Coordinating knowledge work across technologies: Evidence from critical care practices

This paper examines how heterogeneous technologies impact the coordination of knowledge work in complex socio-technical settings. It is based on an in-depth field study of critical care practices characterized by intensive knowledge work and technological heterogeneity. We observe that heterogeneous technologies create workflow gaps within which health professionals adapt technology use to contingencies and local needs, prioritize interventions, and identify problems before they become detrimental to patient care. These adaptations provide opportunities for health professionals to continuously align work across heterogeneous technologies and to accomplish broader professional and ideological goals. Our analysis shows that health professionals use three coordination practices when working across heterogeneous technologies: controlling and enhancing information, reconstructing workflows, and circumventing requirements. We theorize how these practices address coordination needs associated with heterogeneous technologies and discuss implications for knowledge work. We provide a more complete understanding of coordination practices in complex, socio-technical settings which contributes to both knowledge work and coordination literatures.