This is the first year of the two-year pilot project funded by NSF. The key objective of for the project is to understand the coordination processes used by the high-velocity professional work teams (i.e., a trauma resuscitation team), among themselves and with other people (e.g., paramedic, OR nurse, Radiologist, etc.) related to their tasks, in a trauma center. This study has been conducted at a Shock trauma center in mid-Atlantic USA.

Computation and communication technology has the potential to improve coordination but to realize that potential requires a deep understanding of the coordination processes used by teams, especially those that reply on awareness of dynamic task and team situations. This project investigates the coordination processes used by distributed expertise teams operating in highly dynamic work domains such as trauma patient resuscitation. The main objective is to develop a framework for modeling coordination processes by team members in dynamic, multi-tasking, highly stressful environments. The project is conducted by an interdisciplinary teams with wide-ranging research background and experience: team performance, information technologies, medicine, nursing, health care informatics, management sciences, biomedical engineering and ethnography. Qualitative and quantitative methods including ethnographic studies, surveys and interviews are used to capture coordination processes in situ in trauma center settings. The project will result in a better understanding of the role of various communication media and how each medium is used in dynamic work settings to achieve work coordination and to maintain adequate awareness. Also, this project will provide opportunity to develop interdisciplinary research project and to train several graduate students to conduct a research project utilizing both qualitative and quantitative methods.

Given the complexities of studying real work teams, a multidisciplinary research group was formed: Team and Technology in Trauma (TTT). The TTT Group meets monthly and consists of nurses, surgeons, anesthesiologists, and the principal investigators of the project. The TTT Group meetings provide opportunities for clinicians (the research subjects) to learn about the project and for investigators to communicate research ideas and to work on logistics of data collection. Over the last eight months, the researchers (especially those from the School of Management) have furthered the rapport of the clinicians in the study setting for carrying out the project.

The project received remarkable support from graduate students. The inherent multi-disciplinary nature of the project plus the exciting opportunity in observing real teams up-close have attracted high-quality graduate students. Two of the best graduate students from the nursing school joined the project (one of which did so without financial support from the project). From the management school, two brilliant graduate students joined the project. So far, those four students have been a key to the success of the project. In addition, a member of the faculty at the nursing school joined the research team without the support of the project. All counted, the research team now has 11 members. More importantly, the collaboration has broadened the research scope and created more opportunities for further collaborative work.

We expect that the excellent working relationship among all the members of the project and with the clinicians in the study setting will continue to enhance productive research activities.

As the first step in understanding coordination in the trauma center, we have utilized several different data collection methods so far. These methods include interviewing, shadowing and observation with probing. We conducted about 100 hours of observation and the resuscitation of many patients in the Trauma Resuscitation Unit. We conducted interviews with about 30 staff members in the Shock Trauma Center. We have shadowed or followed several number of the clinical staff including attending surgeons, attending anesthesiologists, nurses, etc.

Many different artifacts are used by the clinical and supporting personnel in the trauma center for the purpose of coordination. Some of the artifacts immediately captured our attention. We have performed detailed field observation as well as taken snapshots of the artifacts in use. For example, several different public display boards ("whiteboards") are in active use. The complexity of the symbols in use and the ever-changing layout are difficult to capture just by using written reports.

More so than we had anticipated, the trauma center as a study setting has offered a range of coordination phenomena which occur in real life and immediately accessible. We wrote up some of the findings in three separate submissions to CSCW’2000:

More manuscripts are in preparation. Three of the major findings are summarized here. (1) Coordination and awareness. The work teams in the trauma center use different methods for coordination and maintaining awareness. These methods include verbal but most often non-verbal, such as visual scanning. The robust performance of the work teams could partially be explained by the amount of efforts involved in double-checking and in maintaining awareness (e.g. making sure the surgeons know about the patient’s status) when the patient’s status is critical. (2) Public displays. We focused on one particular board (12 feet by 4 feet) used for coordinating activities in the trauma operating rooms. One finding is that the clinicians have invented several novel uses to meet the changing organization structures and workload demands. These inventive uses have challenged the traditional view of interface design practices, where a design is a final product of user requirement studies. In contrast, we found that it is important to create an interface where the users could invent new uses with ease. The sheer size of the board was found to be an important contributing factor to the utilities of the board. In front of the board, the clinicians jointly plan and resolve potential conflicts. (3) Organizational coordination. As suggested by Hutchins in his book "Cognition in the wild" (1994), we found that the trauma teams have very flexible structures and are highly resistant to performance failures under the condition of varying and uncertain incoming workload. This can be partially explained by the overlapping skills and knowledge but we believe that there are other factors at play.

In the remaining time of the project, we plan to follow primarily these three lines of research, with the use of other techniques such as surveys and paper-and-pencil simulations. Building on the detailed studies, we plan to develop an integrated theoretical frame of coordination in such environments.

The project provides great training experiences to both the principal investigators and graduate students. For the principal investigators, the project has become a vehicle for learning neighboring disciplines and conducting multi-disciplinary research. The project is also an important step in developing programmatic research using the trauma center as a live laboratory for studying coordination and highly skilled expert teams.

For graduate students, the project forced and enticed them to learn qualitative research methodologies in a high-velocity environment. We anticipate at least one Ph.D. dissertation from the project. All students are highly motivated and actively participated in data collection and manuscript write-ups. So far we have had four Ph.D. students participating in the projects.

The project has promoted collaboration between three campuses of the University Maryland: Baltimore, Baltimore County, and College Park. It also bridges a variety of disciplines. We view the collaboration as only the start for future synergistic development in the respective campuses on coordination and information technology.

As the project is highly inter-disciplinary, it is difficult to assign a principal discipline. Nevertheless, two disciplines are directly related to the project: CSCW and organization studies. For CSCW, our contributions are in the understanding of coordination by high-velocity teams and their use of various coordinating artifacts. We contribute to the field of distributed cognition in terms of how coordinating artifacts are used for highly dynamic environments. For organization studies, we contribute to how work teams organize and perform. In recent years, more and more organizations are shifting to team organizing structures. For teams in high-velocity environments, much can be learned from studying how trauma teams perform. By understanding a trauma team, we can provide principles of how to organize and manage knowledge teams and professional taskforces. Those management principles can be applied to other teams in complex settings such as aircraft cockpit teams, consulting teams, product development teams, etc.

There are several disciplines to which this project contributes. We contribute to social psychology through our examination of team performance and leadership behaviors. We contribute to human factors and ergonomics by studying the relationship between people and technology. We contribute to information systems by studying the potential role of communication technologies. Last but not least, our studies provide guidance to design of communication tools to increase the level of shared awareness.