This children’s hospital traced 50% of serious safety events to cognitive bias and created targeted interventions to mitigate the most common cognitive biases found in health care.
Everyone has cognitive bias, and in health care, it can be costly for an organization and devastating for an individual. Cognitive bias is defined as a bias that causes you to wrongly interpret information. According to Cognitive Bias in Clinical Medicine, 30% of errors in emergency departments and 42% of errors in internal medicine wards are caused by cognitive bias.
At Riley Hospital for Children at Indiana University Health in Indianapolis, the number of days between serious safety events (SSE) had plateaued over the last two to three years, and the organization wanted to do better. At the 2019 Annual Leadership Conference, Brian Wagers, M.D., medical director, Quality and Safety at Riley Children’s, discussed how the team came up with a plan to improve. “About 50% of our safety events harken back to cognitive bias,” Wagers says. “We decided to code for individual failure modes to see if we could educate staff and push through the plateau.”
Riley Children’s created a six-point coding process to accurately diagnose what biases were affecting performance. The team has a classification meeting once a week and the process includes:
- Determining the harm level.
- Determining failure modes.
- Determining whether cognitive bias exists.
- If so, which biases are present.
- What “level” of bias (1-3).
- What was the main bias if more than one.
There are more than 200 biases on the Cognitive Bias Codex. Wagers says the most common to occur at Riley Children’s are anchoring, confirmation bias and blind obedience. With the details of bias effects, the hospital uses these de-biasing strategies to improve safety:
- Recalibration. In risky situations, step back to look at evidence anew.
- Group decision strategy. If unsure, ask a friend or colleague what they see and would do.
- Diagnostic pause. Take a moment to pause to appraise information (e.g., the time-out process in the operating room).
- Exposure control. Limit information that “colors” your initial impressions.
Over a three-year period, Riley Children’s moved from 238 days between SSEs to 284.
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