Technical automated systems prove efficient in reducing and preventing errors in many safety critical environments. In the healthcare domain, successfully implemented Computerized Physician Order Entry (cpoe) systems are shown to achieve a significant reduction in Adverse Drug Events in the medication use process. However, sociotechnical or human factors qualitative studies repeatedly uncover unexpected and unintended negative effects of these systems. The present study aims at highlighting the critical role of organizational factors when implementing a cpoe system in work situations; for example, in the way that communication between doctors and nurses is organized. The responsibilities and tasks of doctors and nurses are complementary rather than overlapping; thus, their work is highly interconnected and they are mutually dependent. They also have differing perspectives on patients and on the ordering process. As there is not a priori homogeneous knowledge between doctors and nurses, a core determinant of the quality of cooperative activities is the way that coordination tasks, information processing and monitoring are supported by the organization of their work. A complete, coherent, and updated knowledge of patient status should require direct synchronous communications between team partners.
This paper?s objective is to provide a methodology for analyzing this specific cooperation and to study the role of direct synchronous communications in the distributed planning of actions. Both objectives are listed: a research objective through the study of the hierarchical distribution of the planning, which has not been widely studied to date, and an intervention objective with the design support and implementation of technical systems in work environments. The methodology should allow: (a) the evaluation of the functional nature of cooperative activities to understand how distributed planning is supported; (b) the analysis of the dynamics of cooperative activities to identify the role of each partner in the cooperative relationship; and (c) the identification of representational contents, which are mandatory for efficient activities.