Systems Thinking

by Angela Richard-Eaglin, DNP, MSN, FNP-BC, CNE, FAANP, CDE

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    00:06 One of the - my favorite things, too, when I think about bias, is Daniel System's Thinking.

    00:12 Fast and slow and how we can use that systems thinking theory also when we think about and try to understand our biases from an unconscious and a conscious state.

    00:24 So System 1, is where the unconscious is- unconscious biases are born.

    00:30 And those are intuitive or instinctive.

    00:33 They're automatic, you know, because we've practiced it so much, it's a part of who we are, it doesn't mean we can't undo it, remember the Buddha quote.

    00:40 But my point is, once we learned how to ride a bike, that's the easiest thing to liken this to, you know, get on the bike and think about I need to balance it, now I need to put my foot on the pedal and do whatever.

    00:51 You just jump on and take off.

    00:53 Well, once we practice this so much in terms of shifting from system 1 to system 2, to move those biases from that intuitive space to the space of rational thinking, which is why I just said become in tune to what those behaviors are, how your emotions are, think about all those reactions you're having in that moment, then you can shift them from system 1 to system 2 where you are rationally thinking in your conscious, uh-oh, I'm feeling angry and it's because XYZ just walked through that door and I just cannot stand having to sit in this moment.

    01:26 Well, that's human, to feel like that, but it's inhumane to let those feelings turn into something where you mistreat people, so that's the main thing, to think about how can I shift it from system 1 to system 2 so that I can control it.

    01:41 So, now I want to say think about another way to say this, and I'm always literally thinking about visuals in my head because I know it helps me to move that to a space of pragmatism, where I can actually practice this stuff.

    01:56 So think about in your head, biases are activated in system 1 and we're moving into talking about the strategies.

    02:03 How can I stop those biases that are activated in system 1? First, I need to move them to system 2, and how can I stop them from being applied? Well, this is real life. And there will situations that impact our ability to be able to shift those biases when they're activated in system 1, so think about these little balls moving around everywhere.

    02:24 I can hold them in there or put them in to system 2 and hold them there, but certain things do impact my ability to be able to do that.

    02:32 So if I'm under a lot of time pressure and I have deadlines, and I just love to use ERs as situations and all of a sudden, everything broke lose in ER and we're under all this pressure trying to get all these things done so when different things like something of mass casualties happen, we have to shift.

    02:52 And we're in the mode of saving lives.

    02:55 So my biases haven't gone anywhere even though these things happen and I'm in the life-saving mode, and I'm under some pressure to triage all these patients, prioritize, and save some lives, and now I'm really tired, all kinds of distractions are happening because your team members are asking you where I can find this, I need a bag of IV fluid, have you seen XYZ on the team? So all these things are happening, difficult to sit and focus on, patient X came in and oh, my, goodness, it's someone you know and you've had bad interactions with that person.

    03:26 They may have done something extremely traumatic to you.

    03:29 And you don't realize, you know you're having these feelings but you're not focused on that, so you may be really rude to that person's family.

    03:37 You know, you may have this human inclination to skip over that person because something traumatic happened, and I'm speaking real life, so that's why I'm giving this example.

    03:48 So you're not thinking of, I'm feeling this anger, and now I'm going to shift this but you see those actions come out.

    03:56 So this is real life that happens, but you need to practice it because at the end of the day, your priority is still to make sure you take care of that human being that's in front of you right now and there are options and I'll talk about that later, so you may not directly take care of them, but if you recognize they're bleeding out, they need somebody, you can't do it, call person B next to you.

    04:18 Hey, can you take care of this? Well, let's shift to something like that, but you need to do something to proactively help that patient.

    04:26 If all that is going on and you have the opportunity to be able to slow down, you can slow down, recognize it, that's when you're able to say, you know what, person, I need you to please take care of this patient.

    04:40 I can't explain it right now but can you please go here, can we switch off? Because you're still at least advocating to get someone in there to take care of the patient.

    04:49 Other things, when it's not an emergency situation, we have to get enough rest so we can think rationally.

    04:55 Minimize distractions, and all of that will maximize our ability to be able to notice those feelings we're having as a result of those biases, then we can use our tools such as emotional intelligence, cultural intelligence, and multiple other bias management strategies that we'll talk about, which will lessen the likelihood that you're going to let those bias influence decisions and actions come through.

    05:21 Because at the end of the day, what we signed up for, regardless of our feelings or our biases, is to make sure we take care of every patient with service, mercy, compassion, respect for human dignity, and life.

    05:35 We're just going back to some of those humanitarian principles, that's always your job, your ethical, legal, and moral responsibility regardless of how you, what's your personal feelings are.

    05:47 So, another cute thing I like to think about, we talked a lot about mindfulness, so another practical way to remember that if your mind is full, full of stuff going on, it's hard to be mindful and to be able to employ some of those bias management strategies we're going to talk about. So you have to be in tune so much.

    06:09 You've heard self-awareness so many times that's why you need to practice that self-awareness.

    About the Lecture

    The lecture Systems Thinking by Angela Richard-Eaglin, DNP, MSN, FNP-BC, CNE, FAANP, CDE is from the course Bias in Healthcare.

    Author of lecture Systems Thinking

     Angela Richard-Eaglin, DNP, MSN, FNP-BC, CNE, FAANP, CDE

    Angela Richard-Eaglin, DNP, MSN, FNP-BC, CNE, FAANP, CDE

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