Thinking Out Loud: Coping with information overload

Photo by Noah Näf on Unsplash

I have had the great privilege of working with senior leaders in healthcare for several years. Senior managers, clinicians, nurses and midwives, board members, executive and non-executive directors, chief executives, and chairs. This is the first in a mini-series of blogs that draw from practical examples, academic literature and offer some ideas for responding to information overload at senior level.

Leaders are anxious about the quality and safety of services for which they have responsibility. They care. Their worries are often underpinned by a concern the information they have is not the complete picture. They ask questions, request reports, more paper is produced. There is a belief that more information will provide greater certainty and reduce anxiety. And yet, the anxiety felt by the senior leaders remains – and may even increase as the volume of information does.

Anyone working in this environment no doubt has experienced receiving vast piles of paperwork to read in preparation of a meeting – it’s common for papers to number 400 pages. The volume of information becomes overwhelming. More staff spend more time creating these pages.

Now that these documents are mostly digital, we are taking a positive step toward protecting the environment but there is a danger that without the vast stack of paper to print or carry, we may be even less mindful of how much content we’re asking people to digest.

Can we all be reading this volume of information? Sometimes people will admit that they haven’t read the papers. It can often feel for those requested to produce them that no-one has bothered.

And yet…. Leaders still tell me they feel uncertain and anxious.

This has led me to question the use of ‘information’ and try to understand how we can tackle a problem that seems to be growing. In fact, when discussing with a friend who is the chair of a third-sector, voluntary, organization, her eyes lit up as she recognized the same issues: “We’ve just started talking about this in my Board and we realized we were all colluding and not talking about the information thing”.

Looking at the information that is produced for Boards or Quality Committees for Healthcare Acquired Infections (HCAI) as an example, we can see a huge deluge of information. There are tables of numbers; huge paragraphs of text – include words like ‘below’, ‘above’, ‘increase’, ‘decrease’; patient stories; staff stories; incidents; complaints; appointment lengths; lengths of stay; targets for reducing HCAI; costs associated with HCAI and on and on. A huge volume of data; often overwhelming and rarely wholly connected with different bits in different documents. It is hard to say for certain within this information rich pile of documents that what we’re reading is accurate, can we be certain that the person recounting the patient’s story has interpreted their sentiment correctly, are we reading that correctly or do we interpret the data differently to our colleague sitting next to us?

There is something counterintuitive happening. In our efforts to focus, simplify, clarify, reduce, and streamline our understanding in documentation, we are losing the connection between reality and our discussions and decisions. Our papers are only mere representations of reality, and all of them reduce this multi-dimensional, complex experience to a 2D thing. Inevitably, something is lost. We are then making strategic decisions based upon simplified information, making assumptions that don’t fully represent the patient experience.

I have recently read the most fascinating book (To Obama: A people’s history by Jeanne Marie Laskas) describing the process and content of letter correspondence that went on between President Obama and American citizens during his 8 years of office.

“When you are president, so often you’re talking in shorthand,” Obama said “Almost always you’re being reported in shorthand. You can get into habits. You forget that on the other side of any issue is a complex person, or people, or communities that are trying to sort through a whole bunch of stuff that they’re dealing with.”

President Obama read and responded to 10 letters every night. One of the many implications of this leadership behaviour was that other senior staff in the White House wanted to attend to the mail too.

“For me, a great letter was one that would make me feel confused about issues and expand my understanding of the implications of what we were doing.” One senior staffer is quoted in the book.

These letters are not the ‘papers’ which I discussed early on that we are saturated with; these are first-hand accounts that led staff to accept that the job they were doing was not simple. Rather, it grounded their actions in reality; the letters did not offer a solution to a problem, they did however, provide the opportunity to accept they did not know the answer to every problem.

I think what I’m trying to say is that we can’t understand the environment in which we operate from reports, data and the recounting of other peoples’ stories. We can’t improve and simplify our environment by producing yet another policy to outline what needs to be done in future. We need, within our teams, departments and across all levels to think about our actions and work together to always be aware of what we’re trying to do for our patients and the people that we serve.

My advice, when faced with information anxiety in the future, would be to resist commissioning a new report and instead consider: What might we learn if we switched our usual board papers to 10 letters from patients and staff picked at random? How would that change our conversations about reporting and probing for assurance?

As a senior leader: Go, see, and hear