critical thinking for hro - iha insurance solutions · ‘cold thinking’ is akin to higher order...

Presented by:

Michael R. Rip, PhD MSc(Med)

September 27, 2018

Critical Thinking for HRO

Mark A. Vroman, MBA EFO

34th Annual Risk Managers’ MeetingIllinois Provider Trust/Illinois Risk Management Services

Laying a Cognitive Foundation for Improving Patient Safety

L e a d i n g M i n d sA d v a n c i n g R e a s o n

R e v e a l i n g T r u t hB r e a k i n g P a t t e r n s t o I n n o v a t e

Authors

!2 Copyright © 2011-18 Michael R. Rip, PhD MindLeap LLC

Michael R. Rip, PhD MSc(Med)

Founding Director, MindLeap LLC Founding Director, Program in Healthcare Management (Eli Broad College of Business) Formerly: Founding Director, Program in Public Health (College of Human Medicine) Assistant Professor, Intelligence Program, School of Criminal Justice (College of Social Sciences) Michigan State University, East Lansing, MI 48824

Mark A. Vroman, MBA EFO

Co-Director: MindLeap LLC Battalion Chief, Meridian Township Fire Department Okemos, Michigan 48864

Introduction

© 2017 Michael R. Rip PhD MindLeap LLC

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!4© 2017 Michael R. Rip PhD

MindLeap LLC!4

Introduction

Question

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WhydoesHROnotariseorganically,buthastobeimposedonhumanorganizationalsystems?

Thatis,whyisHROnotthedefaultpositionforhuman-createdprocessesandsystems?

CommonSense!(akaInstinctiveThinking)Answer

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‘Thegreatestdeceptionpeoplesufferfromistheirownopinions.’

WithapologiestodaVinci!—afterLeonardodaVinci(1500s)

Leonardo da Vinci (1452–1519)

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“Anofficer’sfirstweaponistheirmind.”—ColonelStephenLiszewski,USMC

CommandantofMidshipmen,U.S.NavalAcademy(19August2015)

https://www.usni.org/magazines/proceedings/2018-08/dynamic-thinking-no-threat?utm_source=U.S.+Naval+Institute&utm_campaign=728b8d64b2-EMAIL_CAMPAIGN_2018_08_23_Pro_Today&utm_medium=email&utm_term=0_adee2c2162-728b8d64b2-222821625&mc_cid=728b8d64b2&mc_eid=18fdd08abd


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Elite Cognitive Performance

Goal: Achieve Elite Cognitive Performance in the workplace

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It’allaMindGame!

InstinctiveThinking(default)akaCommonSense

Mediocre

Elite CriticalThinking

Performance Type of Thinking

!8 © 2017 Michael R. Rip PhD MindLeap LLC

Business 4.0

Top 10 skills

in 2020in 2015

Complex problem solving

Source: WEF, The Future of Jobs: Employment, Skills and Workforce Strategy for the Fourth Industrial Revolution (January 2016)http://www3.weforum.org/docs/WEF_Future_of_Jobs.pdf

12 Coordinating with others (Teams)3456789

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People ManagementCritical ThinkingNegotiationQuality ControlService OrientationJudgment & Decision-MakingActive ListeningCreativity

Critical Thinking

People ManagementCoordinating with others (Teams)

Service OrientationNegotiation

Complex problem solving

Creativity

Emotional IntelligenceJudgment & Decision-Making

Cognitive Flexibility

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Industry 4.0

•Changeandthepace(rate)ofchange

Some features … that CRITICAL THINKING will be vital for …

•Fastdecision-makingcycle

•Acceptingandworkingwithcomplexity

•Askingthe“right”questions—ratherthanthe“right”solution(answers)

•Thefocusisonthefuture

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—Tactical:employ‘EliteOODALoop’


Common mantra …

But, actually there is an ‘I’ in Team …

We want … •Independentminds•Maximizecollaborationandcooperation

There it is!

•Toavoid/minimizethecognitivebiasofGroup-Think!

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Operational Environment


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The Era of VUCA

This acronym emerged in the U.S. Army War College in the 1990s to describe the capability to engage situations marked by change and challenges

Thenatureanddynamicsofchange,andthenatureandspeedofchangeforcesandchangecatalysts

Thelackofpredictability,theprospectsforsurprise,andthesenseofawarenessandunderstandingofissuesandevents

Themultiplexofforces,theconfoundingofissues,andconfusionthatsurroundanorganization

V = Volatility

U = Uncertainty

C = Complexity

A = Ambiguity Thehazinessofreality,thepotentialformisreads,andthemixed

meaningsofconditions;cause-and-effectconfusion

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[Emphasis added]

“ Adaptability is responding to new needs or

changes without a loss of functionality.

Adaptive leaders possess many different skills and qualities that allow the Army to retain the

initiative. Army leaders think critically, are comfortable

with ambiguity, accept prudent risk, assess the situation continuously, develop innovative

solutions to problems, and remain mentally and physically agile to capitalize on opportunities. ”

U.S. Army

http://www.tradoc.army.mil/tpubs/pams/tp525-3-1.pdf


Mental agility

On Human Thinking …


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Arguing …

https://heleo.com/conversation-humans-are-great-at-arguing-but-bad-at-reasoning-julia-galef-explains-why/11304/

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This is known as the Argumentative Theory

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2 Modes of Thinking: ’Hot’ and ‘Cold’ Thinking

Hot

—Coldcognitionisessentiallythelackofemotionalinfluenceincognitiveprocess

—Decision-makingwithcoldcognitionismorelikelytoinvolvelogicandcriticalanalysis

‘Cold Thinking’ is akin to Higher Order Thinking

—Hotcognitionisahypothesisonmotivatedreasoninginwhichaperson'sthinkingisinfluencedbytheiremotionalstate

—Itissignificantlyinfluencedbycognitivebiasesandfallacies

Cold

Hot equates to Intuitive (Instinctive) Thinking

System 2

System 1

•Trainingoughttominimizeemotionalthinking

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Daniel Kahneman ,Thinking, Fast and Slow (2011) Critical Thinking is the application of Higher Order Thinking to discover ‘truth’

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Characteristics of our ‘Hot’ and ‘Cold’ Thinking Mind

Copyright © 2017 Michael R. Rip PhD MindLeap LLC

Fast

System 1Instinctive Thinking

System 2Higher Order Thinking

Unconscious

Automatic

Pattern-based

Everydaydecisions

Error-prone

Slower

Conscious

Effortful

Notpattern-controlled

Complexdecisions

Reliable

Instinctive Thinking High Order Thinking

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Thehumanbraindoesnotusually‘think,’butadherestosetsofrulesbasedonpatterns.

• Kills creativity ... and eventually innovation suffers

Human ‘Thinking’

•Instinctive-patternedthinking(viapattern-seeking/pattern-finding)•Learned

•Createsasenseofpredictability•Certainty

But • Kills higher order reasoning

• Produces risk-averse thinking and behavior

‘Mindlessness’

‘Conscious awareness drives only about 20% of what we think and do every day.’

•Consistency

© 2016 Michael R. Rip PhDFIRSTRESPONDER

Note:ThisistheoppositeofwhatVUCAcallsfor!

On Instinctive Thinking …


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Common sense is controlled by patterns!

!20 © Dr. Michael R. Rip 2008

Our ‘Hunter-Gatherer’ Minds

Instinctive Thinking

Known as: • Commonsense• Natural Thinking• Intuitive Thinking

We use correlations of patterns to infer explanations

April 2016

The minds key strategy: Pattern-Seeking • Pattern-Finding • Pattern-Extrapolating

Characteristics: • Unconscious• Rapid• Employs heuristics

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Three key insights from neuroscience research

© 2015 Michael R. Rip PhD

The brain seeks …

PATTERNS

PLEASURE

Short-term memory connects new to existing memory through PATTERN MATCHING

Rewards

Reward is exactly how we optimize those choices

Reward influences our happiness, pleasure, and motivation to do something

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PAIN Avoid pain/discomfort

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The brain interprets new information (data) based on existing pattern(s)

© 2015 Michael R. Rip PhD

Patterns …

Got a pattern?

New input (data) is misinterpreted, rejected, or simply disappears!

YES NO

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Pattern-Seeking / Pattern-finding

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LOV EWhat do you see here?


· Oversimplifies complex situations· Jumps to conclusions· Relies on experience· Uses cognitive heuristics (shortcuts) · Uses cognitive biases (predispositions)

Some additional characteristics of Instinctive Thinking

Various effects include: · Inhibits questioning· Inhibits curiosity· Inhibits asking why

The role of emotion

Anxiety and fear cause us to default to ‘hard-core instinctive thinking’

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Cognitive Biases


Let’s Explore These …

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SEEING IS BELIEVING?

Pleasecounttheblackdots...

you are how you think

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Making assumptions

Anexample

Copyright © 2017 Michael R. Rip PhD MindLeap LLC


20 biases that screw up your decision-making

See: Jennifer Wood, ’20 Cognitive Biases That Affect Your Decisions (17 September 2015)http://mentalfloss.com/article/68705/20-cognitive-biases-affect-your-decisions

Cognitive BiasesOur unconscious cognitive predispositions

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Welcome to CONFIRMATION BIAS

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Source:RichardsHeuer,PsychologyofIntelligenceAnalysis.CIA(1999).Availableat<https://www.cia.gov/library/center-for-the-study-of-intelligence/csi-publications/books-and-monographs/psychology-of-intelligence-analysis>.

“Cognitivebiasesaresimilartoopticalillusionsinthattheerrorremainscompellingevenwhenoneisfullyawareofitsnature.Awarenessofthebias,byitself,doesnotproduceamoreaccurateperception.Cognitivebiases,therefore,are,exceedinglydifficulttoovercome.”

[RichardsHeuer,1999,p.112]


Organizing Cognitive Biases to better understand them …

Courtesy of: Buster Benson, ‘Cognitive bias cheat sheet: Because thinking is hard’ (September 1, 2016). Document available at: <https://betterhumans.coach.me/cognitive-bias-cheat-sheet-55a472476b18#.ahp5romx9>.

4 problems that cognitive biases help our minds address

Too much information — so we aggressively filter (cherry-pick) almost all of it out

Problem 1:

Problem 2:

Problem 3:

Problem 4:

Not enough meaning — the world is confusing, so we fill in the gaps via pattern-seeking/-finding to construct meaning

Need to act fast — lest we lose our chance, so we jump to conclusions

What should we remember? — This isn’t getting easier, so we try to remember the important bits

• These 4 problems have 4 consequences (problems) of their own• There are 4 problems that cognitive biases help our minds address

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Courtesy of: Buster Benson, ‘Cognitive bias cheat sheet: Because thinking is hard’ (September 1, 2016). Document available at: <https://betterhumans.coach.me/cognitive-bias-cheat-sheet-55a472476b18#.ahp5romx9>.

Those 4 problems have 4 consequences (problems) of their own

We don’t see everything — Some of the information we filter out is actually useful and important

Consequence 1:

Consequence 2:

Consequence 3:

Consequence 4:

Organizing Cognitive Biases (continued) …

Our instincts can be very wrong sometimes — Some of the conclusions we jump to about what it all means are wrong or outdated

Quick decisions can be seriously flawed — Some of the quick reactions are unfair, self-serving, and counter-productive

Our memory reinforces errors — Some of the stuff we remember for later just makes all of the above systems more biased, and more damaging to our thought processes

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Worst cognitive biases …

Claiming that your Instinctive Thinking is perfect for reasoned thought and decision-making

Claiming that you do not have any cognitive biases!

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On Critical Thinking …


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Getting to CAUSALITY Getting Cause-Effect (Consequence) Correct

A Disciplined, Structured Way of Thinking

Copyright © 2011-18 Michael R. Rip, PhD MindLeap LLC

INSTINCTIVE THINKING

Innovation

Causality

HRO

DISCIPLINED INSTINCTIVE THINKING

CRITICAL THINKINGRT: Reflective ThinkingRC: Reality Checking

Crucial for 21st leadership in the era of Business 4.0 and VUCA

CPS: Creative Problem Solving

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MindLeap Definition of Critical Thinking

© 2015 Michael R. Rip

Critical thinking is the deliberate use of high-level cognitive strategies to avoid the traps of Instinctive Thinking and ensure our understanding of reality (especially causality) is as accurate as possible.

Without critical thinking, we have no way of checking if our perceptions and beliefs about the world are correct. It provides us with a vital negative feedback (error correcting) loop.

Definition according to Michael Rip (2013-17)

MindLeap RT*RC Model for Critical Thinking …

Instinctive Thinking1Mindless / Unconscious / Default

3Critical Thinking

Mindful / Conscious / Deliberate

Reflective Thinking

Reality Checking

key elements

2Disciplined

Instinctive ThinkingMindful / Conscious / Deliberate

MindLeap 6 Step Process

© 2017 Michael R. Rip PhD MindLeap LLC!37FIRST

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Pattern-Seeking / Pattern-Finding

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The Importance of Curiosity


Greatmomentsindiscoveryoccurnotwhenasomeoneexclaims“Eureka!”

…butwhentheymurmur“That’sstrange”

…andsoitiswithinvention…“Why?”

alongwiththeWho,What,Where,When,andHow

MindLeap 6-Step Critical Thinking RT*RC Model

RC: 2 Phases

2 Hypothesis Testing

RT

1 Hypothesis Generation

Who What Where When How

Now get to the WHY question


Investigate the situation

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The importance of WHY?

AskingWHY?manytimes…

•Helpstriggerinquiry,curiosity,andQUESTIONING

•HelpswithrevealingunrecognizedASSUMPTIONS

•HelpsrecognizingunconsciousCOGNITIVEBIASES

•HelpssparkCREATIVITY;INVENTION;andINNOVATION

Must create an environment of WHY

•Helpsavoid(EPIC)BLUNDERS/ERRORS

•Helpsprotectagainst(personal/tactical/strategic)DECEPTION

—Valuecollegiality,andTRUST,butdon’tbecontrolledbyit!

—AskingWHYdoesnotmeandisagreement

•HelpsgenerateMULTIPLEHYPOTHESES

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HRO Principles


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HRO High-Reliability Organization(s) * Refer to handout

1 PREOCCUPATION WITH FAILURE

2 RELUCTANCE TO (OVER)SIMPLIFY

3 SENSITIVITY TO OPERATIONS

4 DEFERENCE TO EXPERTISE

5 COMMITMENT TO RESILIENCE

HRO Traits / Characteristics

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Surgeon General’s Committee on Smoking and Health 1963

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How not to tackle HRO issues …


Stackthecommittee!

“Threeofthememberssmokedcigarettes,andtwosmokedpipesorcigars.Terry,himselfasmoker,servedasthenominalchairmanofthegroup,butitwasagreedhewouldnotparticipateinanyofitsdeliberationsorconclusions.”

Epic Fail and Why HRO is So Important


India's new nuclear ballistic missile submarine INS Arihant

Rear hatch left open

Recording Space Walks and HRO


Failure/Error are not options for astronauts

HRO Principle #1


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Preoccupation with failure


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HRO Principle #1

Feedback Mechanisms

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Avoidthe‘blameandshame’game

Inversion Thinking Tool

Avoidreinforcingfailure

Operationalizebothpositiveandnegativefeedbackloops

Positivefeedback:Self-reinforcing Negativefeedback:Self-correcting

TocounteractInstinctiveThinking(esp.ConfirmationBias)

Prevention and Mitigation Accuratedeterminationofcause-consequence(effect)

Alignrewards/incentives

Every ‘system’ demands both positive and negative feedback loops

Reinforce success Correct errors

Preoccupation with failure

Example IgnazSemmelweisandhand-washing(1840s)


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Putting Negative-Feedback Mechanisms Into Our Systems

Example

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In1999,NASA’s$125millionMarsClimateOrbiterburnedupintheMartianatmospherebecauseengineerstransmittedincorrectunitstothesatellite

“Peoplesometimesmakeerrors.Theproblemherewasnottheerror,itwasthefailureofNASA’ssystemsengineering,andthechecksandbalancesinourprocessestodetecttheerror.That’swhywelostthespacecraft.”

After-Action Review Thrust(navigation)commandswerecalculatedinImperialUnits(aspounds),andnotinMetricUnits(asNewtons)

Systemsmustbeableto‘trap’errors/failures!

Dr.EdwardWeiler(AssociateAdministratorforSpaceScience,NASA)providedavitallyimportantinsight:

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A few items


Using GPS in Afghanistan

Checklists

Employing Checklist

NewtechnologyfortargetingGPS-guidedmunitions

1•batteryissue

2•verballysendingco-ordstocirclingB-52bomber

Usedynamicscrambling

USAirFlight1549landedontheHudsonRiver,NYC

Turbinerestartchecklistissue

USSJohnS.McCainwarshipcollisioninSingaporeStrait

Loststeerage&usedchecklisttorecover,but…

al-Qa’aeda So-called“TrainingManual”eventuallygrewtoover8,000pages!

HRO Principle #2


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Reluctance to simplify


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HRO Principle #2

Goal

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OvercomeInstinctiveThinking

Limit‘oversimplification’bias

Simplify,butbeawareofVUCA(esp.complexity)

Okaytosimplify,but…

Simplify,butbeawareofdistractions

Maintain‘systems’perspectives

AvoidWYSIATIbias! WYSIATI:‘WhatYouSeeIsAllThereIs’

Appreciatemind’sdesireforcertainty

Reluctance to simplify

HRO Principle #3


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Sensitivity to operations


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HRO Principle #3

Importance of Training

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Influenceofemotiononperformance

Training=createtheenvironmentRealism/Realistictraining

Continual(notanevent;continuesintheworkplace)

Embeddedintothefabricoftheorganization

Appropriatelyincentivized/rewarded

Createsconsciousthinking–shiftsdefaultfromunconscioustoconsciousthinking

Sensitivity to operations

Trainingoughttobetested/evaluatedforeffectiveness/outcomes

HRO Principle #4


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Commitment to resilience


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HRO Principle #4

Organizational

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Individual

Comfortablewithchange

Creative&innovativeproblemsolving—rewardproblem-prevention!

Commitment to resilience

Resilience(individual&organization)–howwerespondandrecoverfromerror/failure

Ensurethattheoutcomeremainsthesamenomattertheenvironmentalconditions

Criticalthinkingteams=Negativefeedbackmechanism

—Weseeourfaultsinothersfirst

‘TraintheMind’AvoiddistractionsRealistictraining Dryruns Rehearsal Testing

MinimizepoorthinkingAvoidpattern-baseddecisionmaking(i.e.,absolutes,rules,bestpractices,experience)

Cognitive ability Comfortable with change Critical thinking

HRO Principle #5


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Deference to expertise


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HRO Principle #5

Expertise

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Deference to expertise

Avoidself-justification“everyoneisanexpert”

Avoidover-confidence

Dunning-KreugerEffect–illusory(deeplysubjective)superiority

Causesofepicfailures—CIA

Summary


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A few parting shots …


There are three distinct types (or varieties) of action that lead to epic blunders:

The confidence-skill disconnectWhenaperson’sconfidenceoutstripstheirskill(overconfidenceisaproblem!)

Impulsive actsWhenourbehaviorseemsoutofcontrol.Usuallydrivenbyemotion!

1

2

3 Lapses of attentionDistraction,assumptions,biases…

THE CAUSES OF EPIC FAILURES

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Key Cognitive Strategies (not in any order of priority)

Deliberately minimize distraction and create the opportunity for uninterrupted focus

Deliberatelyrecognizeandbreakpatterns,usingyourpattern-finding/seeking/extrapolatingability

Deliberatelyfocusongeneratingquestions—delayseekinganswers

DeliberatelyuseReflectiveThinking(RT)

Also:employ‘Systems(Theory)Thinking’

DeliberatelyuseInversionThinkingtool

Keypriorityistofullyunderstandtheproblem(situation)

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Overall, Critical Thinking represents a negative feedback mechanism for the HRO adventure

1)

2)

3)

4)

5)

6)

7)

8) Avoidmultitasking

In Closing …


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To end …

Our presentation began with this question

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“WhydoesHROnotariseorganically,buthastobeimposedonhumanorganizationalsystems?”

“Thatis,whyisHROnotthedefaultpositionforhuman-createdprocessesandsystems?”

Your reply … Atthisstageofthepresentation,younowpossessaninformedawarenessandknowledgeofhowcriticalthinkingformsthefoundationforHRO,asenseofhowtoleveragecriticalthinkingintoyourprocessesandoperations,andwhattoavoidorimprove

MindLeap Training Programs


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MindLeap provides 1-, 2-, 3-, and 4-day Critical Thinking and Leadership training programs to support HRO initiatives


RESPONDER

Thank You!

Contact

[email protected]

Michael R. Rip PhD MSc(Med)Director, MindLeap LLC

[email protected]

Mark A. Vroman MBA EFOCo-Director, MindLeap LLC

mailto:[email protected]

mailto:[email protected]

critical thinking for hro - iha insurance solutions · ‘cold thinking’ is akin to higher order...

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