Mapping the Mind Field

This entry is part 1 of 2 in the series Adding Mindset to the Order Set: Changing the Way We Change

In his blog, psychologist Wayne Dyer relates a story of “mind fields” entitled An Airport Parable. 1 The story describes one of those “airline flights from hell.” In short, Dr. Dyer while waiting at the gate for his flight from JFK to Athens, Greece, heard the seven-hour flight delay announcement. As one might expect, all the involved passengers expressed significant distress, with one exception: an elderly Greek lady “perhaps in her eighties, all dressed in black.” As she heard the announcement, she simply sat down and closed her eyes with a smile on her face. Dr. Dyer elected to take a two-hour walk, leave the airport, go to a movie, and then return. He found the lady still in her seat, still smiling. As luck would have it, the woman sat across the aisle from Dr. Dyer allowing him to notice that during the entire 13-hour flight she never moved once, “…with the same contented look on her face.” Dr. Dyer describes this as a “mind field of peace”, one that the woman evidently chose over the alternatives: mind fields of agitation, frustration, and the like. The lesson he took away? We have the option to choose our mind fields.

Could the ability to choose mind fields – to replace a dysfunctional one with a more productive one – have value to us in Health Information Technology (HIT)? The challenges facing health care organizations as they find their way through reform are legion. Most of us believe HIT plays a central role in this evolution. Given the speed of change over the last decade – and the likely speed of change in the coming one – we propose that a deeper understanding of mind fields, particularly related to learning (both individual and organizational learning), may be fruitful. To achieve this understanding, we need to look both backward and forward.

First, looking back, based on the less than stellar performance of the recent past, Black Book Market Research reports about 32% of large hospitals are reevaluating their vendor’s EHR services and products, with 19% likely replacing their existing EHRs because of “…extraordinary delays, cost run-ups, extended implementations and glitches interrupting operations.” 2 There are varied reasons for such decisions; one is that our industry is clearly responsible for missteps – in vendor choice, acquisition and implementation project management – over recent decades. Lorenzi 3 calls them “…the significant sins of the past.” These missteps now weigh heavy on health provider and IT resources as they consider the array of mind field options ahead.

Second, looking ahead, the near-term HIT future offers even more daunting mind fields because there truly is no roadmap. During our attendance at a recent Washington state HIMSS chapter executive dinner, five regional CMIOs defined their perspectives on the IT challenges ahead and how we should proceed – given that none of them could have experience doing what lies ahead. For example, we are about to accommodate using genome data on a scale never considered before. We also face big data and related analytics issues involving wearable data collection associated with the Apple Watch, a multitude of other wearable data collection devices and an unending volume of social media data that already inundates us. All of this data serves us well if we make the right choices, but we need much investigation. For example, health organizations need an enterprise data strategy before collecting this data or selecting and implementing tools that best serve their patient populations.

Clearly, HIT decision-makers have a broad range of difficult and often unprecedented choices to make in the coming years. Of course we all like to think we learn from experiences, including past mistakes. But it may well be that how we consider past mistakes – how our societal and organizational cultures influence us – creates unnecessary barriers to optimal learning.

The good news is we have a choice. Over the last two decades, Carol Dweck, a Professor of Psychology at Stanford University researched a “mindsets” concept similar to Dr. Dyer’s mind fields. Dweck initially worked with learners in educational environments, and more recently with executives and employees within organizations. She defines a mindset as “…a set of assumptions, methods, or notations held by one or more people or groups of people that is so established that it creates a powerful incentive within these people or groups to continue to adopt or accept prior behaviors, choices, or tools”(italics added for emphasis). 4

The basic premise of Dweck’s findings on achievement and success is that we all hold very powerful, conscious and unconscious beliefs about the nature of our intelligence and ability. She proposes that there are two basic sets of these beliefs, which she terms the “fixed mindset” and the “growth mindset.” As she describes it, “In a fixed mindset, people believe their basic qualities, like their intelligence or talent, are simply fixed traits. They spend their time documenting their intelligence or talent instead of developing them. They also believe that talent alone creates success—without effort.” 5 People with a fixed mindset focus on guarding and preserving this limited resource instead of developing it. They are less likely to admit and correct their deficiencies. Instead of learning from failure they worry about maintaining their fixed intelligence and how others judge it.

Conversely, with the growth mindset, failure is not a deficiency but rather an opportunity to experience deeper learning. Failure, therefore, is a necessary intermediate step to greater success. Dweck explains, “In a growth mindset, people believe that their most basic abilities can be developed through dedication and hard work—brains and talent are just the starting point. This view creates a love of learning and a resilience that is essential for great accomplishment. Virtually all great people have had these qualities.” 6 People with a growth mindset create motivation and productivity even in failure. A key finding of Dweck’s research is that ongoing success does not relate directly to one’s innate ability; it relates more to how one perceives ability. Those who consider ability as inherent or fixed are less likely to succeed. Those who perceive ability as a characteristic that one can improve or learn perform better over the long term.

Dweck and her colleagues researched further, asking if these two mindsets apply to organizational cultures as well. The early answer is yes. Her primary findings are intriguing – employees at fixed mindset organizations were often less committed than those at growth mindset organizations, feeling their employer only really cared about or supported a few ‘star’ workers. Worries about failing led to fewer innovative projects, as well as keeping secrets, cutting corners, and cheating to “get ahead.” By contrast, supervisors at growth-mindset organizations were much more positive about their staff than those in fixed mindset organizations, finding them innovative, collaborative, committed to growth and learning, with management potential. 7

  1. Dyer, Wayne W. An Airport Parable. Dr. Wayne W. Dyer (blog post). Retrieved on January 22, 2015 from http://www.drwaynedyer.com/blog/an-airport-parable/
  2. Large Hospitals praise upgraded EHR system analytics and intelligent interoperability, but lose favor in vendor cost run-ups and disruptions, Black Book reports. PRWeb. Retrieved on January 26, 2015 from http://www.prweb.com/releases/2014/02/prweb11589073.htm
  3. Lorenzi, Nancy M., Riley, Robert T., et al (1995). Transforming Health Care Through Information: Case Studies, Volume 772. ‪New York: Springer Science & Business Media. ISBN 978-1-4419-0269-6
  4. Dweck, C. S. (2006). Mindset: The new psychology of success. New York: Random House. ISBN-13: 9780345472328
  5. Dweck, C. S. What is a Mindset? Mindset (web site). Retrieved on January 26, 2015 from http://mindsetonline.com/whatisit/about/index.html
  6. Dweck, C. S. What is a Mindset? Mindset (web site). Retrieved on January 26, 2015 from http://mindsetonline.com/whatisit/about/index.html
  7.  Harvard Business Review Staff (2014, November). How Companies Can Profit from a “Growth Mindset”. Harvard Business Review, November 2014. Retrieved from https://hbr.org/2014/11/how-companies-can-profit-from-a-growth-mindset
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Posted on January 1st, 2015 in Innovating Health Care IT
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