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Patient flow management is a system-wide process but many healthcare providers do not integrate multiple departments into the process to minimise the time between treatments or medical services for maximum patient throughput. This paper presents a case study of applying Distributed Situation Awareness (DSA) to characterise system-wide patient flow management and identify opportunities for improvements in a healthcare system. This case study employed a three-part method of data elicitation, extraction, and representation to investigate DSA. Social, task, and knowledge networks were developed and then combined to characterise patient flow management and identify deficiencies of the command and control centre of a healthcare facility. Social network analysis provided centrality metrics to further characterise patient flow management. The DSA model helped identify design principles and deficiencies in managing patient flow. These findings indicate that DSA is promising for analysing patient flow management from a system-wide perspective. Practitioner summary: This article examines Distribution Situation Awareness (DSA) as an analysis framework to study system-wide patient flow management. The DSA yields social, task, and knowledge networks that can be combined to characterise patient flow and identify deficiencies in the system. DSA appears promising for analysing communication and coordination of complex systems. Abbreviations: CDM: critical decision method; CTaC: carilion transfer and communications center; EAST: event analysis systematic teamwork; ED: emergency department; DES: discrete event simulation; DSA: distributed situation awareness; SA: situation awareness; SNA: social network analysis.

The Process Overview Measure is a query-based measure developed to assess operator situation awareness (SA) from monitoring process plants. A companion paper describes how the measure has been developed according to process plant properties and operator cognitive work. The Process Overview Measure demonstrated practicality, sensitivity, validity and reliability in two full-scope simulator experiments investigating dramatically different operational concepts. Practicality was assessed based on qualitative feedback of participants and researchers. The Process Overview Measure demonstrated sensitivity and validity by revealing significant effects of experimental manipulations that corroborated with other empirical results. The measure also demonstrated adequate inter-rater reliability and practicality for measuring SA in full-scope simulator settings based on data collected on process experts. Thus, full-scope simulator studies can employ the Process Overview Measure to reveal the impact of new control room technology and operational concepts on monitoring process plants. Practitioner Summary: The Process Overview Measure is a query-based measure that demonstrated practicality, sensitivity, validity and reliability for assessing operator situation awareness (SA) from monitoring process plants in representative settings.

We introduce Process Overview, a situation awareness characterisation of the knowledge derived from monitoring process plants. Process Overview is based on observational studies of process control work in the literature. The characterisation is applied to develop a query-based measure called the Process Overview Measure. The goal of the measure is to improve coupling between situation and awareness according to process plant properties and operator cognitive work. A companion article presents the empirical evaluation of the Process Overview Measure in a realistic process control setting. The Process Overview Measure demonstrated sensitivity and validity by revealing significant effects of experimental manipulations that corroborated with other empirical results. The measure also demonstrated adequate inter-rater reliability and practicality for measuring SA based on data collected by process experts. Practitioner Summary: The Process Overview Measure is a query-based measure for assessing operator situation awareness from monitoring process plants in representative settings.

Query- or probe-based situation awareness (SA) measures sometimes rely on process experts to evaluate operator actions and system states when used in representative settings. This introduces variability of human judgement into the measurements that require inter-rater reliability assessment. However, the literature neglects inter-rater reliability of query/probe-based SA measures. We recruited process experts to provide reference keys to SA queries in trials of a full-scope nuclear power plant simulator experiment to investigate the inter-rater reliability of a query-based SA measure. The query-based SA measure demonstrated only 'moderate' inter-rater reliability even though the queries were seemingly direct. The level of agreement was significantly different across pairs of experts who had different levels of exposure to the experiment. The results caution that inter-rater reliability of query/probe-based techniques for measuring SA cannot be assumed in representative settings. Knowledge about the experiment as well as the domain is critical to forming reliable expert judgements.When the responses of domain experts are treated as the correct answers to the queries or probes of SA measures used in representative or industrial settings, practitioners should take caution in assuming (or otherwise assess) inter-rater reliability of the situation awareness measures.