Use of Cognitive Task Analysis to
Support Change Management
Chinook PCN
EnACt
The Challenge
• Alberta Screening and Prevention
• Change is hard!
• Frameworks to help exist...
• ...but are somewhat generic
• Is there something more concrete?
The Tool
• Cognitive Task Analysis
• Family of tools derived from large
body of research
• Long track record in other knowledge
work industries
• Designed to elicit tacit and dispersed
knowledge
Macrocognition
• Sensemaking and learning
• Coordination
• Managing uncertainty, irregularity
• Planning and replanning
• Monitoring and detection
• Decision making
Mental Models
• Our understanding of the work we do,
why we do it, how processes do or
should work, how the environment
affects them, what actions produce
what consequences, and through
what mechanisms
• May be shared or dissimilar
What We Did
• Trained a skilled team
• Worked with a leading-edge partner
• Conducted CTA interviews in 3
practices
• Team of 2 for 2 days, 5 or 6 interviews
• Observations and artifacts
Analysis and Reporting
• Level and style of each
macrocognitive skill
• Summary of practice’s mental model
• Recommendations
• Followup visit several months later
What We Found
• No skills deficits
• Wide range of how skills employed
• Structured vs informal, planned vs opportunistic
• Very different mental models
• Physician autonomy, jazz combo, quality
management
Did It Help?
• Practices became more aware of and
intentional about how they used
macrocognitive skills
• A hard choice indeed
• More information for ongoing
improvement
• Template for practice reboot
Conclusions
• CTA is feasible in primary care
• It can assist practice transformation
• It gets real, and that can be hard