Shaping procedures to deal with complex situations

Handling dynamically-evolving environments, where unpredictable scenarios, incomplete information and pressure for quick decisions are commonplace, might bring great complexity for teams during treatment. Variables considered for undertaking recommended procedures may yield a great number of decision alternatives. Additionally, expectations regarding the response to treatment may not match those actually observed. Thus, recommended procedures usually require adjustments to meet needs and reactions of the ongoing situation. This paper deals with the challenges to diagnosing and adjusting procedures when handling complex situations, specifically during patients' care in emergency rooms. We propose an approach to support physicians' decision-making while shaping medical procedures to emergency cases. It allows physicians identify when observed evolution does not match the procedures described. From this, they can diagnose adequacy of recommended procedures for handling the case faced and, if necessary, adjust these procedures to patient's proper treatment. A case study in labor in poor communities illustrates approach application.