies are often applied to help explain determinants of technology use behavior. Physical, cognitive and social-behavioral performance of a clinician is affected and constrained by nested structural elements of healthcare organization. Analysis of healthcare work may be done through the conceptual lens of patient trajectory that takes the pathway of an individual patient through the care process as anchor point. It allows patient-oriented workflow models to reference cognitive, social and work behaviors of agents in a complex sociotechnical system where actions are not concentrated around individuals or groups but rather distributed among roles in the work setting that converge around the care of a specific patient. Workflow analyses focus on the embedding of illness trajectory, or the way in which an illness typically unfolds in both sequential and temporal order, and how management and treatment actions are planned within the care process. Delivering complex sets of information and collaboration tools effectively into patient care workflows is an ongoing challenge for HIT designers. Cognitive engineers and others whose work supports complex collaborative processes need to address the challenge of gathering empirical evidence and integrating critical contributions of emergent constructs, mental models and distributed knowledge into workflow analyses.