Interruption is a significant burden on goodwill, contributor to medical error, and source of low-quality care. The asymmetry in who interrupts whom makes “manterrupting” a useful theme to reducing the risk and harm from interruption in healthcare settings.
People often interrupt the speech and actions of others – They overtalk, interject, redirect the topic, and do several other things that disrupt the message another person was trying to convey or the task with which they were busy. Not only does this happen during ordinary tasks of daily life, but it occurs in professional settings as well.
While this is usually just irritating, in high-stakes environments like healthcare interruptions can go from irritating to deadly. There is no room for miscommunications, or derailed attempts at discourse in medicine. Interrupted speech and action are a component in many medical errors. The Institute of Medicine (IOM) estimates the cost of medical errors between $17 billion and $29 billion per year, and at risk of inflaming passions, let us say that the cost in morbidity and mortality is far higher than anyone would prefer, and maybe is in the top ten causes of death.
There are striking asymmetries in who interrupts whom, who gets interrupted, and how often. Men interrupt others more than women do, and women get interrupted the most. By far, men interrupt women most. We can safely say that manterrupting is a thing, a cause, a failure mode.
It is useful to consider the quality cost of interruption, and the cost of the asymmetry of interruption.
These can be seen in five areas:
- Patient and Staff Safety
- Quality & Efficiency
- Innovation & Problem-Solving
- Staff Burnout
Patient and Staff Safety
Interruptions cause reduced message integrity and informational survival, resulting in higher error rates and increased unmet needs. In simpler terms, when someone’s message is interrupted, there is a high probability that the meaning of what they were conveying will be degraded or lost, and there is an increased likelihood of the message not being acted on or understood. In a healthcare setting this can have fatal outcomes. It also means that the person interrupted either abandons their attempt to communicate or execute a task, or they will retry and recover.
When one party is not listening or allowing the other person to speak, key messages are lost. Imagine being in a committee meeting and you are the only women there. When you try to bring up the issue of rising infections in the ICU but your male counterparts don’t let you get to your point, do you think anything will be done to address this problem, that can have fatal consequences? Women in healthcare are not just speaking because they like to talk. They have the same professional knowledge and training and should be afforded the opportunity to express their expert opinions. Not doing so is expensive in time and opportunity, as well as quite frankly, harmful.
Quality & Efficiency
Interrupted speech results in higher rates of error, and lower quality execution of work, with more things being missed and greater care gaps. From a patient’s perspective, this translates into longer wait times, more missed opportunities, worse patient experience, and lower value of care provided. It predicts higher 30-day readmissions, lower patient compliance with care plans, and worse measures of success. Imagine being a woman physician trying to provide concerns about a patient’s kidney function to a surgeon who keeps interrupting. Knowing that many medications and procedures can be harmful to the kidneys, it becomes easy to see how quality is sacrificed.
Innovation & Problem-Solving
Interruptions depress creativity, increase guarded thinking, and increase the amount of knowledge hoarding and knowledge hiding. Knowledge hiding results in reduced innovation, and less effective problem solving, and lower operational efficiency and effectiveness. As a result, the organization spends more time and effort per achieved work outcome, and has less velocity in achieving strategic goals.
Many times, women serve as the token female on committees. Those committees allow in a single (or few women) to demonstrate they are not gender discriminating. However, that doesn’t mean women have an equal say at that committee table. Being that token woman makes speaking up even harder. Then, when an idea is brought out, being dismissed only makes that woman, who may be full of great ideas, hesitant to discuss them in the future. Experts talk about thinking outside the box. None of them tell us that box is mostly male and if you are a woman, you may not be allowed to bring your ideas inside.
Staff Burnout
Perhaps the largest impact is in the effect that ubiquitous and frequent interruption has on people. It reduces a sense of organizational attachment, increases stress, and drives up the probability of burnout. People who are frequently interrupted are less committed to organizational goals, less likely to share ideas, and less likely to participate.
High interruption rates are a risk factor for low achievement, high cost, and high turnover. Experts discuss physician burnout which is a very real problem in medicine. It can lead to depression and even suicide. In healthcare, we are all facing some pretty ugly obstacles. If we are not equal players in jumping those hurdles, we are all going to fall down. Everyone, men and women alike, should be given the same chance to speak up and the same respect to be heard. We may or may not agree with what is being said, but how are we going to know if we stop people from even finishing the message they have in mind?
Don’t miss the #PWChat co-hosted by Dr. Girgis and Mr. Loxton on this very topic, Friday, January 11 at 3:00pm EST. Log in to your Twitter account, perform a search for #PWChat, click Latest toward the top left of the results page, and follow the automatically updating page to view and reply to all comments that are part of the chat.
