Mindlessness versus Mindfulness

As mentioned, high reliability organizations (HROs) are built upon a state of mindfulness. The enemy of mindfulness is mindlessness, and in a dynamic environment like a hospital there are still many routine tasks that are done with every patient. The potential to perform the routine tasks mindlessly is something HROs successfully avoid. Instead, every task is approached with mindful questioning, “What’s the big picture here, and what is the worst thing that can happen?” As Weick & Sutcliffe point out in Managing the Unexpected:

…When operators execute operations mindfully, they tend to rework the routine to fit changed conditions and to update the routine when there is new learning. These small adjustments are the bane of a command-and-control system. But those same adjustments keep the system going even as they sustain the illusion that it is commands and rule compliance, not continuing
adjustments, that keep it going.

From Mindful Practice in JAMA 1999 by Ronald Epstein MD

In the healthcare setting, checklists and surgical debriefs are two ways to introduce and incorporate mindful practice into daily routine. Ronald Epstein MD penned a must read article on Mindful Practice in JAMA in 1999, showing how mindfulness can further be applied to medicine. The table to the right itemizes characteristics of mindful practice, not currently taught in medical schools or tested on boards, but skills very necessary to complete a healthcare providers training in order to provide true patient-centered care. As Epstein writes:

…consider what a resident in a busy pediatric emergency department might do when he is unable to determine whether an ear examination is normal or abnormal and the attending physician is not immediately available…(s/he) weighs the consequences of misdiagnosis for the patient, the humiliation of having to call the otolaryngology resident…loss of self-esteem by having to admit incompetence…

…A mindful conscious approach would be to cultivate awareness not only of the correct course of action but also of the factors that cloud the decision-making process. The mindful practitioner is mentally and technically better prepared for the next situation.

Mindfulness shares a number of qualities embedded in emotional intelligence.  Developed by Daniel Goleman, emotional intelligence embraces and draws from numerous branches of behavioral, emotional and communications theories. Forbes.com interviewed Goleman in September of last year, and provides an overview of his work in their piece, Daniel Goleman on Leadership and the Power of Emotional IntelligenceKey to his work are the identification of five emotional intelligence domains:

  1. Knowing your emotions.
  2. Managing your own emotions.
  3. Motivating yourself.
  4. Recognizing and understanding other people’s emotions.
  5. Managing the emotions of others in building strong relationships.

High emotional intelligence requires awareness and control of our own emotions, values, preferences and goals as well as those around us – for caregivers that includes not only our colleagues and peers, but most importantly our patients. Understanding and being mindful of a patient’s emotions, values, preferences and goals is critical to the provision of high quality, safe healthcare.

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One Comment on “Mindlessness versus Mindfulness”

  1. As a doctor, it is a must to be mindful of his patients. If he just focuses on profit without taking care of his patients, medicine seems to be nothing. When visiting a clinic, I tend to be more carefully looked after than hospitals. And I think that you all know the reasons, right?


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