Patient Safety Tip of the Week
May 29, 2007
Read Anything & Everything
Written by Malcolm Gladwell!
We had not planned
to do a Tip of the Week over this holiday weekend. However, our “light” reading
over the holiday was “Blink” by Malcolm Gladwell, who also authored “The
Tipping Point”. Of course, there is nothing really “light” about Gladwell’s
books other than that he has an uncanny ability to present really profound
ideas in such a smooth read that you don’t put his books down. He’s a master at
telling stories to illustrate concepts well-founded in scientific research.
For those who do
root cause analyses (RCA’s), “Blink” provides great insight into how decisions
are made. In many RCA’s your goal is to find out why people made the decisions
they made since others are also likely to use the same decision making
processes in the future. The first premise of “Blink” is that decisions made
quickly can often be as good or better than those requiring much more
deliberation. This “rapid cognition” is really done at a subconscious level.
You might refer to it as your “gut feeling” or “instincts” and you may not be
able to explain well why you came to that decision but such decisions were
probably processed very methodically by the subconscious brain. However,
there are experiential influences that may bias that rapid decision making and
there are other influences that may interfere with rapid cognition. Knowing
what circumstances are likely to cause those influences on rapid cognition may
be very helpful in planning with patient safety in mind. For instance, knowing
what scenarios are likely to lead to deleterious rapid decisions can help
design effective training on avoidance of such decisions. Likewise,
understanding when too much information interferes with rapid cognition can be
important in design of clinical processes. Most of the best solutions to
patient safety problems involve simplification rather than adding more steps to
processes.
An example of
rapid cognition leading to a bad outcome is the high-speed chase, which leads
to predictable behaviors by both the pursuer and the one being chased. Training
to recognize the “high-speed chase” syndrome might help avoid those chases
ending in bad outcomes. Gladwell describes how under extreme stress a
typical reaction is tunnel vision, diminished awareness of sound, and sense
that time has slowed down. That leads to extreme focus on an immediate problem
and a lack of awareness of the surroundings. While this may enhance performance
in dealing with certain problems, it may foster snap judgements that are
detrimental in others. He goes on to describe a problem in Florida where police
were involved in high numbers of violent incidents with citizens. Observers
were placed in squad cars to monitor police behavior. They found that the
police officers did very well when they were face-to-face with suspects but did
a poor job in their approach to the scene. So the department focused on what
the officers did before they approached the suspect and the number of violent
incidents dropped substantially. Clinical analogies obviously exist in multiple
hi-risk environments, like the OR or ER or ICU.
There is even a
chapter on the importance of facial expression in communication. Makes you
wonder how we ever manage to get it right with all those masked people in the
OR!
So no specific
“Tip” this week other than that you’ll be both fully amused and stimulated by
reading Gladwell’s “Blink”. Our bet is that during your next RCA you’ll find
yourself saying “Now I know why they did that!”.
Update: See our May 27,
2008 Patient Safety Tip of the Week “If
You Do RCA’s or Design Healthcare Processes…Read Gary Klein’s Work”
http://www.patientsafetysolutions.com
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