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Regularly irregular: how groups reconcile cross-cutting agendas and demand in healthcare


The flow of technical work in acute healthcare varies unpredictably, in patterns that occur regularly enough that they can be managed. Acute care organizations develop ways to hedge resources so that they are available if they are needed. This pragmatic approach to the distribution of work among and across groups shows how rules can be used to manage a response to irregular demands for care. However, no rule set can be complete enough to cover this setting’s variety of care demands. Expertise is also needed to tie together the loose ends of conflicts that remain where rules no longer suffice. Many informal solutions to systemic problems go unnoticed unless they are the subjects of study. Naturalistic decision making (NDM) methods such as observational study, interviews, and process tracing reveal the activities of workers in their natural settings. Results of findings from such explorations of technical work can improve understanding of large scale work processes and, ultimately, patient safety. We have explored how practitioners cope with the demands that the system presents to them. While not all succeed, successful initiatives workers have developed demonstrate how their solutions create resilience at large scale.

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Dr. Nemeth’s work is supported by a grant (LM007947) from the National Library of Medicine, NIH (Valerie Florance, Ph.D., Deputy Director). Dr. Cook’s work is supported by a grant (HS11816) from the Agency for Healthcare Research and Quality.

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Correspondence to Christopher P. Nemeth.

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Nemeth, C.P., Nunnally, M., O’Connor, M.F. et al. Regularly irregular: how groups reconcile cross-cutting agendas and demand in healthcare. Cogn Tech Work 9, 139–148 (2007).

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  • Cognition
  • Cognitive systems engineering
  • Resilience
  • Technical work
  • Healthcare