I find the fallibility of our human brains very humbling. For me, this is a good reminder that we all need to anticipate our own irrational thinking and build space in our daily lives to make up for these errors. These mental errors influence our ability to make decisions and to make change happen – everything from starting to exercise, hiring people for a job, to how our large systems become stuck in ways of caring for patients that are not based in evidence and best clinical practice.
The book Thinking, Fast and Slow, (by Nobel prize-winning author Kahneman) does a masterful job of outlining our two human ways of thought – instinctive/emotional vs. deliberate/logical. For a faster, and more musical analysis, the short video Fool House Rock – outlines how and why people have tended to not use vaccines to prevent disease – how our human brain has a lot of tricks that make bad ideas seem reasonable – confirmation bias, correlation not equaling causation, perfectionist bias. But we have to work with what we have so our responsibility lies in building systems that lead the best possible outcomes not relying on more biased individual decision making.
My favorite social science study lives at the intersection of psychology and economics – and focuses on whether too many options helps or hurts our ability to make decisions. The study, When Choice is Demotivating: Can One Desire Too Much of a Good Thing, summarizes a series of field and lab-based experiments including whether offering six or 30 samples of plus a coupon for jam to shoppers in a grocery store resulted in them being more or less likely to eventually buy the jam. As it turns out, people given only six jams were much more likely to buy one of the jams than those given 30. I also find that too many options are overwhelming – and overwhelm leads to mental paralysis. This is a very human trait that I share with all of you as well (whether we like it or not).
We have to be intentional with our mental energy and instead of relying on ourselves as individuals, build systems that facilitate making good choices. The ready accessibility of a bag of Cheetos will greatly increase the likelihood that I eat that whole bag. I think we do our best in collaboration with other people, external perspectives that help us see flaws in our own thinking and in the structure of the systems in which we operate. It is so valuable for me to hear what it is like to live and work as someone else and to challenge my own understanding of the day-to-day – from a single clinical workflow to how information flows from place to place to how a person navigates caring for their back pain.
This opportunity for multiple perspectives is why our collaborative communities at the Foundation for Health Care Quality are so compelling. We offer the opportunity to build from the individual expertise we all have to build a health system capable of a bigger impact and healthier patients than any of us could do alone. This healthier – or healthiest Washington – is both an opportunity and a challenge – whether our own focus is on patient safety generally, obstetrics, or cardiac care – we can all collectively be that change we want to see – to collaborate and listen.
Ginny Weir, MPH