MULTI-TASKING vs MONO-TASKING
of Interest to Health Information Managers

(please excuse spelling and grammar errors - author is visually impaired)



"In healthcare the more we try to multitask, the greater number of mistakes we make"
Trunk, Penelope, CEO, Brazen Careerist c/o Boston Globe

    In the late 1980's early 1900's the concept of multi-tasking began
to find its way into our working and domestic worlds.  It has grown 

grown to define people in their roles as health information managers, parents, family members and in a number of roles they perform simultaneously in a limited amount of time.  By switching from one activity to another,  a health information manager becomes less efficient and more errors are made.  The quality of work does not meet its potential quality and a list of known hazards of multi-tasking begins grow.     For many years it was thought the people who multi-task, or perform more than one activity at once (monotask)  had an edge over those who did not.  However, research now suggests that multi-tasking can actually cause  less effective outcomes.  In a study, participants lost significant amounts of time as they switched between multiple tasks and lost more time as the tasks became increasingly complex.                                                                   

                                                                                                                                               

The health information manager and the technology of electronic health information users come together in a work environment that is very much less than ideal.  Health information departments are characterized by excessive noise, constant interruptions, high workloads, tasks demanding rapid need for information stored on a disc.....all which leads to the multi-tasking performance.  It is scenarios such as this that multi-tasking and serious consequences occur.  I am sure the majority of adults who are busy in our communities workplaces  have heard of at least one tragic mistake arising from health data gone wrong.

Consider an event in which a health information manager receives a call form an emergency physician at another hospital and who was in dire need of details regarding a patient who had just presented with septicaemia (an infection in blood - blood poisoning).  The physician wanted to treat the patient with an aggressive antibiotic which was known to have serious side effects. Before the physician administered the medication he felt it necessary to find details re an allergic reaction the patient described when treated at another hospital.  The physician asked the health information manager at that  hospital to scan his patients medical record for details of the allergic reaction. 

The health information manager began to feel anxious and distracted as she was late for a medical audit meeting and frantically worked to create a meeting's agenda.  In a flustered state she found the information that was being asked for by the emergency room physician however misread the medication that the patient was allergic to (a medication of the physician's choice).  With the information he received from the health information manager he had every reason to believe that the medication he chose was safe to administer.  The patient was given the medication by the physician who did so with ease of mind and left the cubical to treat another patient.

Moments later, the patient experienced an anaphylactic reaction to the medication in the form of a respiratory arrest and was hypoxic (without oxygen) for a prolonged period.  He survived, however, brain function was drastically affected and his life quality was forever altered.

An incident such as this must be recognized as a wake-up call....a tragedy secondary to multi-tasking by the heatlh information manager.  It is truly a landscape that requires health information managers to be accountable and responsible for performance outcomes.  The solution to unnecessary and unacceptable errors is the awareness that focus and concentration are imperative to safety....multi-tasking is not a key to success when it comes to mistakes permanently altering one's life unnecessarily.

The psychological ramifications of persistent multi-tasking is an issue of growing interest especially among behavioural scientists, health information officials and even anthropologists.  It has been noted that the need for professional consultation by a psychologist or psychiatrist is on the increase by multi-taskers as their anxiety levels, stemming from this work method/technique, leaves them in a constant sense of failing to achieve and lack of function leading to a heightened sense of failure.  Before the push towards multi-tasking, these individuals greatest driver was in the form of achievement and productivity.

Another health risk of multi-tasking includes depression.  In a state of high level stress, individuals feel a lack of control over their lives.  Several effects combine to create a maelstrom -- the flurry of rapidly occurring activity in lives (already crowded with activities).   There is a constant looming thread of minor catastrophe.  Relationships and family ties are often compromised.  These experiences are a recipe to a meltdown.

While humans attempt to perform two tasks at once, execution of the first task usually leads to post-ponement of the second one.  This task delay is thought to result from a bottleneck occurring at a central amodal stage of information processing that precludes a two-response selection or decision-making operations from being concurrently executed....this suggests that a neural network of frontal lobe areas acts as a central bottleneck of information processing that severely limits our ability to multi-task.

Health information managers who multi-task are significantly less able to make quality judgements in situations requiring focus and attention.

This culture is expected to continue and that the growing interest in self-relaxation practices such as yoga, meditation, Tai Chi, etc. which emphasis quieting the mind, will become even more popular as people continue to juggle multi tasks at once.

Not only does this phenomena have adverse health effects within the healthcare industry as the economic picture is astounding.  The cost to our neighbours in the south is as much as $650 billion a year.

In a multi-tasking study, 36 nurses over a total of 136 hours, 3,441 events of interruptions were captured, 46 hours of multi-tasking were cited and 200 errors were made.  Although nurses manage interruptions and multi-tasking well, the potential for errors is present and strategies to decrease interruptions are needed,

Although many support multi-tasking is a preferred method of work and users are more productive, it may not make them more efficient.  The end result is in lower quality or additional work if the first task was not completed accurately.

Multitasking has arrived in the healthcare workplace and very common in the household in the form of e-mails, cell phone and a multitude of other technology advances pushing the mainstream culture into what critics have dubbed a 24/7 lifestyle.

The electronic health record and health information manager come together in a work environment that is very unique and complex.  Healthcare landscapes are characterized responses to information, etc.  The convergence of the complexities of the electronic health record and need for changes in work flow create a large sociotechnical system where new behaviours emerge....unfortunately some leading to unintended consequences that are error prone.

Questions:  How can a health information manager avoid the dangers of multi-tasking?

Answer:     Start by focusing attention on the task at hand and continue working for a predetermined amount of time.  Scientists are discovering that even after the multi-tasking ends, fractured thinking and lack of focus persists.  A health information manager who is determined to change his/her ways from multi-tasking may have to go as far as creating a strategy that provides a cue to monitor the task method and make the transition back to focusing as required.

Ten Timely Tips:

      1)  Don't manage your time, manage yourself.  Use the same skills you would use in managing others - planning, organizing and delegating.  A vibrating watch or other noiseless technological device can be used as a cue to provide a reality check,

     2)  Set goals and spend each day on the things that are of priority to you and not urgent to others.  This may require some flexibility if your primary issues are in conflict with our supervisor,

     3)  Make time to do nothing - find a quiet corner in the cafeteria during coffee break and reduce as much stimulus as possible.  Have ear plugs handy if noise levels are high.  On warmer days find a bench out-of-doors and sit quietly during a lunch break,

     4)  Identify your time steelers and adjust items,

     5)  Stop interruptions.  Respond to e-mail and voice mail at least once an hour only,

     6)  Get organized.  Create a task list on the onset of work hours.  De-clutter your desk,

     7)  If you are doing something that requires concentration while at home, turn off the TV and other distractions.  If this is not practical and interrupts the family's TV and other distractions.  If this is not practical and interrupts the family's evening hours,  consider the ear plugs once again,

     8)  Get help.  There are hundreds, perhaps thousands of books, seminars and websites offering advice on how to best manage time,

     9)  Exercise the word "no".  It may be the most important word you ever use, and

{personal note by author:  "A dear family friend once said to me that in the practice of a "yes" person, someone always gets hurt".  As a "yes" person, I can certainly support this statement, and

     10)  Explore various methods of relaxation and recreation .... commit to your choices.  

     Many health information managers find that their greatest challenge in life is to remain in full presence of the moment.  Reflecting on one's past,  the individual will likely bring about an awareness that the most meaningful moments have emerged while being "in the moment".  Being fully present takes commitment, awareness and conviction.  It is not easy to do but the with mindful practice it will soon become habitual. 

DEVELOPING  THE  SKILL  TO  BE  FULLY  PRESENT:

In the performance of multi-tasking, ask yourself what is this craving to find distractions at every turn?  Our minds seek instant gratification and our society and technology offer it in abundance.  For some, multi-tasking creates the illusion of real productivity at times.  It therefore takes incredible self-discipline to develop a mindset of being fully present.

....Nightingale

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