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As a member of the Cognitive Technologies Laboratory in the Department of Anesthesia and Critical Care at the University of Chicago (Research Assistant 2002, Post-Doctoral Research Associate 2003-4, and Research Associate (Assistant Professor) 2004-09), I studied human performance in the high hazard work domain of healthcare. My consulting practice and corporate career have encompassed a variety of application areas, including health care, transportation and manufacturing. I retired from the U.S. Navy in 2001 at the rank of Captain after a 30-year active duty and reserve career. As a consultant I have provided services for human factors analysis, product development and as an expert witness. My academic career has included adjunct positions with Northwestern University's McCormick College of Engineering and Applied Sciences (Associate Professor), and Illinois Institute of Technology. My book, Human Factors Methods for Design, is now available from Taylor and Francis. My work continues to combine human factors and design to understand and support human performance in high hazard environments. I am currently a Principal Scientist and Group Leader for Cognitive Systems Engineering with Klein Associated Division of Applied Research Associates. You're welcome to contact me via e-mail at cnemeth@ara.com.
My recent research includes technical work in high hazard environments, research methods in individual and distributed cognition, and understanding how information technology erodes or enhances system resilience. In addition to the CtL, other colleagues who work in these and related areas include Stephanie Guerlain, PhD, Eric Hollnagel, PhD, Anne-Sophie Nyssen, PhD, Emily Patterson, PhD, Emilie Roth, PhD, David Woods, PhD, Robert Wears, MD, and Yan Xiao, PhD.
Human performance in complex systems
Humans are the most adaptive element in any system. Their performance in high hazard settings creates successful, and occasionally adverse, outcomes. Understanding what people do and how they do it is essential to system design, but is also difficult to research. Our studies show how clinicians develop sophisticated ways to deal with the uncertainty and pressures in high hazard real world work. |
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Nemeth CP, Wears RL [2008] A Healthcare Team Communication Research Agenda In Nemeth CP (Ed.), Improving Healthcare Team Communication. Aldershot: Ashgate: 245-50. (698 KB) |
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Nemeth CP, Kowalsky J, Brandwijk M, Kahana M, Klock PA, Cook RI [2008] Between Shifts: Healthcare Communication in the PICU In Nemeth CP (Ed.), Improving Healthcare Team Communication. Aldershot: Ashgate: 135-53. () |
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Nemeth CP, Wears RL, Woods DD, Hollnagel, E, Cook RI [2008] Minding the gaps: Creating resilience in healthcare, In K Henriksen, JB Battles, MA Keyes and ML Grady (Eds.) Advances in patient safety: New directions and alternative approaches. Vol. 3. Performance and Tools, AHRQ Publication No. 08-0034-3. Rockville, MD: AHRQ: (9.29 MB) |
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Hollnagel, E, Nemeth CP, Dekker, S [2008] Resilience Engineering Perspectives, Volume 1: Remaining Sensitive to the Possibility of Failure Book. Aldershot,UK: Ashgate Publishing: () |
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Nemeth CP [2008] Resilience Engineering: The Birth of a Notion In Hollnagel E, Nemeth CP & Dekker S (Eds.), Resilience Engineering Perspectives, Volume 1: Remaining Sensitive to the Possibility of Failure. Aldershot: Ashgate: (659 KB) |
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Nemeth CP [2008] The Context for Improving Healthcare Team Communications In Nemeth CP (Ed.), Improving Healthcare Team Communication. Aldershot: Ashgate: 1-7. (716 KB) |
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Nemeth CP, Walter J, Wears RL, Cook RI [2008] The Path to Resilience in Ambulatory Care AHRQ 2008 Conference: Promoting Quality...Partnering for Change. : () |
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Nemeth, CP (Ed.) [2008] Improving Healthcare Team Communication: Building on Lessons from Aviation and Aerospace Aldershot, UK: Ashgate Publishing. |
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Nemeth CP, Cook RI [2007] Reliability Versus Resilience: What Does Healthcare Really Need? In Dominguez, C. (chair) Symposium on High Reliability in Healthcare. Proceedings of the Human Factors and Ergonomics Society Annual Meeting. Baltimore: 621-5. (79 KB) |
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Nemeth CP, Nunnally ME, O'Connor MF, Brandwijk M, Kowalsky J, Cook RI [2007] Regularly irregular: how groups reconcile cross-cutting agendas and demand in healthcare Cognition, Technology and work. 9(3): 139-48. (266 KB) |
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Wears RL, Nemeth CP [2007] Replacing hindsight with insight: Toward better understanding of diagnostic failures Annals of Emergency Medicine. 49(2): 206-9. (88KB) |
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Nemeth CP [2004] Further Thoughts on Being Forehanded Conference on Surgical Errors. U.S. Army Medical Command (MEDCOM): Washington, DC. (89.5 KB) |
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Cook RI, Brandwijk M, Kahana M, O'Connor MF, Brunetti VL, Nemeth CP [2003] Being Bumpable:Consequences of Resource Saturation and Near-saturation for Cognitive Demand on ICU Practitioners International Anesthesia Research Society National Conference. New Orleans: (200 KB) |
Creation of information displays
Information displays are cognitive artifacts that are intended support the particular work that people perform. All too often, standardized displays ignore the specifics that make each work setting unique. Workers have to make up the difference. In high hazard settings such as healthcare, this can be costly. Clinicians have to assemble, consider and act on many disconnected kinds of information in time-pressured circumstances that can have dire consequences for patients. Our work describes the kinds of research and design activity that is necessary to develop ecological displays that are a good match for healthcare. |
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Nemeth CP, O'Connor MF, Nunnally ME, Cook RI [2007] RePresenting Reality: The Human Factors of Health Care Information In Carayon, P. (Ed.). The Handbook of Human Factors and Ergonomics in Health Care and Patient Safety. Mahwah, NJ. Lawrence Erlbaum Associates: 439-55. |
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Nemeth CP, O'Connor MF, Klock PA, Cook RI [2005] Temporal Cognitive Work: Discovering Requirements for Digital Artifacts Eleventh International Conference on Human-Computer Interaction. Las Vegas: (255 KB) |
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Nemeth CP, Cook RI [2004] Discovering and Supporting Temporal Cognition in Complex Environments In Proceedings of theTwenty-Sixth Annual Conference of the Cognitive Science Society. Chicago: 1005-10. (1.07 MB) |
Information technology in healthcare
Computer support for clinicians, or information technology (IT), is being promoted as a means to improve patient safety. However, IT that does not fit the work that clinicians do can impose a burden instead of being a help. Our studies of infusion devices and scheduling software inform our observations about how to develop IT that is suited to support the work of clinicians who work at the sharp (operator) end of healthcare. |
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Nemeth CP, Nunnally ME, O'Connor MF, Cook RI [2008] For resilient IT: Don't mimic the past, leverage the future Conference on Systems Engineering Research. Redondo Beach, CA: (207 KB) |
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Nemeth CP, Cook RI [2007] Healthcare IT as a Source of Resilience In Nemeth, C. (chair) Symposium on Resilience in Health Systems. Proceedings of the International Conference on Systms, Man and Cybernetics. Montreal: (184 KB) |
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Nemeth CP, O'Connor MF, Klock PA, Cook RI [2005] Mapping Cognitive Work: The Way Out of Healthcare IT System Failures Proceedings of the American Medical Informatics Association Annual Symposium. Washington, DC: 560-4. (.97 MB) |
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Nemeth CP, Nunnally ME, Cook RI, Crowley J, Weinger M, Woods DD [2005] Brave New World: Medical Devices, Clinical Information Systems, Networks, and Patient Safety Proceedings of the Human Factors and Ergonomics Society 49th Annual Meeting. (164 KB) |
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Nemeth CP, Cook RI [2005] Hiding in plain sight: What Koppel et al. Tell Us About Healthcare IT Journal of Biomedical Informatics. 38 (4): 262-3. (84 KB) |
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Nemeth CP, Nunnally ME, O'Connor MF, Klock PA, Cook RI [2005] Getting to the Point: Developing IT for the Sharp End of Healthcare Journal of Biomedical Informatics. 38(1): 18-25. (643 KB) |
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Nemeth CP, Wears RL, O'Connor MF, Perry S, Cook RI [2004] Crafting Information Technology Solutions, Not Experiments, for the Emergency Department Academic Emergency Medicine. 11(11): 1114-7. (128 KB) |
Distributing cognition in complex work settings
Healthcare workers provide continuous care for inpatients across multiple shifts throughout the day. In order to prevent gaps in this care, clinicians hand-off information whenever they change shifts. Recent limits on resident hours have resulted in more frequent shift changes and other clinicians from outside a unit doing “cross cover” assignments. This makes good hand-offs particularly important. While some favor using personal digital assistants (PDAs) to conduct handoffs, our studies have shown these between-shift exchanges are sophisticated negotiations on multiple topics that strive to minimize uncertainty. |
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Nemeth CP [2007] Healthcare groups at work: further lessons from research into large-scale coordination Cognition, Technology & Work. 9(3): 127-30. (114 KB) |
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Nemeth CP [2007] Groups at work: lessons from research into large-scale coordination Cognition, Technology & Work. 9(1): 1-4. (116 KB) |
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Nemeth CP, Kowalsky J, Brandwijk M, O'Connor MF, Nunnally ME, Klock PA, Cook RI [2005] Distributed cognition: how hand-off communication actually works Anesthesiology. 103: A1289. (1.01 MB) |
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Nemeth CP, Cook RI, Kowalsky J, Brandwijk M [2004] Understanding Sign Outs: Conversation Analysis Reveals ICU Handoff Content and Form Critical Care Medicine. 32 (12): A29. (161 KB) |
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Brandwijk M, Nemeth CP, O'Connor MF, Kahana M, Cook RI [2003] Distributing Cognition: ICU Handoffs Conform to Grice's Maxims SCCM. San Antonio. (161 KB) |
How infusion devices influence clinical care
Infusion devices, which are used to provide accurate doses of medications and fluids for patients, are the most widely used IT in acute care. Claims that “user error” causes medication misadministration ignore safety engineering. Simple infusion pump interfaces present small “keyhole” views into very complex programming pathways. Our laboratory and field studies of many infusion devices show how poor interface design forces clinicians to become lost while trying to program medications. |
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Nemeth CP, Nunnally ME, O'Connor MF, Klock PA, Cook RI [2005] Making Information Technology a Team Player in Safety: The Case of Infusion Devices. In K. Henricksen & J. B. Battles & E. Marks & D. I. Lewin (Eds.). Advances in Patient Safety: From Research to Implementation. Agency for Health Care Research. Washington, DC. 1: 319-30. (361 KB) |
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Nunnally ME, Nemeth CP, Brunetti VL, Cook RI [2004] Lost in Menuspace: User Interactions with Complex Medical Devices. IEEE Transactions on Systems, Man and Cybernetics - Part A: Systems and Humans. 34(6): 736-42. (566 KB) |
Reactions to failure in healthcare and ways to improve them
Unlike other high hazard sectors such as aviation, healthcare has no impartial resource to investigate and analyze adverse events. In response to regulator and government mandates, hospitals have developed their own safety programs and committees that are subject to social and political pressure, have no training in forensics, and do not share findings. Their reports of adverse events submitted to regulators routinely lack the contextual information that gives reports meaning. This limits what can be learned from adverse events and erodes public confidence in healthcare. Our studies have explored the potential for a resource to assist hospitals with adverse event investigation and analysis. |
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Nemeth CP, Cook RI, Donchin Y, Dierks MM, Patterson ES, Bitan Y, Crowley J, McNee S, Powell T [2006] Learning from investigation: Experience with understanding healthcare adverse events Proceedings of the Human Factors and Ergonomics Society Annual Meeting. San Francisco, CA. (145 KB) |
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Nemeth CP, Cook RI, Crowley J, Ragan M, Battles JB, Smithson K, Bruley M [2005] Above Board: Issues in Medical Account Investigation and Analysis Proceedings of the Human Factors and Ergonomics Society 49th Annual Meeting. (339 KB) |
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Nemeth CP [2005] Health Care Forensics. In Noy, YI. and Karwowski, W. (Eds.). Handbook of Human Factors in Litigation. New York, CRC Press: 37-1 to 37-18. (12.5 MB) |
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Nemeth CP, Cook RI, Patterson ES, Donchin Y, Rogers ML, Ebright PR [2004] Afterwords: The Quality of Medical Accident Investigations and Analyses Human Factors and Ergonomics Society National Conference. New Orleans. (173 KB) |
Methods to create human-centered systems
Human behavioral research is challenging for a number of reasons, including the complexity and variability of human activities. The social sciences and engineering have developed methods to collect and analyze behavioral data in healthcare. These qualitative data are subject to a range of influences and are difficult to reduce. Clinicians and professionals in human factors and design collaborate in our Lab to accomplish the insights that no single profession could achieve. |
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Wreathall J, Nemeth CP [2004] Assessing Risk: The Role of Probabilistic Risk Assessment (PRA) in Patient Safety Improvement Quality & Safety in Health Care. 13(3): 206-12. (144 KB) |
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Cook RI, Nemeth CP, Brandwijk M [2004] Technical Work Studies: Understanding Human Work Amid Complexity, Uncertainty, and Conflict Administration for Healthcare Research and Quality 3rd Annual Patient Safety Research Conference. Arlington, VA. (71 KB) |
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Nemeth CP, Cook RI, Woods DD [2004] The Messy Details: Insights from Technical Work in Healthcare IEEE Transactions on Systems, Man and Cybernetics - Part A: Systems and Humans. 34(6): 689-92. (442 KB) |
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Nemeth CP [2004] Human Factors Methods for Design London: Taylor and Francis/ CRC Press. |
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Nemeth CP [2003] Get Real: The Need for Effective Design Research. Special Issue: Research in Communication Design Visible Language. 37(1): |
Using cognitive artifacts to understand complex work settings
Complex high hazard settings including the military, aviation, transportation, and nuclear power generation, are particularly challenging for human subject research. We have developed an approach that uses the information tools, or cognitive artifacts, to begin to understand a work domain in any high hazard sector. This method can be used as part of cognitive task analysis to reveal work domain semantics that are essential to create support tools such as information displays. |
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Nemeth CP, Nunnally ME, O'Connor MF, Cook RI [2006] Creating resilient IT: How the sign-out sheet shows clinicans make healthcare work Proceedings of the American Medical Informatics Association Annual Symposium. Washington, DC: 584-8. () |
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Nemeth CP, O'Connor MF, Klock PA, Cook RI [2006] Discovering healthcare cognition: the use of cognitive artifacts to reveal cognitive work Organization Studies: Special issue on Naturalistic Decision Making. 27(7): 1011-35. |
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Nemeth CP, O'Connor MF, Klock PA, Cook RI [2005] Cognitive Artifacts' Implications for Health Care Information Technology: Revealing How Practitioners Create and Share Their Understanding Advances in Patient Safety: From Research to Implementation. Agency for Healthcare Research. Washington, DC. 2: 279-92. (644 KB) |
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Jones P, Nemeth CP [2005] Cognitive Artifacts in Complex Work. In Cai Y (Ed.). Ambient Intelligence for Scientific Discovery: Foundations, Theories, and Systems. Lecture Notes in Computer Science. 3345: 152-83. (1.52 MB) |
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Nemeth CP, Klock PA, O'Connor MF, Cook RI [2004] How Cognitive Artifact Support of Acute Care Distributed Cognition Affects Patient Safety International Conference on Probabilistic Safety Assessment and Management (PSAM) Conference. Berlin. (322 KB) |
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Nemeth CP, Cook RI, O'Connor MF, Klock PA [2004] Using Cognitive Artifacts to Understand Distributed Cognition IEEE Transactions on Systems, Man and Cybernetics - Part A: Systems and Humans. 34(6): 726-35. (1221 KB) |
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Nemeth CP [2003] The Master Schedule: How Cognitive Artifacts Affect Distributed Cognition in Acute Care Dissertation Abstracts International 64/08. 3990, (UMI No. AAT 3101124). |
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Nemeth CP, Cook RI, O'Connor MF, Klock PA [2003] Using Cognitive Artifacts to Understand Distributed Cognition (HFES) In Xiao Y, Special Session on Distributed Planning. IEEE International Conference on Systems, Man & Cybernetics. Washington, DC. (54 KB) |
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Nemeth CP [2003] How Cognitive Artifacts Support Acute Care Distributed Cognition. In Cook R, Woods D, Insights From Technical Work Studies in Healthcare Symposium at Human Factors and Ergonomics Society National Conference. Denver: 381-5. (144 KB) |
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Nemeth CP, Klock PA, Daves S, Cook RI [2002] A Study of How Cognitive Artifacts Affect Distributed Cognition in Operating Room Management Anesthesiology. 97(3A): A1183. (569 KB) |
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