Adapting to new technology in the operating room

The effects of new technology on human performance in domains such as anesthesiology, commercial aviation, and nuclear power operations remain controversial. To study the impact of new technology on skilled practitioner performance, we observed the introduction of a new, highly integrated, microprocessor-based physiological monitoring system for use in cardiac anesthesia. The new computer system differed from its predecessors in method of display, human interface, level of integration, and automation of functions. A process-tracing technique was used to examine physician-computer interaction in the context of 22 anesthesia procedures for cardiothoracic surgery, most of which involved cardiopulmonary bypass. Practitioners experienced a series of problems with the new computer system. Computer system characteristics relative to the specific context of cardiac surgery created new cognitive and physical burdens that tended to congregate at times of high demand, the characteristic feature of clumsy automation. Practitioners as individuals and as a group tried to overcome these problems by adapting the computer system (system tailoring) and their behavior (task tailoring) as they learned about the interaction between characteristics of the new system and characteristics of their field of practice.