Authority as an Interactional Achievement: Exploring Deference to Smart Devices in Hospital-Based Resuscitation

Over the years, healthcare has been an important domain for CSCW research. One significant theme carried through this body of work concerns how hospital workers coordinate their work both spatially and temporally. Much has been made of the coordinative roles played by the natural rhythms present in hospital life, and by webs of mundane artefacts such as whiteboards, post-it notes and medical records. This paper draws upon the coordinating role of rhythms and artefacts to explore the nested rhythms of the Cardio-Pulmonary Resuscitation (CPR) protocol conducted to restore the proper heart rhythm in a patient who has suffered a cardiac arrest. We are interested in how the teams delivering CPR use various 'smart' assistive devices. The devices contain encoded versions of the CPR protocol and are able to sense (in a limited way) the situation in order to give instructions or feedback to the team. Using an approach informed by ethnomethodology and conversation analysis (EM/CA) we analysed video of trainee nurses using these devices as they delivered CPR in dramatized training scenarios. This analysis helped us to understand concepts such as autonomy and authority as interactional accomplishments, thus filling a gap in CSCW literature, which often glosses over how authority is formed and how it is exercised in medical teams. It also helps us consider how to respond to devices that are becoming more active in that they are being increasingly imbued with the ability to sense, discriminate and direct activity in medical settings.