Coping with complexity in home hemodialysis: A fresh perspective on time as a medium of Distributed Cognition

A Rajkomar, Ann Blandford, A Mayer
in Cognition, Technology and Work, Journal article


The existing literature on Distributed Cognition (DCog) mostly presents the temporal distribution of cognition in terms of system evolution that happens over time. In this paper, we illustrate how cognition can also be distributed through time in more immediate ways, through four principles we developed while studying how renal patients cope with the complexity of home hemodialysis. These principles are temporal assignments to tasks to aid prospective remembering; temporal arrangement of tasks to help deal with anticipated problems; temporal distribution of a task plan to avoid omission of steps; and temporal re-arrangement of tasks to reduce peak complexity. Like the physical environment, the time continuum is an external medium that can support distributed cognitive processes, serving as a representation for task reminders and allowing actors to organize the order, duration, and spacing of tasks to reduce complexity in cognitive work. These principles can highlight problems and opportunities in the design of socio-technical systems, by explicitly considering time as another medium that can be used to support DCog in short-term activity. © 2013 Springer-Verlag London.