Meditation increases the depth of information processing

During meditation, practitioners are required to center their attention on a specific object for extended periods of time. When their thoughts get diverted, they learn to quickly disengage from the distracter. We hypothesized that learning to respond to the dual demand of engaging attention on specific objects and disengaging quickly from distracters enhances the efficiency by which meditation practitioners can allocate attention. We tested this hypothesis in a global-to-local task while measuring electroencephalographic activity from a group of eight highly trained Buddhist monks and nuns and a group of eight age and education matched controls with no previous meditation experience. Specifically, we investigated the effect of attentional training on the global precedence effect, i.e., faster detection of targets on a global than on a local level. We expected to find a reduced global precedence effect in meditation practitioners but not in controls, reflecting that meditators can more quickly disengage their attention from the dominant global level. Analysis of reaction times confirmed this prediction. To investigate the underlying changes in brain activity and their time course, we analyzed event-related potentials. Meditators showed an enhanced ability to select the respective target level, as reflected by enhanced processing of target level information. In contrast with control group, which showed a local target selection effect only in the P1 and a global target selection effect in the P3 component, meditators showed effects of local information processing in the P1, N2, and P3 and of global processing for the N1, N2, and P3. Thus, meditators seem to display enhanced depth of processing. In addition, meditation altered the uptake of information such that meditators selected target level information earlier in the processing sequence than controls. In a longitudinal experiment, we could replicate the behavioral effects, suggesting that meditation modulates attention already after a 4-day meditation retreat. Together, these results suggest that practicing meditation enhances the speed with which attention can be allocated and relocated, thus increasing the depth of information processing and reducing response latency

The time is now for action research

Despite highly systematic methods for identifying priority problems and assessing intervention effects, the recent study by Tourgeman-Bashkin and colleagues would not be considered rigorous by conventional standards of validity, nor would its sample size of three units impress policymakers eager to promote large-scale change through improvement programs. Yet, study findings suggest that no single intervention would have accomplished as much as the action research approach the authors’ employed. This perspective argues that although action research may lend itself to neither clean comparisons of intervention and control units over time nor far-reaching improvement campaigns, its advantages, including responsiveness to context, emphasis on implementation and sustainability, and insight about underlying mechanisms of change, make rigorous action research a highly attractive alternative for engendering real world improvement

Operational Failures and Problem Solving: An Empirical Study of Incident Reporting

Operational failures occur in all industries with consequences that range from minor inconveniences to major catastrophes. Many organizations have implemented incident reporting systems to highlight actual and potential operational failures in order to encourage problem solving and prevent subsequent failures. Our study is among the first to develop and empirically test theory regarding which reported operational failures are likely to spur problem solving. We hypothesize that problem solving activities are especially likely to follow reported operational failures that provoke financial and legal liability risks. We also hypothesize that management commitment to problem solving, enacted through managers' communication and engagement practices, can encourage frontline workers to conduct problem solving. We test our hypotheses in the health care context, in which the use of incident reporting systems to highlight operational failures is widespread. Using data on nearly 7,500 reported incidents from a single hospital, we find support for our hypotheses. Our findings suggest that frontline workers' participation in problem solving is motivated by some inherent characteristics of the problems as well as by particular management practices.

Managerial practices that promote voice and taking charge among frontline workers

Process-improvement ideas often come from frontline workers who speak up by voicing concerns about problems and by taking charge to resolve them. We hypothesize that organization-wide process-improvement campaigns encourage both forms of speaking up, especially voicing concern. We also hypothesize that the effectiveness of such campaigns depends on the prior responsiveness of line managers. We test our hypotheses in the healthcare setting, in which problems are frequent. We use data on nearly 7,500 reported incidents extracted from an incident-reporting system that is similar to those used by many organizations to encourage employees to communicate about operational problems. We find that process-improvement campaigns prompt employees to speak up and that campaigns increase the frequency of voicing concern to a greater extent than they increase taking charge. We also find that campaigns are particularly effective in eliciting taking charge among employees whose managers have been relatively unresponsive to previous instances of speaking up. Our results therefore indicate that organization-wide campaigns can encourage voicing concerns and taking charge, two important forms of speaking up. These results can enable managers to solicit ideas from frontline workers that lead to performance improvement.

Consumer Demand for Health Information on the Internet

The challenges consumers face in acquiring and using information are a defining feature of health care markets. In this paper, we examine demand for health information on the Internet. We find that individuals in poor health are more likely than those in better health to use the Internet to search for health information and to communicate with others about health and health care. We also find that individuals facing a higher price to obtain information from health care professionals are more likely to turn to the Internet for health information. Our findings indicate that demand for consumer health information depends on the expected benefits of information and the price of information substitutes.

A Randomized Field Study of a Leadership WalkRoundsTM-Based Intervention

Background: Leadership WalkRoundsTM have been widely adopted as a technique for improving patient safety and safety climate. WalkRoundsTM involve senior managers directly observing frontline work and soliciting employees’ ideas about improvement opportunities. However, the hypothesized link between WalkRoundsTM-based programs and performance has not been rigorously examined in a set of randomly selected hospitals. Objective: To fill this research gap, we conducted a randomized field study of a WalkRoundsTM-based program. Research Design: Fifty-six work areas from 19 randomly selected hospitals agreed to implement an 18-month long WalkRoundsTM-based program to improve safety. We compared their results to 138 work areas in 48 randomly selected control hospitals. Participants: We conducted the program in four types of clinical work areas: operating rooms/post-anesthesia care units; emergency departments, intensive care units, and medical/surgical units. We collected survey data from nurses in those work areas. Measures: To measure the program’s impact, we collected pre and post survey data on perceptions of improvement in performance (PIP)—a proxy for quality and an important organizational climate antecedent for positive, discretionary behaviors of frontline staff. We compare change in PIP in the treatment work areas to the same type of work areas in control hospitals. Results: On average, compared to control work areas, our WalkRoundsTM-based program was associated with a statistically significant decrease in PIP of .17 on a 5-point scale (4.5%). Conclusions: Our study calls into question the general effectiveness of WalkRoundsTM on employees' perceptions, which had been assumed in prior literature

Key Drivers of Successful Implementation of an Employee Suggestion-Driven Improvement Program

Service organizations frequently implement improvement programs to increase quality. These programs often rely on employees’ suggestions about improvement opportunities. Organizations face a trade-off with such suggestion-driven improvement programs. On one hand, the improvement literature recommends that managers focus organizational resources on surfacing a large number of problems, prioritizing these, and selecting a small set of high priority ones for solution efforts. The theory is that soliciting a large number of ideas from employees will surface a set of higher priority problems than would have been identified with a less extensive search. Scarce organizational resources can be allocated to resolving the set of problems that provide the greatest improvement in performance. We call this an “analysis-oriented” approach. On the other hand, managers can allocate improvement resources to addressing problems raised by frontline staff, regardless of priority ranking. This “action-oriented” approach enables more resources to be spent on resolving problems because prioritization receives less attention. To our knowledge, this tradeoff between analysis and action in process improvement programs has not been empirically examined. To fill this gap, we randomly selected 20 hospitals to implement an 18-month long employee suggestion-driven improvement program; 58 work areas participated. Our study finds that an action-oriented approach was associated with higher perceived improvement in performance, while an analysis-oriented approach was not. Our study suggests that the analysis-oriented approach negatively impacted employees’ perceptions of improvement because it solicited, but not act on, employees' ideas. We discuss the conditions under which this might be the case

The Effectiveness of Management-By-Walking-Around: A Randomized Field Study

Management-By-Walking-Around (MBWA) is a widely adopted technique in hospitals that involves senior managers directly observing frontline work. However, few studies have rigorously examined its impact on organizational outcomes. This paper examines an improvement program based on MBWA in which senior managers observe frontline employees, solicit ideas about improvement opportunities, and work with staff to resolve the issues. We randomly selected 19 hospitals to implement the 18-month long MBWA-based improvement program; 56 work areas participated. We find that the program, on average, had a negative impact on performance. To explain this surprising finding, we use mixed methods to examine the impact of the work area's problem-solving approach. Results suggest that prioritizing easy-to-solve problems was associated with improved performance. We believe this was because it resulted in greater action taking. A different approach was characterized by prioritizing high-value problems, which was not successful in our study. We also find that assigning to senior managers responsibility for ensuring that identified problems get resolved resulted in better performance. Overall, our study suggests that senior managers' physical presence on their organizations' frontlines was not helpful unless it enabled active problem solving

What Epistemic Reasons Are For: Against the Belief-Sandwich Distinction

The standard view says that epistemic normativity is normativity of belief. If you’re an evidentialist, for example, you’ll think that all epistemic reasons are reasons to believe what your evidence supports. Here we present a line of argument that pushes back against this standard view. If the argument is right, there are epistemic reasons for things other than belief. The argument starts with evidentialist commitments and proceeds by a series of cases, each containing a reason. As the cases progress, the reasons change from counting in favor of things like having a belief to things like performing ordinary actions. We argue that each of those reasons is epistemic. If the argument succeeds, we should think there are epistemic reasons to consider hypotheses, conduct thought and physical experiments, extend one’s evidence, and perform mundane tasks like eating a sandwich, just as there are epistemic reasons to believe what one’s evidence supports

A mixed methods study of change processes enabling effective transition to team-based care

Team-based care is considered central to achieving value in primary care, yet results of large-scale primary care transformation initiatives have been mixed. We explore how underlying change processes influence the effectiveness of transition to team-based care. We studied 12 academically-affiliated primary care practices participating in a learning collaborative, using longitudinal staff survey data to measure progress toward team-based care and qualitative interviews with practice staff to understand practice transformation. Transformation efforts focused on team formation and capacity building for quality improvement. Using thematic analysis, we explored types of change processes undertaken and the relationship between change processes and effective team-based care. We identified three prototypical approaches to change: pursuing functional and cultural change processes, functional only, and cultural only. Practice sites prioritizing both change processes formed the most effective teams: simultaneous functional and cultural change spurred a mutually-reinforcing virtuous cycle. We describe implications for research, practice and policyThis research was supported by a grant from the Harvard Medical School Center for Primary Care and CRICO [362121]. MAK was supported by a Harvard Business School doctoral fellowship. ELA was supported by funding from a Wellcome Trust Senior Investigator Award [WT097899M]