I suspect that there are few hospitalists faced with the problem of “not enough to do,” but I equally suspect that more and more hospitalists are finding themselves farther and farther to the right side of the Yerkes-Dodson curve. After the inflection point, with more and more stress comes less and less performance, a phenomenon felt in every performance-based career.
The bottom line is this: We have created more and more things for the hospitalist to consciously think about in ensuring patient safety and quality. If you had an index card for every guideline/core indicator/standard the hospitalist was supposed to remember, the stack would be 6 inches thick. And this list will only grow with time.
However, these admonishments “to the conscious mind” only improve performance if the physician has enough time to consciously think about each of them. If there is not enough time, then the physician’s mind reverts to the adaptive unconscious, which, because these QI measures have not been a part of his practice for the past several years, is unable to enact them. It’s captured by the simple sentiment when your patient has a DVT: “Wow, I knew to do that, but it just slipped my mind.” Moving too far to the right on the Yerkes-Dodson curve is more than just a risk for burnout; it has serious implications to ensuring that we design a strategy in quality and patient safety that actually comes to fruition.
And that’s Chapter 2 in the story of us: the need to ensure that our tactics and execution remain as important as our strategy, that one element of the system is never treated in isolation, that reflection on ordinary practice becomes a habit, and that efficiency remains a priority. TH
Dr. Wiese is president of SHM.
- Chan PS, Krumholz HM, Nichol G, Nallamothu BK; American Heart Association National Registry of Cardiopulmonary Resuscitation Investigators. Delayed time to defibrillation after in-hospital cardiac arrest. N Engl J Med. 2008;358(1):9-17.
- Yerkes RM, Dodson JD. The relation of strength of stimulus to rapidity of habit-formation. J Comparative Neuro Psych. 1908;18:459-482.