Ad hoc signage in a new hospital- a useful social tool and cognitive artifact

Introduction: High-stakes industries, such as healthcare, are complex systems prone to influence by various constraining factors. Expert practitioners in these domains work at the “sharp end” of these constraints and must reconcile limitations in the context of operations. When a major constraining factor is changed abruptly, it can induce a rapid sequence of adaptations. We observed the cognitive artifacts of post hoc signage, posted inside the space of the operating rooms of a new hospital facility, to help identify the way clinicians adapt to a new physical plant. Methods: In the first six months of operation of a new hospital facility, a clinician (MN) photographed signage posted on the operatory floor of the hospital. The photographs were classified into general categories to uncover the sorts of adaptive behaviors they represented. Results: We identified 28 signs that fit into four categories: way finding (7); appropriation and item localization (6); equipment activation, instruction and upkeep (9); and malfunction or breakage (6). Way finding and equipment activation, instruction and upkeep signs appeared earlier, and malfunction signs appeared later over the course of observation. Discussion: The physical layout of a building is a concrete example of operational constraints influencing clinical behavior (“sharp end”). Clinicians adapt to several needs when faced with a new workspace. Way finding and operational instructions are important components of this adaptation, but so too is resource appropriation. Physical failings of equipment become evident during operations, and the signage suggests that communicating these failures visually is important. The signs show the way clinicians adapt to constraints, effectively documenting the deficiencies in the interface between the physical structure and the people who work there. They are useful to direct research into new, helpful signage and also to signal the “brittle” aspects of the workplace. They should be celebrated as opportunities for improvement.