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What Reilly and his team at Cook County were trying to do, in short, was provide some structure for the spontaneity of the ER. The algorithm is a rule that protects the doctors from being swamped with too much information—the same way that the rule of agreement protects improv actors when they get up onstage. The algorithm frees doctors to attend to all of the other decisions that need to be made in the heat of the moment: If the patient isn’t having a heart attack, what is wrong with him? Do I need to spend more time with this patient or turn my attention to someone with a more serious problem? How should I talk to and relate to him? What does this person need from me to get better?
“One of the things Brendan tries to convey to the house staff is to be meticulous in talking to patients and listening to them and giving a very careful and thorough physical examination—skills that have been neglected by many training programs,” Evans says. “He feels strongly that those activities have intrinsic value in terms of co
There are, I think, two important lessons here. The first is that truly successful decision making relies on a balance between deliberate and instinctive thinking. Bob Golomb is a great car salesman because he is very good, in the moment, at intuiting the intentions and needs and emotions of his customers. But he is also a great salesman because he understands when to put the brakes on that process: when to consciously resist a particular kind of snap judgment. Cook County’s doctors, similarly, function as well as they do in the day-to-day rush of the ER because Lee Goldman sat down at his computer and over the course of many months painstakingly evaluated every possible piece of information that he could. Deliberate thinking is a wonderful tool when we have the luxury of time, the help of a computer, and a clearly defined task, and the fruits of that type of analysis can set the stage for rapid cognition.
The second lesson is that in good decision making, frugality matters. John Gottman took a complex problem and reduced it to its simplest elements: even the most complicated of relationships and problems, he showed, have an identifiable underlying pattern. Lee Goldman’s research proves that in picking up these sorts of patterns, less is more. Overloading the decision makers with information, he proves, makes picking up that signature harder, not easier. To be a successful decision maker, we have to edit.
When we thin-slice, when we recognize patterns and make snap judgments, we do this process of editing unconsciously. When Thomas Hoving first saw the kouros, the thing his eyes were drawn to was how fresh it looked. Federico Zeri focused instinctively on the fingernails. In both cases, Hoving and Zeri brushed aside a thousand other considerations about the way the sculpture looked and zeroed in on a specific feature that told them everything they needed to know. I think we get in trouble when this process of editing is disrupted—when we can’t edit, or we don’t know what to edit, or our environment doesn’t let us edit.
Remember Sheena Iyengar, who did the research on speed-dating? She once conducted another experiment in which she set up a tasting booth with a variety of exotic gourmet jams at the upscale grocery store Draeger’s in Menlo Park, California. Sometimes the booth had six different jams, and sometimes Iyengar had twenty-four different jams on display. She wanted to see whether the number of jam choices made any difference in the number of jams sold. Conventional economic wisdom, of course, says that the more choices consumers have, the more likely they are to buy, because it is easier for consumers to find the jam that perfectly fits their needs. But Iyengar found the opposite to be true. Thirty percent of those who stopped by the six-choice booth ended up buying some jam, while only 3 percent of those who stopped by the bigger booth bought anything. Why is that? Because buying jam is a snap decision. You say to yourself, instinctively, I want that one. And if you are given too many choices, if you are forced to consider much more than your unconscious is comfortable with, you get paralyzed. Snap judgments can be made in a snap because they are frugal, and if we want to protect our snap judgments, we have to take steps to protect that frugality.
This is precisely what Van Riper understood with Red Team. He and his staff did their analysis. But they did it first, before the battle started. Once hostilities began, Van Riper was careful not to overload his team with irrelevant information. Meetings were brief. Communication between headquarters and the commanders in the field was limited. He wanted to create an environment where rapid cognition was possible. Blue Team, meanwhile, was gorging on information. They had a database, they boasted, with forty thousand separate entries in it. In front of them was the CROP—a huge screen showing the field of combat in real time. Experts from every conceivable corner of the U.S. government were at their service. They were seamlessly co
But once the shooting started, all of that information became a burden. “I can understand how all the concepts that Blue was using translate into pla
Paul Van Riper’s twin brother, James, also joined the Marine Corps, rising to the rank of colonel before his retirement, and, like most of the people who know Paul Van Riper well, he wasn’t at all surprised at the way Mille