Creating resilient IT: how the sign-out sheet shows clinicians make healthcare work.

Information technology (IT) systems have been described as brittle and prone to automation surprises. Recent reports of information system failure, particularly computerized physician order entry (CPOE) systems, shows the result of such IT failure in actual practice. Such mismatches with healthcare work requirements require improvement to IT research and development. Resilience is the feature of some systems that makes it possible for them to respond to sudden, unanticipated demands for performance and return to normal operation quickly, with minimum decrement in performance. Workers create resilience at healthcare's sharp end by daily confronting constraints and obstacles that need to be surmounted in order to accomplish results. The resident sign-out sheet is described as an example of resilience. Efforts to develop successful IT systems for healthcare's sharp end must incorporate properties that reflect work domain traits, as the sign-out sheet shows.