Electronic Thesis and Dissertation Repository


Doctor of Philosophy


Health Information Science


Haggerty, Nicole

2nd Supervisor

Sedig, Kamran

Joint Supervisor


The way that medical decisions are carried out in hospital environments has undergone radical changes in recent years, in part as a result of the changing landscape of care. To make decisions, physicians are expected to keep abreast of a growing and changing body of medical and patient knowledge, collaborate more with clinical colleagues, and utilize more technologies to inform care than ever before. This dissertation reports on a five month cognitive ethnography in an ICU in Ontario Canada, and utilizes distributed cognition to understand the challenges that physicians face in making decision in modern acute care environments. It also seeks to elucidate the strategies used by ICU physicians to cope with the challenges associated with using information from social, material and technological sources in decision-making. My findings demonstrate how information resources are (1) Objectivist, in that too much attention is paid to supporting the formalized, outcome-centered aspects of medical thinking, without due regard to the processes involved in adapting decisions to their situation; (2) Fragmented, in that, while information resources are often well-designed when considered in isolation, they force physicians to bridge gaps in the logic of access or representation when working between resources; (3) Individualistic, in that information resources are often tailored to support the cognitive needs of individual physicians, leaving the cognitive needs associated with collaboration unsupported, and sometimes undermining them. To compensate for the challenges associated with using objectivist, fragmented and individualistic information resources, physicians employed a number techniques, including relying in paper and other flexible artifacts, interpersonal clinical communications, and engaging in mobility work. This research brings us a step closer to understanding how people, paper, and technologies function together to fulfill the complex and dynamic needs associated with making medical decisions.