Cognitive Work Analysis Framework Research Articles

Supporting Decision-Making About Patient Mobility in the Intensive Care Unit Nurse Work Environment: Work Domain Analysis.

BackgroundPatient mobility is an evidenced-based physical activity intervention initiated during intensive care unit (ICU) admission and continued throughout hospitalization to maintain functional status, yet mobility is a complex intervention and not consistently implemented. Cognitive work analysis (CWA) is a useful human factors framework for understanding complex systems and can inform future technology design to optimize outcomes.ObjectiveThe aim of this study is to understand the complexity and constraints of the ICU work environment as it relates to nurses carrying out patient mobility interventions, using CWA.MethodsWe conducted a work domain analysis and completed an abstraction hierarchy using the CWA framework. Data from documents, observation (32 hours), and interviews with nurses (N=20) from 2 hospitals were used to construct the abstraction hierarchy.ResultsNurses seek information from a variety of sources and integrate patient and unit information to inform decision-making. The completed abstraction hierarchy depicts multiple high-level priorities that nurses balance, specifically, providing quality, safe care to patients while helping to manage unit-level throughput needs. Connections between levels on the abstraction hierarchy describe how and why nurses seek patient and hospital unit information to inform mobility decision-making. The analysis identifies several opportunities for technology design to support nurse decision-making about patient mobility.ConclusionsFuture interventions need to consider the complexity of the ICU environment and types of information nurses need to make decisions about patient mobility. Considerations for future system redesign include developing and testing clinical decision support tools that integrate critical patient and unit-level information to support nurses in making patient mobility decisions.

Making Patient Contextual Data Concrete: Abstraction Hierarchyto Understand Patient Self-Management of Type 2 Diabetes

Social determinants of health (SDOH) and other contextual factors influence a patient’s ability to adhere to a plan of care. Providers must understand these factors in order to develop treatment plans which best meet patient needs and preferences. This is particularly important for patients with type 2 diabetes, which is primarily managed by the patient. Abstraction hierarchy is a modeling technique from the cognitive work analysis framework which describes system components at multiple levels of abstraction. This study seeks to examine SDOH as they relate to type 2 diabetes management by the patient and activities carried out by the primary care provider to incorporate these factors into the medical decision-making process. The abstraction hierarchy was developed based on previous literature and interviews with patients and primary care medical personnel. The resulting abstraction hierarchy can be used to inform future screening tools and patient-centered care interventions for addressing SDOH for patients with type 2 diabetes.

Implementing Cognitive Work Analysis to Support Early Phases of Sociotechnical System Development

AbstractSystems engineering (SE) is applied to bring about complex systems, such as sociotechnical systems (STS), based on stakeholder requirements. Introducing new technology into an existing STS may result in unexpected emergent behaviour when prevailing processes, procedures and information flows are challenged. Due to the complexity associated with emergence, the resultant system may fail to achieve the desired utility fully, or the work system produced may not be desirable. Cognitive work analysis (CWA) provides a framework for analyzing, modelling, and designing STS. This study proposes applying CWA modelling to requirement analysis for new technology introduction as part of a validation workflow in aid of SE. Work domain analysis (WDA), the first step in the CWA framework, is applied to a test case, and the resultant abstraction hierarchy (AH) models are analyzed to evaluate the perceived utility. This article shows how analysts were able to apply the method and uncover possible design emergence. We hope that the methods presented herein will aid more designers in applying CWA as part of the SE life‐cycle toward successfully implementing complex STS.

Sustainability of mobile IT sector in industrially developing countries by supporting repairability

This article aims to provide a design intervention to support the repairability of mobile phones and, in turn, promote sustainability. Typically, mobile phones are designed with a view towards obsolescence for users in industrially developed countries, as the expected repair in these circumstances is minimal. In contrast, in developing countries, such as India, these phones are constantly repaired and are owned several times by different people before their final demise. Therefore, to support repairability, a field study based in Mumbai, India, was conducted to understand the cognitive basis of repair. The results were further analyzed using a cognitive work analysis framework that provides insight into the possibilities for informational requirements for design. The findings indicate that small-scale repair shops (3–4 repairmen) and the hole-in-the-wall shops (1 repairman) can benefit from the intervention in terms of informational support for the repair activity. If the cognitive dimension of repair is supported for these low-cost repair shops, we can expect an increase in the capability and efficacy of the repairmen, resulting in fewer phones ending up as e-waste. Thus, due to its low cost, informational diagrams that support the repair activity can be incorporated by the manufacturer without any radical changes in existing proprietary technology, resulting in the possibility for the long-term growth of the repair ecology in a country such as India.

Technology in the emergency department: Using cognitive work analysis to model and design sustainable systems

Emergency Departments (EDs) are highly complex healthcare settings that must be resilient to unpredictable demands. New technologies are regularly introduced into EDs to improve patient care and workflow processes. However, the interaction between social and technical agents can introduce further complexity, making it difficult to identify the factors that influence the dynamic sustainability of interventions. This study aimed to demonstrate how the Cognitive Work Analysis (CWA) Framework can be used to model and design sustainable social-technical ED systems. To identify workspaces, social, technical, and collaboration factors that can be used to design and implement contextually appropriate technologies into the ED, we applied Control Task Analysis (i.e., Contextual Activities Template, CAT), Social Organizational and Cooperation Analysis (SOCA), and Strategies Analysis (StrA) phases from the CWA Framework, developed and validated using data collected during 263 h of observation in a large metropolitan ED. Our models revealed workspaces within the ED that are heavily involved in both clinical and non-clinical tasks for nurses and doctors using a range of technology. Workspaces, technology, and roles that are over- or under- utilized create contextually sensitive opportunities for dispersing work. Application of CWA enables examination of the ongoing, dynamic relationship between technological interventions and context, which can support sustainability and inform future designs.

The scope for adaptive capacity in emergency departments: modelling performance constraints using control task analysis and social organisational cooperation analysis

Patient flow between the emergency department (ED) and hospital wards becomes problematic when bed availability is limited. To better understand the constraints that shape patient flow and everyday work in the ED, we applied Control Task Analysis (i.e. Contextual Activities Template, CAT) and Social Organisational Cooperation Analysis (SOCA) phases from the Cognitive Work Analysis framework to identify ways in which to optimise patient flow. The model and analysis were created through observations in the ED of clinicians (e.g. nurses, doctors), and professional staff (e.g. ward personnel, clerks). The CAT and SOCA-CAT models illustrate workspaces, patient journey phases, and patient volume within the department that are heavily loaded with tasks and human and non-human agents performing these tasks, while others are underutilised. The findings suggest that an ED’s adaptive capacity could be strengthened through the integration of additional human and non-human agents allowing the redistribution of clinical and non-clinical tasks. Practitioner Summary: Workflow in EDs is constrained by uneven geographical distribution of activities, insufficient adaptive support during critical patient journey phases and periods of high patient volume. Adaptive capacity could be strengthened by additional human and non-human agents in combination with a redistribution of tasks, supporting seamless successful structural and behavioural adaptation in ED.

Ecological Design of an Augmentative and Alternative Communication Device Interface

Autism spectrum disorder, cerebral palsy, brain stem stroke, and neurological injury are examples of conditions that may limit vocal communication. Augmentative and alternative communication (AAC) systems can provide a communication pathway to users who experience such complex communication needs, facilitating their societal participation and supporting some ability to direct their own care. We adapted the cognitive work analysis (CWA) framework to a linguistic domain for insights into an AAC design that best supports users’ communication. First, we applied the work domain analysis (WDA) to a popular commercial AAC system, Proloquo2Go. Data were gathered from guided AAC system use, domain experts, and the syntactic rules of the English language. The WDA exposed unmet needs in the commercial system. We then applied worker competency analysis to consider different approaches to present information and support user actions. The design included graphic forms and process views, and their integration into viewports and the workspace. Our novel application of CWA uncovered new considerations in AAC interface design and presents a nascent area of investigation, namely, AAC displays that more effectively support users’ goals. Future investigation will evaluate the mental workload of this AAC interface compared to that of current commercially available systems.

Identifying Constraints on Everyday Clinical Practice: Applying Work Domain Analysis to Emergency Department Care.

Emergency departments (EDs) are complex socio-technical work systems that require staff to manage patients in an environment of fluctuating resources and demands. To better understand the purpose, and pressures and constraints for designing new ED facilities, we developed an abstraction hierarchy model as part of a work domain analysis (WDA) from the cognitive work analysis (CWA) framework. The abstraction hierarchy provides a model of the structure of the ED, encompassing the core objects, processes, and functions relating to key values and the ED's overall purpose. Reviews of relevant national and state policy, guidelines, and protocol documents applicable to care delivery in the ED were used to construct a WDA. The model was validated through focus groups with ED clinicians and subsequently validated using a series of WDA prompts. The model shows that the ED system exhibits extremely interconnected and complex features. Heavily connected functions introduce vulnerability into the system with function performance determined by resource availability and prioritization, leading to a trade-off between time and safety priorities. While system processes (e.g., triage, fast-track) support care delivery in ED, this delivery manifests in complex ways due to the personal and disease characteristics of patients and the dynamic state of the ED system. The model identifies system constraints that create tension in care delivery processes (e.g., electronic data entry, computer availability) potentially compromising patient safety. The model identified aspects of the ED system that could be leveraged to improve ED performance through innovative ED system design.

Designing success: Applying Cognitive Work Analysis to optimise a para sport system

Within the last decade, Para sport has experienced increased growth, global popularity, and scientific research. Likewise, there is increasing application of systems ergonomics methods to optimise sports performance. Despite this, few studies have attempted to analyse Para sport as a complex system. The aim of this study was to apply a systems ergonomics framework to redesign a current Para sport system via a multi staged approach. The Cognitive Work Analysis framework was used to model and redesign the Para sport system, via the insertion of design interventions. The findings offer insights into the complexity of the Para sport system via the multiple interacting factors that influence the performance of the system. In addition, the design interventions had substantial influence on the Para sport system by creating multiple new processes, functions, measures, and purposes, and enhanced multiple components of the existing system. This study provides a unique contribution to ergonomic science and extends system ergonomics theory and methods in sport. This study has practical implications for policy development by providing a template that can be used by others wanting to optimise able-bodied sport, Para sport, and non-sport systems.

The degrees of freedom problem: How to guide trajectories with the dynamic safety model to assist activity in loosely coupled work systems

Through the Dynamic Safety Model, Rasmussen (1990) pointed out that operators in complex work systems must cope with many degrees of freedom that involve uncertainty and risk. How to deal with these degrees of freedom without risk constitutes a central issue to devise proactive methods in risk analysis. The Abstraction Hierarchy technique is viewed as a tool that can assist operators in resolving the degrees of freedom problem. The method consists in creating a functional model of the work domain to help operators understand and control it. Such a method is well-adapted to organizations tightly coupled with their work domain (e.g. aviation, nuclear plants). However, in more loosely coupled work systems, many degrees of freedom also come significantly from the organization itself (self-organizing processes, equipment, and team management) in addition to those coming from the work domain. Through a heuristic version of Cognitive Work Analysis, this article presents the State Space Sketch as a technique to describe the constraints required to control a loosely coupled work system. The resulting model of constraints may be used to analyse potential failures and failure propagation. A first application to a medical emergency situation controlled by a medical team is presented. The State Space Sketch conforms to the formative and proactive requirements involved in the Cognitive Work Analysis framework and can contribute to devising assistance strategies.

Sports Organizations as Complex Systems: Using Cognitive Work Analysis to Identify the Factors Influencing Performance in an Elite Netball Organization.

There is increasing interest in the adoption of a complex systems thinking approach when attempting to understand and optimize sports performance. Despite this, few studies have attempted to model elite sports organizations. The aim of this study was to use methods from the Cognitive Work Analysis (CWA) framework to develop a model of an elite netball organization and identify wider organizational functions and constraints influencing performance. Two phases of CWA were used: (i) Work Domain Analysis (WDA); and, (ii) Social Organization and Co-operation Analysis (SOCA). A WDA model of the elite netball organization was developed via subject matter expert (SME) workshops, and a SOCA was undertaken to identify the different functions, roles, and responsibilities of key actors within the organization. The findings identify various factors that influence performance. Functions that appear to provide a competitive edge are discussed, including a strong club ethos, a shared responsibility for performance, and a focus on player and staff health and well-being. Factors that potentially have a negative impact on performance include organizational priorities not related to playing netball, and additional coach and athlete roles beyond coaching, training, and playing. The implications for understanding and optimizing elite sports organizations are discussed.

Visualizing Purpose and Functionality Overlaps of Health IT Systems using an Abstraction Hierarchy

The development of health IT fuels a digitalization process that affects the work of hospital staff negatively in the case of poor integration of IT systems. A challenge lies in keeping track of the existing IT systems and possible overlapping functions. The Abstraction Hierarchy model from the Cognitive Work Analysis framework describes how parts of a complex system relate to the over-arching goals of the system, which could work as an overview of the IT systems. In this study, we explore how an Abstraction Hierarchy can be used to visualize how IT systems’ functions overlap, interfere with, or depend on each other. The Abstraction Hierarchy was developed based on documentation, interviews, and a study visit at a hospital ward. The overlaps in functionality visualized in the Abstraction Hierarchy could serve as indicators for the need for further investigation of effects on the hospital staff’s work.

Practical application of hierarchical task analysis and cognitive work analysis in a surgical training system design

Hierarchical task analysis (HTA) and cognitive work analysis (CWA) were applied to laparoscopic surgery to identify critical technical, cognitive, and social challenges. Our purpose was to understand the complexity of laparoscopy and use this knowledge to develop a surgical training system. Five laparoscopic procedures were analyzed using the HTA methodology, while generic laparoscopic approaches were analyzed by applying the five phases of the CWA framework. The results from these analyses were applied to a surgical training system. The focus was on the application of partial-task training to areas that could be more technically challenging. Additionally, practical, social, and cognitive training aspects were included into the training system, based on our findings from the analyses. Practical Relevance: The use of digital training systems is becoming increasingly important in complex work systems, especially when it comes to simulations that can have serious consequences in reality. This paper presents the development of a surgical training system.

Scenario-based approach adopted in the ELECTRA project for deriving innovative control room functionality

Here, the authors analyse the operator point of view of the Web-of-Cells concept defined in the EU project ELECTRA, by identifying operator tasks into the supervision of a highly automated power system, and the information requirements to facilitate appropriate operator situation awareness. The study outlines the methodology adopted, which is based on the cognitive work analysis framework, to provide an overview of the most interesting scenarios and to summarise the requirements analysis results. In order to derive required control room functionality, a set of relevant control room scenarios have been identified based on the Web-of-Cells control concept. The authors considered scenarios that challenge traditional control schemes, scenarios that caused major failures (i.e. blackouts), and scenarios that can be expected to appear in the future. For each scenario, information concerning network layout, triggering events, physical constraints, manually/automatic operations, operators' tasks, and relevant analytics have been analysed.

Revisiting the technologies of the old: a case study of cognitive work analysis and nanomaterials

Nanotechnology is bringing about changes in everyday technologies in fundamental ways, both obvious and non-obvious. In order to address nanotechnology, Human Factors and Ergonomics (HFE) as a research discipline requires multiple methods in engaging this novel technology strategically. One mode of engagement is through nanomaterials. Nanomaterials can be addressed by HFE in four significant ways: health and safety; new products and embedding in existing technologies for improved qualities; industrial production; along with, through university laboratory research. The aim of this article is to present one manner of engaging nanomaterials and HFE through addressing nanomaterials as embedded in existing technologies and their involvement in university research laboratories. This aspect of engagement is depicted by addressing the use of nanomaterials in an existing well-entrenched technology of concrete to produce an enhanced product--nanoconcrete. Using the framework of Cognitive Work Analysis (CWA), this article addresses the work domain of nanoconcrete in terms of work practices in university laboratory settings. The models derived from CWA are used to identify the various constraints ranging from the environment to the people involved in the concrete domain. The results emphasize that to address nanomaterials (in this case, nanosilica), one has to comprehend its overarching matrix of the material (concrete) in which it is embedded. While the current article presents just one facet studying the intersection between nanomaterials and HFE, further research can identify new ways in which nanotechnology could be integrated robustly in the disciplinary viewpoint of HFE.

Workload in Nursing

Nursing is a high workload profession, and excessive workload has been shown to have an adverse effect on patient care. Prior research has focused on patient-staff ratios and skill mix to analyze the relationship of workload and degradation of care. This study used a comprehensive, multi-dimensional approach for analyzing nurses’ workload in a large general hospital. Workload drivers were introduced as unique factors that contributed to the totality of nursing workload. Cognitive Work Analysis (CWA) framework was used to map out the work domain of nurses and identify sources of workload within it. The output was a collection of diagrams, tables, and interviews that illustrated areas in nursing that produced the most workload. A detailed integration of the material supported an estimation of workload experienced by nurses.

Applying the prompt questions from the Cognitive Work Analysis Design Toolkit: a demonstration in rail level crossing design

ABSTRACTAccidents at rail level crossings (RLXs) represent an important public safety concern. Traditional approaches to RLX safety have focused on the implementation of technology such as warnings and barriers to control road user behaviour. However, as RLXs are complex sociotechnical systems, there is a need to apply systems-based approaches to analysis and design within this domain. This will enable road and rail stakeholders to develop innovative design solutions which are appropriate for the complexity of the domain, including adaptability to future changes in a dynamic transport environment. This paper describes the use of one aspect of a systems thinking-based design toolkit to prompt design insights following the application of the cognitive work analysis framework to RLXs. The process resulted in the identification of design insights for use in a participatory design process and supported the research team to consider the principles of sociotechnical systems theory.

Analysing mine emergency management needs: a cognitive work analysis approach

In this paper, we argue that cognitive work analysis (CWA), a framework for analysing, modelling and designing complex work systems, is an effective approach to determine the emergency management needs of mine operators. To demonstrate, we applied work domain analysis (WDA), the first phase of the CWA framework, to the analysis of the mine emergency management needs of control room operators in an Australian underground coal mine context. Overall, we found that CWA supported a holistic approach to the analysis of emergency management needs by capturing requirements that involved (a) emergency and routine operations, and (b) social and technical aspects of the work. We conclude with implications for the development of procedures, technology and training in underground coal mine emergency management systems.

Designing Human-Machine Interface for Autonomous Vehicles

This paper deals with Human-Machine Interface (HMI) design for autonomous vehicles. This automation level involves automated driving phases as well as transition phases where the driver has to reengage in the driving task. Each phase requires an appropriate interface to allow the driver to establish accurate situation awareness. The paper presents a methodology aiming to answer the following questions: what should be displayed, how and when? This methodology relies on the Cognitive Work Analysis framework as well as on the notions of Human-Machine Cooperation and Transparency. Taking the example of the “lane change” function, it leads to identify and to categorize the information to be displayed in order to make “transparent” the autonomous system.

Representing energy efficiency diagnosis strategies in cognitive work analysis

This article describes challenges encountered in applying Jens Rasmussen's Cognitive Work Analysis (CWA) framework to the practice of energy efficiency Monitoring & Targeting (M&T). Eight theoretic issues encountered in the analysis are described with respect to Rasmussen's work and the modeling solutions we adopted. We grappled with how to usefully apply Work Domain Analysis (WDA) to analyze categories of domains with secondary purposes and no ideal grain of decomposition. This difficulty encouraged us to pursue Control Task (ConTA) and Strategies (StrA) analysis, which are under-explored as bases for interface design. In ConTA we found M&T was best represented by two interlinked work functions; one controlling energy, the other maintaining knowledge representations. From StrA, we identified a popular representation-dependent strategy and inferred information required to diagnose faults in system performance and knowledge representation. This article presents and discusses excerpts from our analysis, and outlines their application to diagnosis support tools.