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.