A disclaimer: I am not a psychologist. I work with a bunch of brilliant industrial organizational psychologists and some of their concepts have rubbed off on me, but that’s about it. That doesn’t stop me from jumping into some interesting debates (even though they keep telling me I’m wrong!).
The question: A hospital CEO was dealing with the repercussions of a series of patient care errors. They asked us whether we could, or should, assess potential employees for what he is calling “critical thinking”.
1. What is “critical thinking?” You’ll find numerous definitions. Here’s one I like:
...seeing both sides of an issue, being open to new evidence that disconfirms your ideas, reasoning dispassionately, demanding that claims be backed by evidence, deducing and inferring conclusions from available facts, solving problems, and so forth.
2. Can you measure it? Yes – we can, and do, measure what I’ll call “content neutral” critical thinking. It is measuring your core, innate ability to process information and to use that information critically.
3. Can you improve it? Many psychologists will tell you that what they define and measure as critical thinking cannot really be taught or improved much, if at all.
4. Can you measure or improve “clinical” critical thinking? There are plenty of programs that purport to help your staff improve their “critical thinking” I would suggest what they are really trying to do is teach individuals how to think “clinically” – to complete certain clinical tasks (including analysis and diagnosis) in a manner that helps them sift through information and avoid omissions or errors. Even within that context those who have higher innate critical thinking skills will likely out-perform those who don’t.
5. What is the role of expertise and topic knowledge? None when we measure critical thinking, but a big role in “clinical” thinking. I may be really strong in critical thinking but if you ask me to solve a complex nursing problem, I’m highly unlikely to succeed (I’m not a nurse, either), even if compared to a nurse with poor critical thinking skills but a vast (or minimal for that matter!) nursing knowledge base.
6. The role of experience? Significant in clinical thinking skills. A more seasoned nurse, with, even one who scores a bit lower on innate critical thinking, may outperform a good critical thinker with a less experience because she’s had more opportunities to apply her knowledge base to complex problems and learned from those experiences.
7. What’s the role of critical thinking in the hospital errors? Now that’s complicated. What REALLY caused the error? Is there a knowledge deficiency? Is there a lack of attention to detail? Is the provider low in conscientiousness? Are they more prone to take risks? We can, and do, measure all of these things.
The best case scenario is the person with strong innate critical thinking skills, a vast knowledge base, sufficient experience and strong behavioral skills like adaptability, collaboration, and conscientiousness. It’s a complex problem. Of course, that means there are no easy solutions or tools, but there are steps we can take to develop, select and train for all of these attributes.