Perception, communication, and representation of activity delays in dynamic medical teamwork

Activity delays in medical settings could lead to poor patient outcomes. Specifically, in time-critical and high-risk settings such as trauma resuscitations, effects of delays are augmented as decisions need to be made within the span of seconds and errors could be fatal. Therefore, effective communication and work coordination are crucial to support continuous temporal awareness among trauma resuscitation team members. The use of information systems for real-time data sharing has the potential to enhance team communication, support awareness, and decrease medical errors. To design these systems, there is a need to understand how team members perceive time and estimate delays on the ground, how these delays are communicated, and how team members coordinate their activities to mitigate the delays. This dissertation used methods including participant observation, video review, contextual inquiry, stimulated recall interviews, as well as thematic, discourse, and interaction analyses to explore communication patterns and user behaviors during delays in dynamic medical settings. Through the conceptual lenses of articulation work, coordination mechanisms, and temporal rhythms, this work examined how team members estimated activity delays, how they coordinated and situated their activities with those of others, and how they mitigated the delays. Key findings of this dissertation research include: (1) rich descriptions of the nature of verbal communication during high-tempo medical activities and their performance stages, (2) thorough understanding of team members' perceptions of delays and coordination behaviors during activity delays, and (3) detailed insights into the role of verbal communication in team members' management of activity delays in time-critical medical settings. Armed with these insights, I contribute to the literature by: (1) introducing speech-based coordination mechanisms as an extension to immaterial coordination mechanisms and discussing their role in supporting articulation work during activity delays, (2) describing the process of shaping of new rhythms-rhythms of the resuscitation process, the team members, and the patient record-and synchronization of these rhythms through the manifestation of collective temporal horizons, and (3) explaining experiences and lessons learned as a researcher conducting ethnographic fieldwork in high-risk medical settings. I also contribute to information system design by: (1) constructing narrative schemas for fast-paced medical activities and a speech-flow model for supporting activity delay detection, and (2) developing a framework for recognizing delays and providing appropriate alerts through optimal approaches to support decision-making in dynamic medical settings.