Fragmentation and choreography: Caring for a patient and a chart during childbirth

CSCW has long been concerned with how work is coordinated. A rich body of literature examines the mechanisms underlying cooperative work and the articulation of discrete tasks into meaningful sequences of action. However, there is less treatment of how workers balance multiple streams of work at once. In hospitals, the introduction of Health Information Technologies coupled with increased requirements for documentation means that workers must simultaneously care for and integrate two work trajectories: that related to the patient and that related to the medical record. Using data from an ethnographic study of labor & delivery nurses in a mid-size hospital, I describe the situated, embodied, and effortful work of coordinating multiple streams of action into a single coherent performance of work, a process I refer to as choreography, and present a number of choreography practices. I then describe implications of this perspective for CSCW.