Firstly I should make it clear that I am not a psychologist nor in the truest sense of the word am I a scientist, although as an aviator I have a broad understanding of a lot of science. My knowledge of cognitive dissonance, in particular, comes from extensive research into why pilots were flying approaches to land – the ‘approach’ being the last part of the flight descending towards the runway – when all of the available evidence indicated that the landing could not be achieved either safely or in compliance with operating procedures. The approach trajectory was either too steep or too shallow, the aircraft was too fast or too slow or the landing gear and flaps were not in the correct configuration. Pilots’ standard operating procedures required them to execute a ‘go-around’ in such circumstances, to abandon the approach, climb away safely and start again but some were simply not complying. This ‘unstable approach’ phenomenon as it is known, has been one of the most common contributory factors in commercial aviation accidents over the last 30 years or more but the tendency to press on in spite of the evidence is not unique to pilots.
This brought me to the work of Bluma Zeigarnik, a psychologist and psychiatrist born in Lithuania at the turn of the last century. She is probably best known for studies inspired by her Professor’s observation that a waiter appeared to have a much better recollection for orders that had yet to be paid for, than those which had already been settled. The waiter’s workflow involved taking the order, delivering the food and drinks and finally taking the money, at which point the workflow would be finished. He stored the order in his memory until the customer had paid and then subconsciously dumped it. In other words, an incomplete pattern of work held a much higher priority for retention in the memory than one which was effectively completed.
Zeigarnik went on to study school children learning in class and found that those who were interrupted in the course of their work remembered more, and more accurately than those who were allowed to finish without interruption. In isolation that is interesting but doesn’t tell us a great deal. However, Zeigarnik and her successors have shown that the increased memory retention is attributable to a heightened level of cognitive arousal whilst a task is being conducted, which is replaced by a more satisfied lower arousal once the task is successfully completed. The heightened cognitive arousal was in turn attributed to a degree of discomfort that the goal may fail, discomfort that could only be assuaged by success. Nowadays we know this as the ‘Zeigarnik Effect’. To take it one step further, research suggested that humans remember bad things more clearly than they remember the good things; perhaps from a survival perspective this makes sense – we remember what has done us harm so that we can avoid it in future.
So finally, the outcome of this ‘cognitive dissonance’, the disparity between aspiration and reality during the conduct of a task, is that we humans harbour a compelling desire to complete a task once we have commenced it. This can be so compelling that we may press on although all of the indications, our instincts and maybe even our own colleagues are telling us to stop and rethink the strategy. This is what we found when the ‘unstable approaches’ continued to landing – pilots had become so focused on achieving the goal that they were able to ignore the evidence that it was failing – and it probably applies to many other aspects of professional and personal life.
Eva pinpoints contributory factors, such as cognitive dissonance, in order to highlight the real causes of patient harm. If you would like to learn more about Eva and how it can improve patient safety within your organisation, you can book a free 30-minute consultation with Eva’s founder, Ed Marsden, here. Alternatively, send us an email at [email protected].