Interactions in Sociotechnical Systems: Achieving Balance in the Use of an Augmented Reality Mobile Application

OBJECTIVE

We explore relationships between barriers and facilitators experienced by users to understand dynamic interactions in sociotechnical systems and improve a mobile phone-based augmented reality application that teaches users about the contents of a standardized pediatric code cart.

BACKGROUND

Understanding interactions between performance obstacles and facilitators can provide guidance to (re)designing sociotechnical systems to improve system outcomes. Clinicians should know about contents and organization of code carts, and an augmented reality mobile application may improve that knowledge but changes the sociotechnical system in which they learn. Prior work identified barriers and facilitators impacting the use of this application-participants described dimensions together, indicating interactions that are explored in the current study.

METHOD

We conducted four focus groups (number of clinicians = 18) and two interviews with clinicians who used the application. We performed a secondary analysis of focus group data exploring interactions between previously identified barriers and facilitators to application use. We used epistemic network analysis to visualize these interactions.

RESULTS

Work system barriers interacted with barriers and facilitators interacted with facilitators to amplify cumulative negative or positive impact, respectively. Facilitators balanced barriers, mitigating negative impact. Facilitators also exacerbated barriers, worsening negative impact.

CONCLUSION

Barriers and facilitators interact and can amplify, balance, and exacerbate each other-notably, positives are not always positive. To obtain desired outcomes, interactions must be further considered in sociotechnical system design, for example, the potential improvements to the application we identified.

Steady-Hand Eye Robot 3.0: Optimization and Benchtop Evaluation for Subretinal Injection

Subretinal injection methods and other procedures for treating retinal conditions and diseases (many considered incurable) have been limited in scope due to limited human motor control. This study demonstrates the next generation, cooperatively controlled Steady-Hand Eye Robot (SHER 3.0), a precise and intuitive-to-use robotic platform achieving clinical standards for targeting accuracy and resolution for subretinal injections. The system design and basic kinematics are reported and a deflection model for the incorporated delta stage and validation experiments are presented. This model optimizes the delta stage parameters, maximizing the global conditioning index and minimizing torsional compliance. Five tests measuring accuracy, repeatability, and deflection show the optimized stage design achieves a tip accuracy of < 30 μm, tip repeatability of 9.3 μm and 0.02°, and deflections between 20-350 μm/N. Future work will use updated control models to refine tip positioning outcomes and will be tested on in vivo animal models.

Team Cognition in Handoffs: Relating System Factors, Team Cognition Functions and Outcomes in Two Handoff Processes

OBJECTIVE

This study investigates how team cognition occurs in care transitions from operating room (OR) to intensive care unit (ICU). We then seek to understand how the sociotechnical system and team cognition are related.

BACKGROUND

Effective handoffs are critical to ensuring patient safety and have been the subject of many improvement efforts. However, the types of team-level cognitive processing during handoffs have not been explored, nor is it clear how the sociotechnical system shapes team cognition.

METHOD

We conducted this study in an academic, Level 1 trauma center in the Midwestern United States. Twenty-eight physicians (surgery, anesthesia, pediatric critical care) and nurses (OR, ICU) participated in semi-structured interviews. We performed qualitative content analysis and epistemic network analysis to understand the relationships between system factors, team cognition in handoffs and outcomes.

RESULTS

Participants described three team cognition functions in handoffs-(1) information exchange, (2) assessment, and (3) planning and decision making; information exchange was mentioned most. Work system factors influenced team cognition. Inter-professional handoffs facilitated information exchange but included large teams with diverse backgrounds communicating, which can be inefficient. Intra-professional handoffs decreased team size and role diversity, which may simplify communication but increase information loss. Participants in inter-professional handoffs reflected on outcomes significantly more in relation to system factors and team cognition (p < 0.001), while participants in intra-professional handoffs discussed handoffs as a task.

CONCLUSION

Handoffs include team cognition, which was influenced by work system design. Opportunities for handoff improvement include a flexibly standardized process and supportive tools/technologies. We recommend incorporating perspectives of the patient and family in future work.

Haptic Orientation Guidance Using Two Parallel Double-Gimbal Control Moment Gyroscopes

This paper presents a system of two double-gimbal control moment gyroscopes (CMGs) for providing ungrounded kinesthetic haptic feedback. By spinning a second flywheel opposite the first, and rotating them through opposite trajectories, undesired gyroscopic effects can be eliminated, isolating a single torque axis. This produces a moment pulse proportional to the flywheel spin speed and rotation speed. Rotating the CMG gimbals quickly in one direction, then resetting them more slowly generates repeated torque pulses indicating a clear direction cue. We present the mathematical model for moments produced by this system and verify that the performance of our device matches this model. Using these asymmetric moment pulses, we provide haptic cues to participants in two studies. In the first study, users simply identify the direction of torque cues. In the second study, we use the torque pulses to guide users to target orientations. Performance in both studies shows that this system has the potential to provide useful guidance for applications where ungrounded haptic feedback is desired.

People-Technology-Ecosystem Integration: A Framework to Ensure Regional Interoperability for Safety, Sustainability, and Resilience of Interdependent Energy, Water, and Seafood Sources in the (Persian) Gulf

OBJECTIVE

The aim of this study is to identify the interdependencies of human and organizational subsystems of multiple complex, safety-sensitive technological systems and their interoperability in the context of sustainability and resilience of an ecosystem.

BACKGROUND

Recent technological disasters with severe environmental impact are attributed to human factors and safety culture causes. One of the most populous and environmentally sensitive regions in the world, the (Persian) Gulf, is on the confluence of an exponentially growing number of two industries--nuclear power and seawater desalination plants--that is changing its land- and seascape.

METHOD

Building upon Rasmussen's model, a macrosystem integrative framework, based on the broader context of human factors, is developed, which can be considered in this context as a "meta-ergonomics" paradigm, for the analysis of interactions, design of interoperability, and integration of decisions of major actors whose actions can affect safety and sustainability of the focused industries during routine and nonroutine (emergency) operations.

CONCLUSION

Based on the emerging realities in the Gulf region, it is concluded that without such systematic approach toward addressing the interdependencies of water and energy sources, sustainability will be only a short-lived dream and prosperity will be a disappearing mirage for millions of people in the region.

APPLICATION

This multilayered framework for the integration of people, technology, and ecosystem--which has been applied to the (Persian) Gulf--offers a viable and vital approach to the design and operation of large-scale complex systems wherever the nexus of water, energy, and food sources are concerned, such as the Black Sea.