Twenty Years of Cognitive Work Analysis in Health Care

Abstract

Improving patient safety, within the context of a complex system, forms one of the key challenges in health care today. Cognitive work analysis (CWA) is one way to analyze complex systems, and although it has been applied to health care for 20 years, little is known about its effectiveness or future research needs. This article presents a review of CWA studies in health care, addressing questions of use, usefulness, challenges, and opportunities. Results of the review make clear that the research agenda is largely confined to acute care. Of the 39 articles reviewed, 28 relate to this setting. There appears to be a growing interest in medical informatics, error investigation, and decision support. Conversely, work in physiological monitoring has slowed, associated with the uncertainties of modeling “biological” systems. Studies related to “organic” social systems are similarly challenged, although there is a recognition that important opportunities exist, such as studying work flow processes between teams. Other opportunities relate to new methods to enhance CWA; new technologies, such as auditory displays; and new applications, such as requests for proposals and incident investigation. Ultimately, the capacity to foster an understanding into the deep structures of a system may prove to be the greatest contribution of CWA to health care today.