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MacroCognition LLC

3601 Connecticut Ave NW, #110,
Washington, DC 20008


By applying macrocognition to healthcare, we help organizations, professionals, and patients manage the complexity of the health care system and health maintenance regimens. For example, we develop programs that support patients with diabetes to discover how to manage their own blood glucose levels and avoid the crippling effects (e.g., blindness, amputations, kidney failure) that afflict millions.

Individual Challenges
The case of Type 2 diabetes. This disorder is a difficult health challenge around the world. Medical science has made great strides in understanding the physiological mechanisms of diabetes, pharmaceutical companies produce effective medications, and product designers have developed state-of-the-art equipment. It is the patient, however, who typically must manage daily decisions about meals, exercise, and medication adherence. We find that about 2/3rds of all people with type 2 diabetes fail to control their blood glucose levels. To learn why so many people with type 2 diabetes fail to control their disorder, we have collected interviews with people with type 2 diabetes to better understand their problems.

Our research has found that the failures are not usually because patients lack knowledge of physiology. They don't need more lectures about how the pancreas works. Providing a long list of behavioral ‘do's’ and ‘don'ts’ also cannot prevent failures. This approach generally fails. These are simply not useful for people with busy and often complicated lives. We found that most patients simply don't have a mental model of how their decisions about meals, exercise, medication, and stress interact to regulate blood glucose. They do not understand what they must do to regulate their glucose levels during changing demands and uncertainty.

The current medical model may contribute to the problem by trying to take control from patients. Healthcare providers have patients collect and bring in test results, but they don't use the finding of cognitive science and naturalistic decision making research to guide patients in interpreting results, discovering and correcting anomalies, and planning/replanning future choices. Patients are not learning to make their own discoveries about how they can better control their blood glucose levels through diet, exercise, stress, and medication, and how these variables interrelate. We use a dynamic control model together with techniques discovered by professions working in systems control to convey these critical capacities.

Organizational Challenges
Healthcare organizations also must continually monitor their operations to reflect changes in the patients served, medical advances, legal and fiscal constraints, and professional availability. Here, the focus must be on continual attention to the whole healthcare system. Organizations must detect changes early, make sense of their potential impact, plan for anticipated changes, and make timely and astute decisions. While we can address specific challenges, our real interest is in building the competence for ongoing adaptive capacity in the organization itself.

Selected Health Care Publications:
Klein, H.A., Jackson, S.M, Street, K., Whitacre, J.C., Klein, G. (2013). Diabetes Self-Management: Miles to Go. Hindawi Publishing Corporation, 1-15.

Klein, H. A., & Lippa, K. D. (2012). Assuming control after system failure: type ii diabetes self-management. Cognition, Technology & Work, 14 (3), 243-251.

Lippa, K.D., & Klein, H.A. (2008). Portraits of patient cognition: How patients understand diabetes self care. Canadian Journal of Nursing Research, 40(3), 80-95.

Lippa, K. D., Klein, H. A., & Shalin, V. (2008). Everyday expertise: Cognitive demands in diabetes self-management. Human Factors, 50, 112-120.

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