Beyond a Shadow of a Doubt

Added on Aug 11, 2015

By my own accounting, I have wasted countless minutes of my life in needless second checks: Did I turn off the coffeepot? Do I have my cell phone? Did I close the garage door?

Hospital Safety Procedures

These are routine, skill-based tasks that I perform at least daily – and when I am in my usual distracted/ fatigued/multi-tasking mental state, I can’t remember if I have done them or not. That last item is particularly troubling. I live at the bottom of a cul-de-sac and I am forever circling back from the top of the street to be sure that the garage door is down. I am sure that all of my neighbors must think I am crazy.

Dr. David Diamond, professor of psychology and molecular pharmacology at University of South Florida, offers some insight as to why this happens. As we age (I prefer to think of it as becoming chronologically challenged), our hippocampus (the memory forming center of the brain) becomes weaker particularly when it is competing for our scarce attentional resources with other areas of our brain.1

As a student of safety and error prevention, I know the cure for this problem is S.T.A.R. –

  • • Stop
  • • Think
  • • Act
  • • Review


By simply pausing for a second or two, to allow me to be more attentive to the task at hand I can reduce the chances of leaving the coffee pot on by as much as ten times. But even when I am diligent about practicing S.T.A.R., I find that I am often still plagued by such self-doubt (did I REALLY complete the safety critical task?) that I end up going back for that second check. I attribute this self-doubt to another phenomena associated with the chronologically challenged. At some level, we are all worried that we are “losing it” – falling victim to senility, dementia, or worse. This fear creates distrust of our own performance. So, I have added another strategy in addition to S.T.A.R. When I am tempted to circle back for that second check, I visualize my own performance of the “R” (Review). By invoking the memory of the review (think mindfulness), I reassure myself that the task was done. This review and brief visualization takes much less time than driving back down the street!

As a human performer, I know I will always be vulnerable to skill-based errors or mistakes (safety science says that three to five skill based errors occur out of every 1,000 attempts). But as long as my aging hippocampus and I use the right error prevention strategies, I hope to beat those odds. The aging healthcare workforce (according to a 2013 survey conducted by the National Council of State Boards, 55% of the nursing workforce is age 50 or older) operate under increasingly distractive and stressful conditions. “Pausing for cause” (by practicing S.T.A.R. and mindfulness) should be a part of every healthcare organization’s error prevention arsenal.


1Forget-me-nots.  Gene Weingarten, The Washington Post Magazine, April 3, 2015