Alignment Under Pressure: AR-HMD Support Tools for Action Teams

Abstract

Team communication breakdowns represent a contributor to patient safety risks within action teams — defined as interdependent groups of specialized people who perform coordinated work under high workload, time pressure, and uncertainty. Approximately 70% of such instances lead to adverse patient outcomes amid intense time pressure, uncertainty, and high cognitive load. While prior research has focused on maintaining shared cognition during these interactions, existing technologies largely prioritize individual task execution and decision-making, offering limited support for real-time team coordination. This study investigates the potential of augmented reality head-mounted displays (AR-HMDs) to address this gap by facilitating what we call 'team alignment' — the active maintenance of shared understanding regarding tasks, patient state, responsibilities, and ongoing clinical activity. Through an 11-month multi-phase qualitative study with ten healthcare professionals, we first elicited coordination challenges through semi-structured interviews complemented by real-time storyboard creation. Participants then engaged in reflection and refinement of these scenarios while contemplating the potential impact of AR-HMDs on their situation. Our findings revealed that breakdowns frequently arose when clinicians lacked sufficient contextual information, when assigned responsibilities did not align with available expertise, or when procedural progress was difficult to track — particularly during critical bedside activity. We subsequently developed the Team Alignment and Coordination Taxonomy (TACT), encompassing information, expertise, procedural, and cognitive dimensions. By reframing coordination as this active maintenance of alignment, our research shifts the design focus from individual decision support systems to holistic, team-level system interventions.

Highlights

• An 11-month multi-phase qualitative study with ten healthcare professionals, combining semi-structured interviews with real-time storyboard creation.
• Introduces 'team alignment' — the active maintenance of shared understanding of tasks, patient state, responsibilities, and ongoing activity — as a lens on coordination breakdowns.
• Contributes the Team Alignment and Coordination Taxonomy (TACT), spanning information, expertise, procedural, and cognitive dimensions.

Citation

@article{segal2025alignment,
  title={Alignment Under Pressure: AR-HMD Support Tools for Action Teams},
  author={Segal, Jonathan Isaac and Nicoly, Jalynn Blu and Cao, Huajie and Kim, Soyon and Tanjim, Tauhid and St. George, Jonathan and Ching, Kevin and Ortega, Francisco Raul and Lee, Hee Rin and Taylor, Angelique},
  journal={arXiv preprint arXiv:2502.17295},
  year={2025}
}