My friend Phil Shapiro, CFO of Babson College, led me to this website. It lists the common forms of cognitive bias.
Each time I look at it, I see another that is prevalent in hospitals. Confirmation bias is certainly one that is found in clinical decision making, as noted by Jerry Groopman. Status quo bias occurs in every walk of life. I bet that CFOs like Phil often are faced with reminding people about sunk cost bias. I particularly like the concept of survivorship bias, forgetting to include firms that no longer exist in research reports when strategic planning takes place!
In the body politic, the bandwagon effect is well known....
The most frequent form of bias (if one could call it that) I saw among health care leaders was something I call "muddy thinking." When confronted with an incident, error, or complex issue needing resolution, this manifested as a group inability to see through to the heart of the matter - that is, the root cause that was leading to all the rest of the problems. Often, much time at meetings was wasted on trying to solve something that was actually a consequence, not a cause.
ReplyDeleteThis is why a formal root cause analysis process is necessary, but often still not sufficient (e.g., one can still answer all the "why" questions wrongly). But, how does one teach clear thinking?
If I were to redesign medical (or nursing education) I would focus a ton on how we make decisions as human beings and as professionals. Cognitive biases would be a major part of the foundation of this course.
ReplyDeleteThanks for featuring this site.
Oops, in keeping with Paul's challenge to not be anonymous, I forgot to include my moniker at 10/8:30. And I was referring to medical staff leaders as well as administrative leaders.
ReplyDeletenonlocal
I like the section on decision-making mistakes. The two that I have noticed the most in health care errors are "Overconfidence in Your Judgment" (i.e. I already know what is best for this patient) and "Shortsighted Shortcuts" (i.e. this works for 90% of people, so we can do the same for everybody).
ReplyDeleteOf course, there is also "Not Keeping Track" and "Failure to Audit Your Decision Process" that perpetuate the other mistakes when they could be corrected.
In general, I think cognitive biases are an overrated fad.
ReplyDeleteHowever, hospitals are one of the few places where their application really shines.
I discuss the fad angle in these two posts:
http://koanic.wordpress.com/2010/07/16/statistical-cognitive-bias-meme-is-useless-brain-candy/
http://koanic.wordpress.com/2010/07/15/81/
Keep up the good work.
-Koanic