Decision Fatigue – Building a Case For Checklists

How many food-related decisions do you make in a day? Ten? Fifty? A hundred?

When Cornell University staff and students were asked this question in a recent study, the average response was fifteen. However, after they answered specific questions about when, what, how much and where they ate, researchers found they actually made an average of 221 food-related decisions each day.

The more decisions we make throughout the day, the harder each choice is for our brains to process. No matter how rational and clear-minded you try to be, you can’t make the estimated 35,000 daily decisions we all make, without paying a biological price. It’s called decision fatigue. Although you are not consciously aware of being tired, each decision you make takes its toll on your mental energy. Eventually our brains look for shortcuts. One shortcut is to become reckless: to act impulsively instead of expending the additional energy to think things through. The other shortcut is to simply do nothing at all.

“Good decision-making is not a trait of the person, in the sense that it’s always there,” says social psychologist Roy F Baumeister. “It’s a state that fluctuates.”

Baumeister, a researcher and professor of psychology at Florida State University says, “The best decision makers are the ones who know when not to trust themselves.”

In high-pressure environments like a veterinary hospital, we are up against two main decision-making difficulties. The first is our own fallible memory and attention, especially when routine matters are overlooked under the strain of more pressing events. In the swirl of sedating a patient, placing a catheter, inducing anesthesia, clipping for surgery, and transporting the patient to the surgery table, it’s easy to overlook the routine task of checking the amount of oxygen left in the tank.

The second difficulty is that we sometimes lull ourselves into deliberately skipping steps, even when we remember them. Even the most competent people have been known to tell themselves that certain steps don’t matter. For example, it’s standard to check a patient’s pulse and heartrate during a physical examination. But being diligent to do both – listen to the heart and feel the pulse – rarely uncovers a worrisome issue. So sometimes we skip one. “It’s never been a problem before,” we tell ourselves. Until one day it is.

Simple checklists can provide protection against these mental failures. According to Atul Gawande, in his book The Checklist Manifesto, checklists remind us of the bare minimum necessary steps in any procedure by making them explicit. They catch mental flaws inherent in all of us – flaws of memory and attention.

A good checklist doesn’t have to be long to be effective. But good checklists are always precise and efficient. They leave zero room for interpretation. Don’t attempt to spell out every single step, instead provide reminders of only the most critical and important steps. Good checklists are, above all, practical.

Checklist ManifestoOnce a checklist is written, it’s important to be disciplined and stick with it. No matter how smart, talented or experienced we are chances are we’ll still drop the ball sometimes. And we’re not alone. The fact is, we are all plagued by missed subtleties, overlooked knowledge, and out-right errors. No one is immune to screwing-up. Checklists are absolutely essential for handling the high stakes and complex situations that happen to anesthetists. As Gawande points out in The Checklist Manifesto, simple checklists save time and money. But more importantly, in our line of work, checklists save lives.

For additional reading:
“Mindless Eating: The 200 Daily Food Decisions We Overlook,” Environment and Behavior, 2007, 39:1 (January), 106-23, Brian Wansink and Jeffrey Sobal.
“Do You Suffer From Decision Fatigue?” New York Times 08/21/2011, John Tierney
The Checklist Manifesto: How to get things right, by Atul Gawande
Ken writerKen Crump (kencrump.com) is a writer and animal anesthetist and writes Making Anesthesia Easier for Advanced Anesthesia Specialists.  He makes dozens of Continuing Education presentations on veterinary oncology and anesthesia across the United States and in Canada.  Ken retired from Colorado State University in 2008. 

 

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One Response to Decision Fatigue – Building a Case For Checklists

  1. Glenn Fahnestock DVM says:

    Good one, thanks Ken.

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