COLUMN: The Fatality Of Selective Attention
Published: Sunday, September 29, 2013
Updated: Sunday, September 29, 2013 21:09
A trip to the hospital is about as safe as bungee jumping. This is not a statistic about the chances of being healed by a hospital trip—it is a statistic about one’s chances of being harmed. Data collected by the World Health Organization and the organization Healthcare Performance Improvement have exposed the startling regularity with which hospitals harm their patients. Selective attention in the high-risk field of healthcare allows for serious injury and fatality where it need not occur. Health systems and hospital administrators across the country have recognized this problem and have begun implementing programs borrowed from other high responsibility organizations like commercial airlines and nuclear power plants to break the stranglehold of selective attention to foster cultures of safety. The ills of selective attention are everywhere, and we have the capability—the responsibility—to eliminate them.
Selective attention is a natural and necessary function of the human brain. In his book, Thinking, Fast and Slow, Daniel Kahneman describes the two systems of the brain that govern how we think. One he calls System 1, which is fast, emotional, and intuitive. The other he calls System 2, which is logical, slower, and more deliberative. He presents the necessity of both systems along with the problems and cognitive biases that arise from the interaction (or lack thereof) between the two systems. The Selective Attention Test demonstrates this idea well—it is a video of three people in white shirts passing a basketball back and forth around and between three people in black shirts. At the beginning of the video the viewer is instructed to count the number of passes made by the team in white. The video lasts about one minute and the tally of passes comes to 15. Most viewers succeed in counting the number of passes correctly, however, (spoiler alert: if you haven’t seen the video and want to test your selective attention, pause here and watch the video before I ruin the surprise) many people fail to notice the person in a gorilla suit stroll into the frame halfway through the video. By focusing on the movement and passes made by the team in white, the viewer becomes blind to the team in black. The viewer fails to see the gorilla because selective attention lumps the black fur in with the team wearing black, which is the visual information not focused on, and thus, not processed.
The ability to focus and hone our attention is a vitally important one. Selective attention allows us to read, converse, and drive—allows us to interact with the world without being overwhelmed by sense data. The problem with selective attention is that we do not always choose the right thing to focus on. The healthcare industry is a perfect example of this. The health of the patient is the goal of the hospital and the medical staff that populates it. This goal is normally sought by attending to diagnosis and treatment— however, this focus cannot be the only focus if the patient’s health is to be realized. Attention to the things that need to be avoided has proven as important if not more important than the attention given to things that need to be done. A patient will be thankful if a surgery is completed and the inflamed appendix has been removed, but if the surgeon forgets to count his surgical sponges and stitches the patient up with a sponge still inside him, the goal has been missed.
To avoid these kinds of mistakes hospitals implement practices learned from the commercial airline and nuclear power industries to foster cultures of safety. There are several lessons that can be drawn from the examples set by these industries. Success might require refocusing. Before a hospital sees a decrease in injuries, it records a huge spike. There are not more injuries happening, the injuries simply start being noted and reported. Before the focus is turned to the mistakes it seems that fewer injuries and deaths occur because no one is tracking them. Before a problem can be fixed, attention must be given to the problem. Focusing on the problems we create ourselves, painful as it might be, is the only path out of a complacent cycle of self-harm.
Focusing on the important issue is a dynamic process. After a hospital begins to record its mistakes, it can focus on creating a system that prevents them. This process is dynamic in that it requires constant attention and persistent improvement. Once past the spike in recorded injuries and deaths, hospitals often see a steady decline in these types of accidents. One or two years into the program, however, there is another influx of accidents. This is complacency. As the new system becomes routine, the hospital staff begins to lose focus, apathy sets in, and patients are harmed. The danger lies in seeing results and thinking the job is done. Constant, persistent attention is required in a dynamic process that continues to function properly.
The task of focusing properly is a communal project. One of the greatest challenges in creating a culture of safety in a hospital is getting the entire staff’s support. Every nurse, physician, custodian, and administrator must invest in the project if it is to be successful. Leaving any one level of the hierarchy out of the process will create holes through which mistakes can slip, resulting ultimately in harm to patients. The entire system of individuals must harmonize on the importance of an issue before any action can be implemented effectively.
Do we, as a society, suffer under the dominion of poorly placed selective attention? There are certainly a handful of topics in the public eye (Syria, socio-moral issues, healthcare) that receive an enormous amount of attention. It is our responsibility to continually assess our need to refocus, to tirelessly concentrate our attention on the issues we deem important, and to ensure that the entirety of the population is included in the discussion. Forgoing these practices will leave us in danger of cutting off the wrong appendage, prescribing the wrong treatment, and entirely missing our own mistakes.