Cognitive bias can be a serious impediment to rational decision-making by health leaders. We use a hypothetical case study to introduce some basic concepts of bias with examples of mitigation strategies. We argue that the effect of biases should be considered when making every significant administrative decision.
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References
1.
SeshiaSSMakhinsonMPhillipsDFYoungGB. Evidence-informed person-centered healthcare part I: do ‘cognitive biases plus’ at organizational levels influence quality of evidence?J Eval Clin Pract. 2014;20(6):734–747.
2.
LieffSJYammarinoFJ. How to lead the way through complexity, constraint, and uncertainty in Academic Health Science Centers. Acad Med. 2017;92(5):614–621. doi:10.1097/ACM.0000000000001475
3.
HaseltonMGNettleDAndrewsPW. The evolution of cognitive bias. In: BussDM, ed. The Handbook of Evolutionary Psychology. Hoboken, NJ: John Wiley & Sons Inc; 2005:724–746.
4.
StanovichKE. The comprehensive assessment of rational thinking. Educ Psychol. 2016;51(1):23–34.
5.
CroskerryP. Bias: a normal operating characteristic of the diagnosing brain. Diagnosis. 2014;1(1):23–27.
YetivSA. National Security Through a Cockeyed Lens: How Cognitive Bias Impacts U.S. Foreign Policy. Baltimore, MD: Johns Hopkins University Press; 2013.
Editorial. Let’s think about cognitive bias. Nature. 2015;526(7572):163.
12.
VaughnVMChopraVHowellJD. War games and diagnostic errors: could lessons from the cold war help reduce diagnostic error?BMJ. 2016;355:i6342. Available at:http://www.bmj.com/content/bmj/355/bmj.i6342.full.pdf. Accessed July 25, 2017.
13.
PappKKHuangGCLauzon ClaboLM. Milestones of critical thinking: a developmental model for medicine and nursing. Acad Med. 2014;89(5):715–720.
14.
ZoriSMorrisonB. Critical thinking in nurse managers. Nurs Econ. 2009;27(2):75–79, 98.
StanovichKEWestRFToplakME. Myside bias, rational thinking, and intelligence. Curr Dir Psychol Sci. 2013;22:259–264.
18.
CampbellSGCroskerryPBondWF. Profiles in patient safety: a “perfect storm” in the emergency department. Acad Emerg Med. 2007;14(8):743–749.
19.
HuangYFSoonCSMullette-GillmanOAHsiehPJ. Pre-existing brain states predict risky choices. Neuroimage. 2014;101:466–472.
20.
CroskerryP. Individual variability in clinical decision making and diagnosis. In: CroskerryPCosbyKGraberMLSinghH, eds. Diagnosis: Interpreting the Shadows. Oxford, UK: CRC Press, Taylor Francis Group; 2017. In press.
21.
KahanDMBramanDGastilJSlovicPMertzCK. Culture and identity-protective cognition: explaining the white male effect in risk perception. J Empirical Legal Stud. 2007;4(3):465–505.
SchullMJ. The effect of low-complexity patients on emergency department waiting times. Ann Emerg Med. 2007;49(3):257–264.
24.
AfilaloMGuttmanAColaconeA. Emergency department use and misuse. J Emerg Med. 1995;13(2):259–264.
25.
GuoBHarstallC. Strategies to reduce emergency department overcrowding. Edmonton, AB, Canada: Alberta Heritage Foundation for Medical Research. Health Technology Assessment;38. 2006. Available at: http://www.assembly.ab.ca/lao/library/egovdocs/2006/alhfm/154656.pdf. Accessed July 25, 2017.
AffleckAParksPDrummondARoweBHOvensHJ. Emergency department overcrowding and access block. CJEM. 2013;15(6):359–384.
28.
AsplinBRMagidDJ. If you want to fix crowding, start by fixing your hospital. Ann Emer Med. 2007;49(3):273–274.
29.
Canadian Health Services Research Foundation. Myth: emergency room overcrowding is caused by non-urgent cases. J Health Serv Res Policy. 2010;15(3):188–189.
30.
InnesG. Sorry—we’re full! access block and accountability failure in the healthcare system. CJEM. 2015;17(2):171–179.
31.
CroskerryP. Clinical cognition and diagnostic error: applications of a dual process model of reasoning. Adv Health Sci Educ Theory Pract. 2009;14(suppl 1):27–35.
BunnFByrneGKendallS. The effects of telephone consultation and triage on healthcare use and patient satisfaction: a systematic review. Br J Gen Pract. 2005;55(521):956–961.
42.
CroskerryPSinghalGMamedeS. Cognitive debiasing 1: origins of bias and theory of debiasing. BMJ Qual Saf. 2013;22(suppl 2):ii58-ii64.
43.
CroskerryPSinghalGMamedeS. Cognitive debiasing 2: impediments to and strategies for change. BMJ Qual Saf. 2013;22(suppl 2):ii65-ii72.
44.
GraberMLKissamSPayneVL. Cognitive interventions to reduce diagnostic error: a narrative review. BMJ Qual Saf. 2012;21(7):535–557.
45.
LambeKAO’ReillyGKellyBDCurristanS. Dual-process cognitive interventions to enhance diagnostic reasoning: a systematic review. BMJ Qual Saf. 2016;25(10):808–820.
46.
DicksonGThollB.Bringing Leadership to Life in Health: LEADS in a Caring Environment. London, UK: Springer; 2014. Available atwww.springer.com/medicine/book/978-1-4471-4874-6. Accessed May 25, 2017.
47.
GraberMLFranklinNGordonR. Diagnostic error in internal medicine. Arch Intern Med. 2005;165(13):1493–1499.