The Executive Suite: What you can do about the negativity bias in medicine

Friday, July 12, 2019

What you can do about the negativity bias in medicine

Ever notice a tendency to focus more on what’s wrong than what’s right? To notice what people do wrong more than what they do well? Or to offer criticism or advice more than positive appreciation?

Well, you are not alone: Our brains are hardwired for a negativity bias. That means that negative experiences and information grab more of our attention, are more memorable and their effects last longer than positive experiences. At the end of the day, it’s the negative experiences that we remember more rather than the positive ones.

The negativity bias not only affects how we feel, it also impacts work culture and patient care. Let’s first look at its implications on the workplace.

If people are more strongly impacted by the negative than the positive AND if we tend to notice the negative more, then people are probably getting more criticism or “helpful” advice (which, when unsolicited, is perceived as criticism) than they are appreciation or positive acknowledgments.

This is what I consider low-hanging fruit for improving interactions at work. We know that it takes about eight or nine positives to counteract the negativity bias. By giving employees specific and genuine recognition for a job well done, we can shift the workplace culture to one of greater collaboration and appreciation.

And best of all, it’s easy and free. Tell people what specific behaviors they are doing or have done that made a positive impact. Recognition or appreciation is rewarding to the brain. What’s more, anything that is rewarding tends to be repeated. Not only does positive feedback make people feel good, it reinforces behaviors that we want to be reinforced, a win-win.

An additional benefit of mitigating the negativity bias is that when people feel appreciated by others, they are more likely to want to collaborate and contribute. Their morale and engagement at work improves as well, making them more productive and effective.

Now let’s shift our focus to how the negativity bias impacts patient care. The negativity bias is alive and well in medicine. It starts in medical school where students are frequently exposed to teaching methods that create feelings of shame, ineptitude and incompetency. Early on in their careers, physicians learn both the importance of preventing and avoiding errors as well as the need for perfection.

And yet, we know that mistakes are inevitable. We also know that if we talk about them, we are more likely to prevent their recurrence. The problem is that healthcare workers often avoid acknowledging that an error has occurred. This is typically due to a culture where mistakes are accompanied by some form of punishment, and people often feel humiliated and blamed. Hospital settings can also perpetuate a culture where the negativity bias is enhanced with physician peer review committees and incident reporting systems.

We need a solution. We need to transform a culture of blame into a culture of learning, where the reporting of medical errors is welcomed because it serves as a teaching opportunity. Even the word “error” can sound daunting and intimidating. I encourage healthcare professionals to instead think of errors as learning opportunities to make it easier to talk about.

Here are five practical strategies to mitigate the negativity bias and improve patient safety and outcomes:

Build a culture that rewards the reporting and discussion of medical errors and reframes them as learning opportunities. Rewards can take the form of verbal and/or written recognition. There might be a “case of the month,” where managers identify a case or cases with the greatest learning opportunity.
Provide a system that encourages reporting of near misses, which are also great learning opportunities.
Ask questions focused on the what, why or how and less on the who when creating a learning opportunity from a near miss or an error. This will help minimize feelings of blame and shame.
Delay submissions of incident reports until after you speak with the person who is identified in the report. This avoids the problem of many reporting systems where people write someone up rather than communicate directly.
Augment learning from errors or mistakes with lots of acknowledgement of what people have done well. Remember, it takes about eight or nine positives to overcome the effects of the negativity bias.

To paraphrase Alexander Pope, "To err is human, but to learn is divine."