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Development and evaluation of an offshore oil and gas Emergency Response Focus Board
Abstract
IntroductionThe primary objective of this research was to explore the use of an interactive whiteboard as an Emergency Response Focus Board (ERFB) for offshore emergency response teams (ERT) during a training and assessment process.Methods
Thirty-seven participants completed simulation testing in a randomized study design with two visual display conditions (static and dynamic display). Outcome measures included speed and accuracy of response to situation awareness questions presented orally during three separate simulation freezes, and self-rating of performance.ResultsResults indicate that the type of ERFB display significantly influenced the speed and accuracy of responses. Qualitative results indicate that situation awareness was increased when using the dynamic ERFB.Conclusions
It can be concluded that the dynamic ERFB offers an objective measure of performance and as a consequence, it is recommended that dynamic ERFBs be implemented into future offshore emergency response assessment training.Relevance to industryGiven the enormous amount of information available during an emergency, the dynamic ERFB offers an improved system for data logging, consolidation of information, and greater comprehension of relevant resource allocation factors.
... The types of action teams examined in the literature have been quite diverse. These include teams working in mission control (e.g., Onken, 2013), aviation (e.g., Chiappe et al., 2012;Liang, Lin, Hwang, Wang, & Patterson, 2010), traffic operations (e.g., Glynn, 2011), the military (e.g., Chen & Barnes, 2012;Fischer, 2011), emergency response (e.g., Heard, Thakur, Losego, & Galluppi, 2014;Lewis et al., 2011;Taber, McCabe, Klein, & Pelot, 2013), sports (e.g., De Keukelaere, Kermarrec, Bossard, Pasco, & De Loor, 2013), nursing (e.g., Deckers, 2011), and surgery (e.g., Blavier & Nyssen, 2010). ...
... Other than system design and evaluation studies, research in this area has focused on identifying common attributes of technological a rtefacts that enable the formation of situation awareness. These attributes include using displays that are interactive (Taber et al., 2013), reducing cognitive load by enabling a common operational picture among team members (Banks & McKeran, 2005;Funke & Galster, 2009;Seppänen, Mäkelä, Luokkala, & Virrantaus, 2013), and automating the retrieval of regularly accessed information (Glynn, 2011). ...
... Ironically, situation awareness is often evaluated only once within longitudinal studies in which other variables are evaluated over time (e.g., Funke & Galster, 2009;Mackintosh et al., 2009). Moreover, in studies that measure situation awareness over multiple time points, the data are often averaged during analyses (e.g., Sulistyawati et al., 2009;Taber et al., 2013). In a notable exception, Saner and c olleagues (2009) examined changes in SAGAT across five different scenarios within 2 hours. ...
This chapter focuses on team mental models (TMM) (shared, organized understanding of teamwork and taskwork knowledge) and team situation awareness (TSA, shared knowledge about current and future environmental events) because both capture unique aspects of team cognition, and derive from distinct literatures and methodologies. It provides an integrative review across TMM and situation awareness domains, answering the call for greater synthesis across team cognition constructs. After providing a brief overview of team cognition, TMMs and situation awareness, the chapter presents an integrative framework and identifies future research needs. As a multidimensional construct, team cognition comprises many specific exemplars, and the authors chose to focus on TMM and situation awareness, which emphasize knowledge content. To avoid redundancy with comprehensive reviews of the research on TMMs and situation awareness, the individual coverage of each construct emphasizes current research.
... The ability to wait to answer probes until the participant is ready was also found to create a problem, systematically biasing SPAM results toward lower workload periods (Cunningham et al., 2015;Loft et al., 2016;Trapsilawati, Wickens, Qu, & Chen, 2016). In addition, problems with speed-accuracy tradeoffs were found (Alexander & Wickens, 2004, 2005Jones & Endsley, 2004;Morgan, Chiappe, Kraut, Strybel, & Vu, 2012;Taber, McCabe, Klein, & Pelot, 2013), showing that the ability to look at displays while answering questions via SPAM fails to capture SA as an ongoing understanding of the world, but rather measures people's ability to look up information. ...
... In examining the nine studies that measured both SAGAT and subjective confidence in SA, five studies did not report correlation assessments (Lichacz, Cain, & Patel, 2003;Selkowitz, Lakhmani, & Chen, 2017;Sulistyawati et al., 2009Sulistyawati et al., , 2011Taber et al., 2013). Two studies reported no significant correlation between subjective confidence level and SAGAT (Endsley et al., 1998;Hamilton et al., 2017), and three studies reported a weak correlation (Lee, 1999;Lichacz, 2008Lichacz, , 2009. ...
A review of 37 studies that included both objective and subjective measures of situation awareness (SA) was conducted. Objective and subjective measures of SA were found to diverge across a wide range of measurement techniques. Reasons for these differences include a lack of meta-awareness about one’s own SA, poor SA/confidence calibration, and confounds with workload among some measures. A model that shows how objective and subjective SA combine to affect performance is presented.
... The Deepwater oil rig explosion in 2010 is one of the causes of human error. The accident killed 11 people and lost $ 44 billion in assets (14). In December 2009, a large fire broke out in the surface water canal under the maintenance of the ancillary service pipelines in the Mahshahr petrochemical area. ...
... Since these researches have considerable contributions in theoretical and practical aspects to the maritime transportation industry, most of them mainly suffer one major limitation: not to use a marine-specific method. There are also some studies related to human error prediction to monitoring human reliability performance in offshore operations (Konstandinidou et al. 2006;Turan et al. 2011;Taber et al. 2013;Zhang and Tan 2018) and a study of the current generation of quantitative risk analysis in the off-shore petroleum industry (Zhen et al. 2020). In the context of maritime HRA, there is a lack of research in the literature to adopt marine-specific PSF in evaluating the performance of human reliability. ...
Preparation for a sea voyage is one of the fundamental aspects of navigation. Several complexities are involved during the preparation of the ship for navigation due to the nature of maritime work. At this point, analysing human-related error is of paramount importance to ensure the safety of the ship and the crew. This paper describes the principles of a methodology, namely fuzzy-based shipboard operation human reliability analysis (SOHRA), to quantitatively perform human error assessment through procedures of preparing the ship for navigation. While the SOHRA (a marine-specific HRA approach) quantifies human error, the fuzzy logic deals with ambiguity and vagueness in the human error detection problem. The findings show that the total HEP (Human error probability) is found 1.49E-01 for preparing the ship for navigation. Consequently, the paper provides practical contributions to shore-based safety professionals, ship managers, and masters of the ship since it performs a systematic human reliability assessment and enhances safety control levels in the operational aspect.
... Due to the large amount of complex information faced by ER disaster personnel, an individual experiencing cognitive overload can consequently fail to recognise relevant information, leading to poor decisions and becoming a 'bottleneck' to information sharing. Taber, McCabe, Klein and Pelot [67] examined prototype software applications to support SA of ER personnel by decreasing mental workload. Comparing different whiteboard configurations (a traditional static whiteboard and a dynamic electronic whiteboard) their results indicated increased SA in the dynamic condition. ...
Automated shuttles are currently being trialed as a new transport solution however to date there has been a lack of studies investigating how other road users interact with these new types of vehicles. The aim of this study was to understand the situation awareness (SA) of road users (driver, cyclist, motorcyclist, pedestrian) interacting with an automated shuttle on a public road. Naturalistic data were collected, and the Event Analysis of Systemic Teamwork was used to develop task, social and information networks for a scenario when all four road user types interacted with the automated shuttle at a T-intersection. The findings provide early insights into SA of different road users when interacting with automated shuttles at unsignalized intersections. Such insights could be used to improve the design of shuttles and road environments to support the SA and decision making of human road users.
... Due to the large amount of complex information faced by ER disaster personnel, an individual experiencing cognitive overload can consequently fail to recognise relevant information, leading to poor decisions and becoming a 'bottleneck' to information sharing. Taber, McCabe, Klein and Pelot [67] examined prototype software applications to support SA of ER personnel by decreasing mental workload. Comparing different whiteboard configurations (a traditional static whiteboard and a dynamic electronic whiteboard) their results indicated increased SA in the dynamic condition. ...
Effective emergency response to any disaster is predicated on successful multi-agency coordination, which in turn relies on agencies to understand ‘what is going on’, generally known as Situation Awareness (SA). SA can be viewed from an individual, team or a systems perspective. Research in other safety critical environments and multi-team systems that have adopted a systems thinking perspective indicates that Distributed Situation Awareness (DSA) may be a suitable theoretical framework to use when attempting to understand and optimise multi-agency emergency response (ER) systems. Despite its popularity in other domains, it is unclear the extent to which the DSA perspective has been applied in the ER context. The aim of this review is to provide an overview of the current literature in the area of SA in multi-agency disaster response, and to establish the extent to which the theory of DSA has been examined in this context. A structured search of the literature identified only one study that applied the established DSA methodology to their research. Findings from this review reveal a knowledge gap exists in investigating SA from a systems perspective in ER and therefore future research utilising the theory of DSA in this domain is warranted.
... They found that SA queries were more accurate when the displays remained visible, as would be expected, but that response time was almost 2 s slower, revealing a significant speed-accuracy tradeoff. Several other studies have also found speed-accuracy tradeoffs for SPAM and real-time probe measures (Alexander & Wickens, 2004Jones & Endsley, 2004;Taber, McCabe, Klein, & Pelot, 2013). In general, it appears that people will look to check before answering queries if the information is available, showing that SPAM more accurately assesses the time for people to look-up information on a display, regardless of whether they know the answer. ...
Objective
To examine evidence of sensitivity, predictiveness, and methodological concerns regarding direct, objective measures of situation awareness (SA).
Background
The ability to objectively measure SA is important to the evaluation of user interfaces and displays, training programs, and automation initiatives, as well as for studies that seek to better understand SA in both individuals and teams. A number of methodological criticisms have been raised creating significant confusion in the research field.
Method
A meta-analysis of 243 studies was conducted to examine evidence of sensitivity and predictiveness, and to address methodological questions regarding Situation Awareness Global Assessment Technique (SAGAT), Situation Present Assessment Technique (SPAM), and their variants.
Results
SAGAT and SPAM were found to be equally predictive of performance. SPAM (64%) and real-time probes (73%) were found to have significantly lower sensitivity in comparison to SAGAT (94%). While SAGAT was found not to be overly memory reliant nor intrusive into operator performance, SPAM resulted in problems with intrusiveness in 40% of the studies examined, as well as problems with speed-accuracy tradeoffs, sampling bias, and confounds with workload. Concerns about memory reliance, the utility of these measures for assessing Team SA, and other issues are also addressed.
Conclusion
SAGAT was found to be a highly sensitive, reliable, and predictive measure of SA that is useful across a wide variety of domains and experimental settings.
Application
Direct, objective SA measurement provides useful and diagnostic insights for research and design in a wide variety of domains and study objectives.
Regular performance assessment is an integral part of (high-) risk industries. Past research shows, however, that in many fields, inter-rater reliabilities tend to be moderate to low. This study was designed to investigate the variability of performance assessment in a naturalistic setting in aviation. A modified think-aloud protocol was used as research design to investigate the reasoning pairs of pilots use to assess the performance of an airline captain in a high-risk situation. Standard protocol analysis and interaction analysis methods were employed in the analysis of transcribed verbal protocols. The analyses confirm high variability in performance assessment and reveal the good, albeit fuzzy, justifications that assessor pairs use to ground their assessments. A fuzzy logic model exhibits a good approximation between predicted and actual ratings. Implications for the practice of performance assessment are provided.
Relevance to industry
Many industries aim at achieving consistency in identifying true performance levels. However, if the variability in performance assessment is a real phenomenon, as reported here, then practitioners and researchers might have to test whether it can be used positively, e.g., as opportunity for improving the resilience of crews.
This study examined the validity of real-time probes as measures of situation awareness (SA). Real-time probes are verbal queries (derived from an SA requirements analysis) posed to the operator concurrent with operations. Mixed results were obtained. A weak but significant correlation was found between real-time probes (both accuracy and latency measures) and Situation Awareness Global Assessment Technique queries, indicating that real-time probes were measuring some facet of SA. However, correlations with workload were also found, and this correlation needs to be investigated further. Although real-time probes show promise, more research is needed to assess the utility of real-time probes as a metric of SA.
In this study, air traffic control instructors controlled simulated traffic while three techniques for determining situation awareness (SA) were implemented. SA was assessed using a self-report measure (SART); a query method that removed information on the plan-view display (SAGAT); a query technique that did not have a memory component (SPAM); and the detection of errors integrated into the scenarios (implicit performance). We used these measures of SA together with a measure of workload, NASA TDC, to predict two different performance measures. One performance measure was an over-the-shoulder, subjective assessment by a subject matter expert (SME). The other performance measure was a count of the number of control actions remaining to be performed at the end of the scenario. The SME evaluation was predicted by workload and the controller's appreciation of both the present and the future. The remaining-actions count (RAC) was predicted by the controller's appreciation of the future. In fact, an appreciation of the present led to poorer RAC scores: The better the participant was at answering questions about the present or the better he or she understood the present situation, the larger the number of actions remained to be performed. The results have implications for the relationships among workload, situation awareness, and performance, and suggest limitations on several of the measures currently proposed as SA techniques. The results confirm that future versus present is an important conceptual difference in air traffic control. More importantly, the results suggest that a controller who remains overly focused on the present may do so at the expense of the future.
In order to improve our understanding of situation awareness (SA) in teams performing in technologically advanced command, control, and communications (C3) operations, researchers need to develop valid approaches to assess both individual and shared SA. We investigated SA in an interdisciplinary military rescue operation training exercise. For this study, we developed procedures to measure the degree of shared SA between two team members and to improve the accuracy of their shared SA scores. We suggest that SA scores that are calculated using many existing methods may be inflated because they often fail to account for error in terms of both the amount of information that is thought to be relevant and in the accuracy of a person's knowledge of it. We calculated true SA scores that account for both of these types of error. The measures were then used to evaluate five potential predictors of shared SA. Our analysis suggested that failure to compensate for error in SA may lead to overestimation of performance in a situation. The results also revealed a significant relationship between shared SA and participants' distance from a central, joint service team, which acted as the organizational hub within the C3 structure. Shared SA was better the further away from the hub people were, which suggests that a person's role and position within an organization affects the level of shared SA that can be achieved with other individuals.
We report from a case study of the implementation of an electronic whiteboard system at two emergency departments at Danish hospitals. The purpose of the whiteboards is to support the clinicians in maintaining an overview of the patients at the departments. The electronic whiteboard system was designed in collaboration with clinicians from the departments. Compared to existing dry-erase whiteboards, the electronic whiteboards present more information and allow some automated updating. Based on observations supported by interviews we describe how tradition and transcendence were balanced in the implementation of the whiteboards at the two emergency departments. The electronic whiteboards were initially configured to resemble the dry-erase whiteboards and then gradually reconfigured and extended through an improvisational process, along with changes in the clinicians' work practices.
The present study examined the long-term usefulness of estimated parameters used to adjust the scores from a performance assessment to account for differences in rater stringency. Ratings from four components of the USMLE® Step 2 Clinical Skills Examination data were analyzed. A generalizability-theory framework was used to examine the extent to which rater-related sources of error could be eliminated through statistical adjustment. Particular attention was given to the stability of these estimated parameters over time. The results suggest that rater stringency estimates obtained at a point in time and then used to adjust ratings over a period of months may substantially decrease in usefulness. In some cases, over several months, the use of these adjustments may become counterproductive. Additionally, it is hypothesized that the rate of deterioration in the usefulness of estimated parameters may be a function of the characteristics of the scale.
The theoretical framework presented in this article explains expert performance as the end result of individuals' prolonged efforts to improve performance while negotiating motivational and external constraints. In most domains of expertise, individuals begin in their childhood a regimen of effortful activities (deliberate practice) designed to optimize improvement. Individual differences, even among elite performers, are closely related to assessed amounts of deliberate practice. Many characteristics once believed to reflect innate talent are actually the result of intense practice extended for a minimum of 10 yrs. Analysis of expert performance provides unique evidence on the potential and limits of extreme environmental adaptation and learning. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Several CSCW studies have shown that coordination of work in hospitals is particular challenging, and that clinicians put much ef- fort into maintaining mutual awareness on the flow of work. De- spite these apparent challenges, very little work has been done to design technology which helps people coordinate highly coopera- tive work in such a critical setting. In this paper we propose a novel way of supporting coordination in this hectic and time-critical en- vironment. AwareMedia is a system which promotes social, spa- tial, and temporal awareness in combination with a shared messag- ing system. AwareMedia runs on large interactive displays situated around the hospital, and it is designed especially to support coor- dination at an operation ward. We present the design, implemen- tation, and deployment of AwareMedia and based on preliminary data from our on-going deployment, we discuss how AwareMedia is working in-situ.
This paper discusses challenges to coordination in the emergency operations center (EOC). A county-level EOC is made up of
representatives from a range of organizations including local government, fire, police, hospital, utility, and Red Cross representatives.
These ad hoc teams are tasked with coming together during an emergency to obtain and deliver resources to first responders
on the scene of the disaster, as well coordinating transportation of casualties, tracking of fatalities, and establishment
of shelters. Two county-level exercises were observed. Themes were identified across the two exercises. Recommendations for
better supporting coordination in crisis management are offered.
Distributed cognition as an approach to collaborative work holds that a work unit is cognitive system in which cognitive activities are carried out jointly by workers with the use of tools. This approach has several direct implications to the study of collaborative work. In this paper, we analysed staff interactions with a large display board in a Level I trauma centre operating room unit. Coordination needs are exacerbated by the unpredictability of incoming emergency surgery patients admitted to the trauma centre as well as other contingencies (such as changes in scheduled surgery cases or staffing). The public display board has evolved into a key component for supporting collaborative work. The physical and perceptual properties of the board are exploited by the clinicians to support rapid paced, highly dynamic work. The canvas-like appearances of the display board, combined with magnetic objects attached to the board, afford its users to taylor the board as an effective coordinative tool and to invent new ways of representing information. Based on the concept of display-based cognition, our analysis illustrates the role of public displays in facilitating negotiation of scheduling, joint planning, and augmenting inter-personal communication.
An activity is inseparably bound up with time, and interdependent cooperative activities thus need to be coordinated in time. The nature of time is therefore an ever-present issue in the design of computer systems supporting coordination. Based on Activity Theory this paper defines the concept of Temporal Coordination. Then, based on in-depth studies of the socio-temporal aspects of coordinating cooperative work at hospitals, the paper explores this notion of temporal coordination. This analysis identifies some of the highly intertwined temporal problems, constraints, interests, and conflicts, which arise when work subject to temporal limits is to be coordinated. The paper then introduces the PATIENT SCHEDULER, which is a prototype designed during this project to illustrate how aspects of temporal coordination can be supported by computer technology.
This paper presents a theoretical model of situation awareness based on its role in dynamic human decision making in a variety of domains. Situation awareness is presented as a predominant concern in system operation, based on a descriptive view of decision making. The relationship between situation awareness and numerous individual and environmental factors is explored. Among these factors, attention and working memory are presented as critical factors limiting operators from acquiring and interpreting information from the environment to form situation awareness, and mental models and goal-directed behavior are hypothesized as important mechanisms for overcoming these limits. The impact of design features, workload, stress, system complexity, and automation on operator situation awareness is addressed, and a taxonomy of errors in situation awareness is introduced, based on the model presented. The model is used to generate design implications for enhancing operator situation awareness and future directions for situation awareness research.
Methodologies for the empirical measurement of situation awareness are reviewed, including a discussion of the advantages and disadvantages of each method and the potential limitations of the measures from a theoretical and practical viewpoint. Two studies are presented that investigate questions of validity and intrusiveness regarding a query-based technique. This technique requires that a simulation of the operational tasks be momentarily interrupted in order to query operators on their situation awareness. The results of the two studies indicate that the query technique is not intrusive on normal subject behavior during the trial and does not suffer from limitations of human memory, which provides an indication of empirical validity. The results of other validity studies regarding the technique are discussed along with recommendations for its use in measuring situation awareness in varied settings.
After making a choice between 2 objects, people reevaluate their chosen item more positively and their rejected item more negatively (i.e., they spread the alternatives). Since Brehm's (1956) initial free-choice experiment, psychologists have interpreted the spreading of alternatives as evidence for choice-induced attitude change. It is widely assumed to occur because choosing creates cognitive dissonance, which is then reduced through rationalization. In this article, we express concern with this interpretation, noting that the free-choice paradigm (FCP) will produce spreading, even if people's attitudes remain unchanged. Specifically, if people's ratings/rankings are an imperfect measure of their preferences and their choices are at least partially guided by their preferences, then the FCP will measure spreading, even if people's preferences remain perfectly stable. We show this, first by proving a mathematical theorem that identifies a set of conditions under which the FCP will measure spreading, even absent attitude change. We then experimentally demonstrate that these conditions appear to hold and that the FCP measures a spread of alternatives, even when this spreading cannot have been caused by choice. We discuss how the problem we identify applies to the basic FCP paradigm as well as to all variants that examine moderators and mediators of spreading. The results suggest a reassessment of the free-choice paradigm and, perhaps, the conclusions that have been drawn from it.
This article summarizes two articles by Endsley on situation awareness (SA) and presents the influence of the concept on subsequent practice and theory of human factors.
In her articles, Endsley integrated and consolidated existing research done in the prior decade.
I carefully examined and integrated subsequent articles on the SA topic written by Endsley and by others.
This integration revealed that SA has been applied to areas of training, error analysis, design, selection, teamwork, and automation. Some key issues related to automation and SA are reviewed in detail.
Situation awareness is a viable and important construct that still possesses some controversy over measurement issues.
Ways in which human factors practitioners have used the SA construct and numerous citations are provided to assist designers.
Two experiments explored the attention and memory processes governing sensorimotor skill. Experiment 1 compared novice and experienced golf putting performance in single-task (putting in isolation) and dual-task conditions (putting while performing an auditory word search task). At specific intervals, participants also produced episodic descriptions of specific putts. Experiment 2 assessed novice performance following training on the same putting task. In Experiment 1, experienced golfers did not differ in putting accuracy from single-to dual-task conditions and, compared to novices, had higher recognition memory for words heard while putting but diminished episodic memories of specific putts. However, when using an s-shaped arbitrarily weighted "funny putter" designed to disrupt the mechanics of skill execution, experienced golfers produced extensive episodic memories of specific putts but showed decreased dual-task putting accuracy and recognition memory for secondary task words. Trained novices produced results intermediate between the untrained novices and experienced golfers. As predicted by current theories of practice-based automaticity, expertise leads to proceduralized control that does not require constant attention. Resources are free to devote to secondary task demands, yet episodic memory for primary task performance is impoverished. Novel task constraints (e.g., a funny putter) increase attention to execution, compromising secondary task performance but enhancing memory for skill execution.
There are numerous organizational issues that confront the nation's emergency departments. This article will emphasize how obtaining staff buy-in is crucial to the success of the Electronic Tracking Board. A philosophy and strategies are recommended for the development of the board. The article will also discuss how the tracking board enhanced the overall organization of the department and decreased the length of stay for patients.
Introduction Private Versus Public Sectors Management Practices Best Practices Conclusions References
The focus of this work is on prediction of human error probabilities during the process of emergency musters on offshore oil and gas production platforms. Due to a lack of human error databases, and in particular human error data for offshore platform musters, an expert judgment technique, the Success Likelihood Index Methodology (SLIM), was adopted as a vehicle to predict human error probabilities. Three muster scenarios of varying severity (man overboard, gas release, and fire and explosion) were studied in detail. A panel of 24 judges active in the offshore oil and gas industry provided data for both the weighting and rating of six performance shaping factors. These data were subsequently processed by means of SLIM to calculate the probability of success for 18 muster actions ranging from point of muster initiator to the final actions in the temporary safe refuge (TSR). The six performance shaping factors considered in this work were stress, complexity, training, experience, event factors and atmospheric factors.
In a recent paper, Hu, Ericsson, Yang, and Lu (2009) found that an ability to memorize very long lists of digits is not mediated by the same mechanisms as exceptional memory for rapidly presented lists, which has been the traditional focus of laboratory research. Chao Lu is the holder of the Guinness World Record for reciting the most decimal positions of pi, yet he lacks an exceptional memory span for digits. In the first part of this paper we analyzed the reliability and structure of his reported encodings for lists of 300 digits and his application of the story mnemonic. Next, his study and recall times for lists of digits were analyzed to test hypotheses about his detailed encoding processes, and cued-recall performance was used to assess the structure of his encodings. Three experiments were then designed to interfere with the uniqueness of Chao Lu's story encodings, and evidence was found for his remarkable ability to adapt his encoding processes to reduce the interference. Finally, we show how his skills for encoding and recalling long lists can be accounted for within the theoretical framework of Ericsson and Kintsch's (1995) Long-Term Working Memory.
To account for the large demands on working memory during text comprehension and expert performance, the traditional models of working memory involving temporary storage must be extended to include working memory based on storage in long-term memory. In the proposed theoretical framework cognitive processes are viewed as a sequence of stable states representing end products of processing. In skilled activities, acquired memory skills allow these end products to be stored in long-term memory and kept directly accessible by means of retrieval cues in short-term memory, as proposed by skilled memory theory. These theoretical claims are supported by a review of evidence on memory in text comprehension and expert performance in such domains as mental calculation, medical diagnosis, and chess.
The public display of information is not a new phenomenon; whiteboards (and blackboards before them) have commonly been used to share information. Once annotated, these collaborative information sources have clear benefits for cognition, reducing the burden on short-term memory and supporting parallel processing. This paper introduces a structured approach for considering the design and development of these cognitive artefacts with the aim of enhancing system performance. To illustrate this approach, a case study of military support to large-scale civilian emergencies is used. Using the introduced process, a number of displays are developed supporting individual and shared understanding of the domain, enhancing the crisis planning and management process. The case study demonstrates how the proposed structured approach can inform the designer and lead to domain specific designs. A clear trail can be plotted between the analysis of the domain and the development of the cognitive artefacts. STATEMENT OF RELEVANCE: This paper presents a generic approach for the design of cognitive artefacts to enhance system performance. Illustrated by a case study, it is contended that the approach, and adaptations of it, are applicable to supporting the design of information aids for a wide range of complex domains.
Effective and timely communication of information is essential for quality patient care. Information and communication technology tools have the potential to transform and enable health care processes to be more accurate, timely, and integrated. This study describes the development, implementation, and evaluation of an electronic whiteboard in a General Internal Medicine (GIM) inpatient unit of an acute care hospital.
The development, implementation, and evaluation of the inpatient whiteboard included scope discussions, workflow analyses, communication and training, and issues and enhancement reporting, all managed through a central project team. Evaluation of the whiteboard was two-fold: a survey given to allied health, nursing and physician disciplines (n=120), and an audit performed on whiteboard usage.
The whiteboard displays relevant, real-time patient information, in a single, highly visible, user-friendly display. With a quick glance at the whiteboard, one can get an accurate snapshot view of the current patient activity in the unit. Approximately 71% of survey participants believed that the whiteboard improves and standardizes communication within the care team. Further, approximately 62% of the participants agreed that the whiteboard saves them time when searching for information on a patient and their care plan. In addition, the whiteboard has had an impact on the work practices of many GIM care providers, and it along with its users has acted together as agents for positive change. Whiteboard utilization has significantly increased since its implementation.
The success of the whiteboard is in part due to overall change management methodologies through collaborative development throughout the project development lifecycle and subsequent continuous improvement initiatives. The multidisciplinary care team embraced the tool, took ownership of it, and tailored it to meet their needs.
Leaving out necessary task steps is the single most common human error type. Certain task steps possess characteristics that are more likely to provoke omissions than others, and can be identified in advance. The paper reports two studies. The first, involving a simple photocopier, established that failing to remove the last page of the original is the commonest omission. This step possesses four distinct error-provoking features that combine their effects in an additive fashion. The second study examined the degree to which everyday memory aids satisfy five features of a good reminder: conspicuity, contiguity, content, context, and countability. A close correspondence was found between the percentage use of strategies and the degree to which they satisfied these five criteria. A three stage omission management programme was outlined: task analysis (identifying discrete task steps) of some safety critical activity; assessing the omission likelihood of each step; and the choice and application of a suitable reminder. Such a programme is applicable to a variety of healthcare procedures.
Complex, well defended, high technology systems are subject to rare but usually catastrophic organisational accidents in which a variety of contributing factors combine to breach the many barriers and safeguards. To the extent that healthcare institutions share these properties, they too are subject to organisational accidents. A detailed case study of such an accident is described. However, it is important to recognise that health care possesses a number of characteristics that set it apart from other hazardous domains. These include the diversity of activity and equipment, a high degree of uncertainty, the vulnerability of patients, and a one to one or few to one mode of delivery. Those in direct contact with patients, particularly nurses and junior doctors, often have little opportunity to reform the system's defences. It is argued that some organisational accident sequences could be thwarted at the last minute if those on the frontline had acquired some degree of error wisdom. Some mental skills are outlined that could alert junior doctors and nurses to situations likely to promote damaging errors.
As the demands on the emergency medicine (EM) system continue to increase, improvements in the organization of work and the access to timely clinical and system information will be required for providers to manage their workload in a safe and efficient manner. Information technology (IT) solutions are beginning to find their place in the emergency department (ED) and it is time to begin understanding how these systems are effecting physician behavior, communication and workload.
The study used a time-in-motion, primary task analyses to study faculty and resident physician behavior in the presence of an electronic whiteboard. The NASA-Task Load Index (TLX) was used to measure subjective workload and the underlying dimensions of workload at the end of each physician observation. Work, communication and workload were characterized using descriptive statistics and compared using Mann-Whitney U-tests.
Physicians in our study performed more tasks and were interrupted less than physicians studied previously in conventional EDs. Interruptions interrupted direct patient care tasks less than other clinical activities. Temporary interruptions appear to be a major source of inefficiency in the ED, and likely a major threat to patient safety. Face-to-face interruptions persist even in the presence of advanced IT systems, such as the electronic whiteboard. Faculty physicians exhibited lower workload scores than resident physicians. Frustration was a significant contributing factor to workload in resident physicians. All physicians ranked temporal demands and mental demands as major contributing factors to workload.
The results indicate that the electronic whiteboard improves the efficiency of work and communication in the ED. IT solutions may have great utility in improving provider situational awareness and distributing workload among ED providers. The results also demonstrate that IT solutions alone will not solve all problems in the ED. IT solutions will probably be most effective in improving efficiency and safety outcomes when paired with human-based interventions, such as crew resource management. Future studies must investigate team interaction, workload and situational awareness, and the association of these factors to patient and provider outcomes.
Human error has played a role in several large-scale hazardous materials events. To assess how human error and time of occurrence may have contributed to acute chemical releases, data from the Hazardous Substances Emergency Events Surveillance (HSEES) system for 1996-2003 were analyzed. Analyses were restricted to events in mining or manufacturing where human error was a contributing factor. The temporal distribution of releases was also evaluated to determine if the night shift impacted releases due to human error. Human error-related events in mining and manufacturing resulted in almost four times as many events with victims and almost three times as many events with evacuations compared with events in these industries where human error was not a contributing factor (10.3% versus 2.7% and 11.8% versus 4.5%, respectively). Time of occurrence of events attributable to human error in mining and manufacturing showed a widespread distribution for number of events, events with victims and evacuations, and hospitalizations and deaths, without apparent increased occurrence during the night shift. Utilizing human factor engineering in both front-end ergonomic design and retrospective incident investigation provides one potential systematic approach that may help minimize human error in workplace-related acute chemical releases and their resulting injuries.
Efficient information management and communication within the emergency department (ED) is essential to providing timely and high-quality patient care. The ED whiteboard (census board) usually serves as an ED's central access point for operational and patient-related information. This article describes the design, functionality, and experiences with a computerized ED whiteboard, which has the ability to display relevant operational and patient-related information in real time. Embedded functionality, additional whiteboard views, and the integration with ED and institutional information system components, such as the computerized patient record or the provider order entry system, provide rapid access to more detailed information. As an information center, the computerized whiteboard supports our ED environment not only for providing patient care, but also for operational, educational, and research activities.
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