Resilience is not control: Healthcare, crisis management, and ICT

Like other high hazard sectors, successful crisis response relies on a well-founded understanding of the work domain and the manner in which operators perceive and deal with obstacles to achieving goals. That understanding is essential to the development of information and communications technology (ICT) that are intended to support operator performance. While crises are uncommon in other high hazard sectors such as nuclear power generation and aviation, acute and ambulatory healthcare work encounters life-and-death crises daily. This makes healthcare a useful living laboratory to develop ICT in order to manage crises. This paper shows how healthcare organizations that continually deal with complex, uncertain, high-tempo operations can serve as a model to develop ICT that supports crisis management. We illustrate the results of using these methods through an example of cognitive systems engineering research that identifies ambulatory care risks to patients. We then describe multiple methods that can be used together to efficiently study complex, high hazard work settings. We conclude with an example of how it can support the development of a cognitive aid for diabetic care to support work in that setting.