Introduction Preliminary efforts and literature review led to the creation of Narrative Descriptions. The user was asked to describe an event, and associated emotions. Then a discussion was added with three points of view, personal, interpersonal-communicative, and organizational. Originally these were for discussion within our group. Later we suggested a written narrative focus be added with consideration of probable uses: editing and re-reading, a naive reader, a teaching file, a categorization or an ontology. These could be characterized as goals or _WorkPoints._ Our beginning trials with the Narrative Discussions revealed a complexity requiring a more complete examination of events. We discovered John Flanagan’s early work on the Critical Incident Technique (CIT) , His goal was to develop a scientific basis for identifying critical factors to account for WWII student pilots who failed in training. Previously reasons given by examiners were often cliches or lacked depth. This large careful study with well defined goals led to many other applications both in aviation and later in manufacturing, business, management and nursing . (PubMed alone has 2543 articles and 231 review articles on CIT in Nursing.) Early attempts to cope with medical error tended to focus on a model of Blame and Train however, safety studies from other fields suggested there was greater complexity. To a psychiatrist it appeared there was little attempt to search for problems outside of awareness, due to unconscious, denied or unobserved detail. We combined the approach of examining specific events (CIT) with pushing the user to consider emotional reactions and states in our Complex Context Critical Incident Report (CCCIR). In this new approach the user applies multiple points of view to include feelings and emotions, the nature of communication, or lack thereof, and systemic/organizational factors. We asked users of our reflection tools to include any possible relevant associations: what comes to mind, even if it was a tune, a book, a movie, a distant memory of an event. Keywords are added for future categorization or teaching. _WorkPoints_ emphasize text has special meaning in our methodology. CamelCase could indicate ideas to be explored, related concepts, or plans of action or solution. The rather complicated template embraces and clarifies complex situations The final tool was called a Complex Context Critical Incident Report (CCCIR). While with some support even naive users can rapidly learn to use such a template a simplified unit was needed for self-training in close observation and participant observation. Repetitive use also increases recall, associations, and resolves minor impasse. We have some optimism that a future system could be developed utilizing more productively the world wide web, social media and hypertext elements. While computers speed up these tools, all that is necessary is pencil and paper. We hope these tools may be useful in worlds as different as academic medical centers and pre-literate tribal societies. _Literacy Bridge_ a clever and effective program produces changes in maternal and child health and agriculture by supporting communication with spoken word devices. Complexity Complex systems have multiple parts. Human use the technical parts and interact with other humans, introducing communication. All this is in constant change over time. Investigating and Defining Complex Systems Failure This area has been investigated extensively and from many points of view. A summary of important considerations concerning health care is found at the Cognitve Technologies Lab in a handout by Richard I. Cook: _How Complex Systems Fail_ accessible as full text through Research Gate. One of the problems of research in this area is the view from the top down is strongly influenced by the language and habits of the different disciplines, they are looking for a particular canary in the coal mine, one from the areas with which they are familiar and were they can develop testable hypotheses. From the ground, the bottom up, the case report, the life story, the perspective is somewhat different. We do not want to miss something just because it is new, or rare or unfamiliar to us. One of the most troubling problems in medicine is the patient who presents with something unexpected or unknown to us. They are frequently blamed for not having the right picture to fit our expectations. They are blamed for imagining something or come to feel they are hypochondriacs. One of my OB/Gyn professors drummed into our minds the “first symptom of carcinoma of the cervix is no symptoms.” Extending an Investigation While we began with specific incidents we found in order to have an adequate context we needed both a wider and a deeper look. In the literature this is called _thick description_ an idea introduced by Gilbert Ryle, a philosopher of Mind ,and popularized by Clifford Geertz, an anthropologist, who applied the idea in field work in Bali. . In our reflection tools the deeper look is expressed in the Narrative Report, the wider look is the result of the Complex Context Critcal Incident Report. The SwampNote is the basic description of one view of an incident and the author’s view including their feeling state. SwampNote is a term we began using fifteen years ago. We found the idea in the work at MIT of Donald Schon. He contrasted the different worlds of the academy and work in the trenches which he called the Swamp. In recent years the term has become so loaded in political and media discussion that the original meaning has become smothered by a new one. This is not uncommon that language changes or loses meaning and is no longer as useful. Famously that was illustrated in Anmimal Farm and 1984. As this became clear to us we had already tried another original term of our own OoopsaDaisy for a note based simple system. In practice it is not important what it is named or called but it is important that it not frighten or intimidate users. In repeated use observation and description are sharpened. Several notes may contribute to a Narrative Report and/or a CCCIR. We provide samples of the tools in Section 4 and clarify how they relate to each other and how they can and should be adapted to local, on the ground conditions. The next sections explain what situations and questions led us to develop this way of looking at important life incidents.
