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Interruptions during clinical work have long been a source of concern. Accordingly, interventions have been introduced to reduce or eliminate interruptions to high-risk clinical tasks. Although interventions are often successful at protecting the individual’s work from interruption, they may disrupt the work of others or be incongruent with patient-centered care. We propose that interventions may not fit the intended work system because methods used to study interruptions fail to reveal why they happen in the first place. In contrast to typical approaches used to study interruptions, we employ a complex systems perspective that moves the focus away from discrete interactions between individuals towards the intersection of work functions that make up the broader work system (Rasmussen & Lind, 1981). Analysis using a cognitive systems engineering orientation proposes that many interruptions are caused by “operational failures”(Tucker & Spear, 2006) in the system. It follows that it may be preferable to fix the source of the operational failure than to ban interruptions altogether. Given that some interruptions are necessary for clinical work to progress (Grundgeiger & Sanderson, 2009; Rivera-Rodriguez & Karsh, 2010), researchers need a better way of judging whether and when there will be a net benefit in making an intervention, and determining the form the intervention will take. Using a dual perspective observation technique we investigated the origins of interruptions in an Intensive Care Unit (ICU). To assist with conceptualization of ICU work functions and coordination of work, we adopted the integrated model of ICU communication and care …