Hospitals are supposed to help heal the sick. How, then, do we explain the four hundred thousand Americans harmed in hospitals every year when patients are given the wrong medication?
In addition to the devastating human toll, these preventable errors cost an estimated $3.5 billion in extra medical expenses. According to surgeon Martin Makary and research fellow Michael Daniel of Johns Hopkins University, “If medical error was a disease, it would rank as the third leading cause of death in the U.S.”
Becky Richards was part of a special team tasked with developing ways to save lives by fixing the medication-error problem at the Kaiser Permanente South San Francisco Medical Center. As a registered nurse, Richards knew many of the mistakes occurred when highly trained, well-intentioned people made very human errors that were often a result of a work environment filled with distracting external triggers. In fact, studies found nurses experienced five to ten interruptions each time they dispensed medication.
One of Richards’s solutions did not go over particularly well with her nursing colleagues, at least at first. She proposed nurses wear brightly colored vests to let others know they were dispensing medication and should not be interrupted. “They felt it was demeaning,” Richards said in an article on the nursing website RN.com. After initial resistance, she found one group of nurses in an oncology unit whose error rate was particularly high and who were desperate for a solution.
However, despite these nurses’ initial willingness, the test was met with more objections than Richards anticipated. For one, the orange vests looked “cheesy,” and some complained they were uncomfortably hot. They also attracted interruptions from doctors who wanted to know what the vests were about. “We were really thinking about abandoning the whole idea, because the nurses did not like it,” Richards said.
It wasn’t until the hospital administration provided Richards with the results of her experiment four months later that the impact of the trial became clear. The unit recruited for Richards’s experiment saw a 47 percent reduction in errors, all thanks to nothing more than wearing the vests and learning about the importance of an interruption-free environment.
“At that point we knew we could not turn our backs on our patients,” added Richards. One by one, nurses started sharing the practice, until it spread throughout the hospital and to other care centers. Some hospitals even devised their own unique solutions, like creating a specially marked “sacred zone” on the floor where nurses prepared medications. Others created special distraction-free rooms or blacked-out windows so nurses couldn’t be interrupted while they worked.
More data emerged about how effective these practices were at reducing errors by shutting out unwanted external triggers.
A multihospital study coordinated by the University of California, San Francisco, found an 88 percent drop in the number of errors over a three-year period.
Julie Kliger, director of the university’s Integrated Nurse Leadership Program, told SFGate.com in 2009 that her inspiration to expand the program came from an unlikely place—the airline industry. It’s called the “sterile cockpit” rule, a series of regulations passed in the 1980s after several accidents occurred as a result of distracted pilots. The regulations banned commercial pilots from performing any noncritical activities when flying under ten thousand feet. The regulation specifically calls out “engaging in nonessential conversations” and bars flight attendants from contacting pilots during the most dangerous parts of the flight, takeoffs and landings.
“We liken it to flying a 747,” Kliger said. “[The zone of dangerous distraction] for them is anything under ten thousand feet . . . In the nurses’ world, it’s when giving medications.” Richards reports that nurses not only make fewer mistakes while wearing the vests but also feel that focused work time passes more quickly. Suzi Kim, a nurse at Kaiser Permanente West Los Angeles Medical Center, said that while wearing the vests, “we can think clearly.”
While the impact of distraction is rarely as lethal as it is for those in the medical profession, interruptions clearly have an impact on our work performance for any job requiring focus. Unfortunately, interruptions are pervasive in today’s workplace.
The misuse of space is often a significant contributing factor. Seventy percent of American offices are arranged as open floor plans. Instead of individual workspaces separated by walls, workers today likely have a clear line of sight to their colleagues, the break room, reception, and, well, virtually everything else.
Open-office floor plans were supposed to foster idea sharing and collaboration. Unfortunately, according to a 2016 metastudy of over three hundred papers, the trend has led to more distraction. Not surprisingly, these interruptions have also been shown to decrease overall employee satisfaction.
Given the toll distractions can take on our cognitive capabilities, it’s time we took action, just as Becky Richards did. While I’m not advocating the wearing of bright orange Do Not Interrupt vests at the office—nor am I insisting on a floor-plan overhaul—I am suggesting a solution that is explicit and effective at deterring interruptions from coworkers.
In the middle of this book, you’ll find a piece of card stock. (If you’re reading an e-book edition, you can download and print your own by visiting NirAndFar.com/Indistractable.) The card contains, in large font, a simple request to passersby: I NEED TO FOCUS RIGHT NOW, BUT PLEASE COME BACK SOON. Place the card on your computer monitor to let your colleagues know that you don’t want to be interrupted. It sends an unambiguous message in a way that wearing headphones can’t.
Just as bright vests reduce prescription errors, a screen sign sends a signal to coworkers that you’re indistractable.
While the screen sign can be understood by just about anyone, I recommend discussing the purpose with your coworkers. This conversation could inspire them to do the same and can serve as an entry point to a discussion about the importance of working without distraction.
Sometimes, though, we need an even more explicit way to signal our request for interruption-free time, particularly when we’re working from home. Using the same principles to block unwanted external triggers, my wife bought a hard-to-miss headpiece on Amazon for just a few dollars. She calls it the “concentration crown,” and the built-in LEDs light up her head to send an impossible-to-ignore message. When she wears it, she’s clearly letting our daughter (and me) know not to interrupt her unless it’s an emergency. It works like a charm.
When working from home, family members can be a source of distraction. My wife’s “concentration crown” lets us know she is indistractable.
Whether it’s a vest, a screen sign, or a light-up crown, the way to reduce unwanted external triggers from other people is to display a clear signal that you do not want to be interrupted. Doing so will help colleagues or family members pause and assess their own behaviors before they break your concentration.
REMEMBER THIS
• Interruptions lead to mistakes. You can’t do your best work if you’re frequently distracted.
• Open-office floor plans increase distraction.
• Defend your focus. Signal when you do not want to be interrupted. Use a screen sign or some other clear cue to let people know you are indistractable.