The War on Interruptions, an Excerpt from “Switch: How to Change Things When Change Is Hard”

The following is an excerpt from Chip and Dan Heath’s new book, Switch: How to Change Things When Change Is Hard, which will be released on February 16.

One of the most consistent findings in psychology is that people behave differently when their environment changes. When we’re in a place where people are quiet (church), we’re quiet. When we’re in a place where people are loud (stadiums), we’re loud. When we’re driving and the lanes narrow, we slow down. When they widen, we speed up again. This may seem obvious, but when we try to make change at work, we often make the mistake of obsessing about the people involved rather than their environment. Often the easiest way to drive change is to shape the environment.

This environment-shaping strategy was used in 2006 by Becky Richards, the Adult Clinical Services Director at Kaiser South San Francisco hospital, who was determined to drive down medication errors. On average, nurses commit roughly 1 error per 1000 medications administered. That’s an impressive record of accuracy. Still, given the huge volume of medications delivered at Kaiser South, that error rate led to about 250 errors annually, and a single error can be harmful or even deadly. For instance, if a patient received too much Heparin, a blood thinner, the patient’s blood would no longer clot and the patient could hemorrhage. If a patient got too little Heparin, he could develop a blood clot that could lead to a stroke.

Richards believed that most errors happened when nurses were distracted. And it was all too easy to get distracted—most traditional hospitals put the medication administration areas right in the middle of the nursing units, which tended to be noisiest places on the floor. Tess Pape, a professor at the University of Texas who has studied medication errors, said, “Today we admire people for multitasking, we celebrate people who can accomplish many things at once. But when you’re giving out medications is the last time you should be multitasking.”