If you’re looking for signs of a pending Zombie Apocalypse, look no further than your nearest emergency room. Go to an ER at 2:00 a.m. and you will see what looks like a callout for zombie extras. Everywhere you turn you see bleary-eyed souls stumbling around a sea of people, mentally exhausted humans searching for help, or others half-asleep carrying dangerous blades.
And those are just the doctors!
At any hour of any day in any hospital in the United States, there is a chance you will be treated by a resident who has been working thirty hours without any sleep. It’s a chilling thought, but this practice is a common rite of initiation for physicians. In an effort to improve patient care and reduce harmful errors, the Accreditation Council for Graduate Medical Education changed the maximum shift length for interns from 30 hours to 16 in 2011. It seems like common sense. No one wants a sleep-deprived resident making life or death decisions. You don’t need to be smarter than a fifth grader to come to that conclusion.
Two recent studies at Johns Hopkins and the University of Michigan Medical School tracked the results of this implemented shift change. The findings were shocking. The shorter shifts actually did more harm than good. The reduced hours did not improve doctors’ rates of depression or increase the number of hours they slept. What’s more, harmful medical errors increased by 15-20%. Some say this is likely due to the fact that the interns’ workloads didn’t decrease, and the number of patient hand-offs, where many errors occur, increased significantly.
While the original assumptions were false, we can consider the research a success. Imagine the lives that could have been lost had hospitals not tested the assumptions behind such a “common sense” solution.
Which begs the question: How often do we make changes or implement new processes in our organizations based on faulty assumptions? How often do we let majority opinion make the decision for us? How often do we make decisions based on our experience, even when that experience may not be applicable to the given situation? It happens far more frequently than we want to admit. Sure, you will have your fair share of successes by doing these things. But you also leave your organization open to a lot of costly risk and rework.
The key to success is in asking the right questions. As you approach your next big organizational initiative, ask the following questions to minimize your risk and improve your chance of success.
1. What assumptions are we making?
2. How can we test these assumptions?
3. Where can we find evidence to contradict our majority opinion?
4. Who else will be responsible for the success of this initiative, and how can we obtain their insights?
5. What alternative conclusions exist?
Organizations benefit greatly from asking contrary questions in advance to a big implementation. Of course, it takes time, but the knowledge gained from the experience prevents costly rework and results in more comprehensive solutions.
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