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





Patient Safety Tip of the Week Archive


What’s New in the Patient Safety World Archive