Posts in Healthcare
Healthcare practitioners in the zone

If you’re an athlete or have exercised vigorously, you’ve probably experienced the state of “flow” or being “in the zone.”

You’ve pushed past some limits and you reach a state where your breath, your muscles, every part of your body and mind are in absolute synch. Time disappears, you’re totally in the moment, nothing else exists. You may be tired but you hardly notice.

If you enjoy some sort of creative activity – painting, pottery, writing or playing a musical instrument – you’ve probably had similar experiences when you are totally immersed, time disappears, and it feels like inspiration is simply flowing through your body onto your medium.

Actually, you can experience “flow” or “being in the zone” while doing almost any activity you enjoy and that stretches you.

In fact, for some health practitioners, those times of “flow” or being “In the Zone” are what keep them in their profession. Sometimes it’s one-on-one with a patient, sometimes it’s during those times of supreme teamwork. It’s times when you instantly understand what’s happening with a patient and the environment, and what’s needed at that moment. Again, you’re totally focussed and immersed, super-aware and super good at what you do.

Nothing is more fulfilling than being “in the Zone;” of being impeccable, giving it your all, stretched as you do something you know is worthwhile.

#healthcare #ems #paramedicine #nursing #doctors #physicians #performance #psychology

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Healthcare Practitioners and Performance Psychology: Part 2

Deliberate practice in health care

Medicine, nursing, paramedicine or any other health care practice is considerably more complex than the practice of, say, cycling or running. Not every aspect of health care practice has yet been analyzed to identify the superior reproducible behaviours involved in each task.

However, Dr. Ericsson has identified areas of diagnosis and treatment that lend themselves to deliberate practice. He says, “This prospect is particularly exciting because in medicine, unlike sport or other competitive domains where the expert performance approach has been more widely applied, the beneficiaries of improved performance are not only the performers themselves but also society at large.”

He mentions simulation training as being extremely valuable in providing opportunities for deliberate practice of diagnosis and treatment tasks. Among other benefits, simulation training makes it possible to practice without fear of doing harm to a patient.

#healthcare #ems #paramedicine #nursing #doctors #physicians #performance #psychology

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Health Practitioners and Performance Psychology: Part 1

30-plus years of peak performance research

The most quoted name in the study of performance is Swedish psychologist K. Anders Ericsson. He’s author of the research behind the “10,000 hours to expertise” rule described by author Malcolm Gladwell.  Dr. Ericsson is the world’s foremost expert on the acquisition and maintenance of skills and expertise. His work is so influential that his 2004 paper, “Deliberate practice and maintenance of expert performance in medicine and related domains,” is one of only 36 works referenced in the American Heart Association’s 2015 ECC Highlights. His research directly influenced the American Heart Association's 2015 Core Educational Concepts.

In 2016, Dr. Ericsson and science writer Robert Poole published Peak, which summarizes Dr. Ericsson's 30 years of research into performance and expertise.

The main point was this: all expert performers in every arena of human endeavour attained their expertise through the same common pathway, one that works because of human beings’ common psychology.

Dr. Ericsson named this pathway “deliberate practice.”

#healthcare #ems #paramedicine #nursing #doctors #physicians #performance #psychology

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Critical success factors: From cycling to Health Care

Marginal gains: A core health care practice

In health care, accurate assessment and diagnosis is the basis of everything that comes later. An unfortunate fact is that the third leading cause of death in North America is medical error. The most common type of medical error? Error of diagnosis.

Fortunately, we know the critical success factors that contribute to expert diagnostic performance: diagnostic cue recognition and pattern recognition.

In 2013, Loveday et al reported on two studies that examined diagnostic expertise. They said, “…experienced diagnosticians could be divided into competent and expert practitioners based on their capacity for pattern recognition or cue utilization.”

#healthcare #ems #paramedicine #nursing #doctors #physicians #performance #psychology

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From laughing stock to world dominance

The 1% approach (“marginal gains”)

British cycling coach Sir Dave Brailsford became fascinated by a process improvement technique (“marginal gains”) based on the idea that small positive changes can create major improvements. He thought if they analyzed everything that goes into competing on a bike and then improved each element by 1%, the athletes on the team would achieve a significant increase in overall performance.

For example, when they noticed dust under the trucks (bad for cyclists and bikes), they painted the floor white so it would be easier to see and clean the dust.

#healthcare #ems #paramedicine #nursing #doctors #physicians #performance #psychology

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The power of marginal gains

So what does Cycling have to do with health care – and you?

What can health care – and you – learn from the British Cycling experience? More important, how can you apply it to your health care practice?

Sir Dave Brailsford is a former professional cyclist who also holds a Master of Business Administration (MBA) – an interesting combination! While working on his MBA, he’d been fascinated by “kaizen” – a Japanese word meaning “improvement.” It’s a process improvement technique based on the idea that small, ongoing positive changes (“marginal gains”) can add up to major improvements. Sir Dave thought the techniques could be applied to cycling. He gambled that if the team analyzed everything that goes into competing on a bike and then improved each element by 1%, they would achieve a significant increase in overall performance.

Their consistent stunning record in the past ten years speaks to the success of that calculated gamble.

#healthcare #ems #paramedicine #nursing #doctors

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Recognizing cues – Solving the challenges of diagnostic mastery

Part 2:  Solving the challenges of diagnostic mastery

Four of the challenges to mastery learning for health practitioners (if you’re a health practitioner you’ve almost certainly experienced them) are…

  1. Multiple Cues. Within each area of initial patient assessment, there are multiple cues related to Airway, Breathing, Circulation, Disabilities, and Exposure (A-B-C-D-E). In classroom, simulation or practicum experiences, or in professional practice, you could go months or years and not encounter some of the possible cues. To become a master of identifying cues and recognizing patterns could take decades.

  2. Multiple sub-actions. Within each skill set involved in assessment and diagnosis, there are many sub-actions. Even during training, you may have few opportunities to practice sub-sets of skills, again and again, to become so proficient you can perform each action expertly and automatically, almost without thinking.

  3. No opportunity to slow it down. During training, whether in classrooms, simulation settings or practicum placements, the entire Observe, Orient, Decide, Act process often unfolds quickly without the opportunity for you to slow it down and look at each cue and its potential meaning or each component of each skill within a larger process. In the real world of practice, of course, “slowing it down” is even less possible than during training.

  4. Limited opportunity for immediate feedback. Though trainers, colleagues, and supervisors to provide feedback to students and practitioners, mastery learning requires immediate feedback about each aspect of your performance. That is simply not possible even during training, and certainly not once you are registered as a certified professional.

#healthcare #EMS #medicine

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Recognizing cues – In life and in health care

Features with deeper meaning

The low fuel light in your car.

The half-open lid of your mailbox.

The sound of your front door opening.

These are all features of our environment that have meaning for us. They all signify something deeper than what you see or hear. We need to get gas, the mail arrived, our significant other is home.

Features that signify deeper meaning – called cues – are all around us. Knowing the meaning of cues is a key element of going about our daily lives. Cues are also key to making accurate decisions quickly in situations when making accurate decisions is important.

#healthcare #ems #paramedicine #nursing #doctors

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Error-proofing: part 2

Part 2: It’s not magic, it’s mastery learning using Recognize

In health care and in other fields, the science of peak performance enables practitioners to operate at optimum levels in the face of external challenges, even in moments when they are not at their personal best.

You may have had some of those moments yourself, when you surprised yourself by what you were able to do under adverse conditions. You may have observed the best people in your profession operating at that super-level. As a dedicated professional, you probably want to reach that level of consistent mastery yourself.

It’s not magic. There is a specific, science-based, research-proven, systematic step-by-step method of learning that can take you to that level of peak performance. It’s called mastery learning and it’s within your reach.


#healthcare #medicine #paramedicine

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Error-proofing: Part 1

Most everybody recognizes that health care providers – nurses, paramedics, physicians, and other practitioners – ought to be in top form when they’re on the job.

But here’s a fact of life most everybody also knows. Human beings cannot always be in top form.

Unlike most other professions, in health care practice the stakes are so high that tolerance for error is zero. That’s even though, as a health care provider, you must make quick assessments and decisions in high-pressure environments, and even though no human being can be at an optimum level all the time.

#Medicine #Paramedicine #healthcare #nursing #doctors #ems

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Enhancing healthcare practitioners cue recognition: Part 2

Deliberate practice and mastery learning

Mere practice (repeating an activity) does not necessarily improve performance. In fact, practice by itself, without external guidance, may even result in reinforcing poor performance!

Deliberate practice is an evidence-based method “grounded in information processing and behavioural theories of skill acquisition and maintenance” developed by learning psychologist K. Anders Ericsson, an icon of peak performance.

#Medicine #Paramedicine #healthcare #nursing #doctors #ems


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Enhancing healthcare practitioner cue recognition: Part 1

Improving assessment and diagnosis in a high-stress environment: pattern recognition

The risk of medical error begins within the first few minutes of patient contact: assessment and diagnosis in a high-stress environment. The most common type of medical error is an error of diagnosis.

We know about factors that contribute to error (chaotic environments, high mental workload, distraction, fear, time constraints, etc.) – but what do we know about factors that contribute to expert diagnostic performance?

#medicine #paramedicine #healthcare #nursing #doctors #ems

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