Updating as Part of Everyday Work: An Interactional Perspective.

Abstract

Despite the importance of updating, which I define as a process in which actors revisit and potentially revise their current understanding of and response to an evolving situation, we know relatively little about what updating looks like and when and how updating occurs. To address this gap in the literature, I use an inductive approach to study how emergency department (ED) healthcare providers make sense of a patient’s symptoms and update their understanding as that patient’s symptoms change over time. I study updating of in two research contexts – the field (the ED) and the medical simulation lab – and draw on qualitative data consisting of non-participant observations and archival video footage to develop theory around how updating is accomplished.

In the ED, I find that updating is indeed part of everyday work but is also a more problematic process than is often suggested. Healthcare providers recognize the challenges associated with updating and engage in proactive behaviors – including revisiting the patient’s trajectory of care, surfacing expectations, and communicating richly – to facilitate updating. My data suggest that a specific type of social interaction – bids for attention – helps to shape updating. I develop theory around bids for attention and responses to those bids, which I then elaborate and refine in my lab study.

In the lab, I compare and contrast the performance of 24 teams of ED healthcare providers participating in simulation training. I find that effective updating occurs the majority (67%) of the time but with significant variation in performance. My lab study confirms that social interactions are important for updating but also shows that updating can emerge as healthcare providers interact with the physical or cognitive environment. I discover that updating can be accomplished through a variety of pathways, ranging from an individual acting alone to collective action. Last, I identify important qualitative differences in how high and low-performing teams interact with each other and highlight the need for a more nuanced examination of the building blocks of social interaction (double-interacts) to gain additional insight into how more or less effective updating is accomplished.