“The hardest thing about being a doctor is that you learn best from your mistakes, mistakes made on living people.” —Dr. Karen Delgado
As a physical therapist, I face a similar daily challenge as described by Dr. Delgado. I may not face life or death situation, but my decisions can have substantial influences on a patient’s life.
I try to make the best clinical decisions possible. To improve clinical decision-making, most clinicians — doctors or physical therapists — focus on continuing education and gaining more experience.
These are great strategies, but they are limited by the environment the clinician works in. The same holds true for any profession.
Your skills and preparation will be either limited or enhanced by your work environment.
The influence of your work environment
Our work environment influences our cognitive load — or how much our brain has to work.
If we are in a busy environment, we have many pieces of information to process at a given moment. Experience and intuition can help us process the information.
Intuition is our ability to rapidly understand without conscious reasoning. It is our ‘gut feeling.’ Intuition requires synergy between knowledge, experience, and expertise.
Unfortunately, we don’t all have experience and intuition to draw on.
A novice professional will struggle with higher cognitive loads from busy environments as they cannot rely on intuition. They do not have a vault of experiences to fall back on.
This leaves us with a couple of options.
- We can seek and develop more algorithms — decision trees — to ease decision making
- Novice professionals can partner with a senior leader who can review decisions and provide guidance
- Novice professionals can lighten their workload to allow time for reflection and critical thinking.
In any field, all people have a saturation point for their cognitive load, even senior leaders and expert technicians. We must consider all the tasks someone is trying to complete at a given time.
Our brains can only focus on a single task at a given time. The perception of multi-tasking is a repeated, rapid switch in attention. The more tasks we try to complete at a given time, the higher the “switch cost” will be.
Switch cost is the reduction in performance accuracy or speed that results from shifting between tasks. Our ability to quickly process information and recognize situations improves our ability to handle multiple tasks, but we still need to consider the overall cost.
What is the lens by which we decide what cognitive load is appropriate? Completing a task does not mean it was completed well.
Quality performance is not a dichotomous phenomenon. Service is not either good or bad; there are many gradations of quality. This brings me to the second environmental influencer of clinical decision making: culture
The influence of company culture
I work for PT Solutions Physical Therapy and one of their core values is Live Clinically. To Live Clinically is to put the patient’s needs first; to filter all clinical and business decisions through the patient’s needs. Quality care is at the epicenter of the practice.
My job is to enhance our company’s ability to Live Clinically.
Expectations influence our experiences. The culture an employee works in will influence their decision-making.
As a physical therapist, the practice I work for and I have expectations about caseload, speed of clinical decision, clinical quality, customer service, and employee engagement. The priority of each depends on values and incentives.
“Perhaps the most important rule in management is “Get the incentives right.” The whole trick in life is to get so that your own brain doesn’t mislead you. “ — Charlie Munger
Incentives are not strictly monetary. An incentive can be fulfillment in completing a task. A thank you note, a positive google review, an ideal work shift, additional responsibilities, and structured mentorship are all versions of incentives.
Incentives are rewards for behaviors we want to be repeated.
What are the behaviors we want to be repeated in our company? What type of service do you expect to deliver? What about your colleagues? Reflect on what motivates you and the people around you. Are the incentives aligned with your values and behaviors?
All of my clinical decisions start with, “what is the best thing for the patient in front of me.” From that lens, I refine my decisions.
I start with treatments that are supported in the evidence, then filter with my expertise and experience, and finish with patient values and expectations. All treatments should run through those filters. Decisions start with objective evidence and finish with patient values.
Steps are never skipped.
If my values don’t align with my practice’s values, then my decision-making will be negatively influenced. I will have to hide my approach or battle with my boss and colleagues every day. This will increase my cognitive load, worsen my decision, and promote burnout.
“Very few people or companies can clearly articulate WHY they do WHAT they do. By WHY I mean your purpose, cause, or belief — WHY does your company exist? WHY do you get out of bed every morning? And WHY should anyone care?” — Start With Why by Simon Sinek
If your company’s culture and values don’t align with your values, it is time to cut ties.
All our decisions should filter through core values.