Thinking Fast and Slow, Revisited
Over the weekend, I heard psychologist Daniel Kahneman interviewed in a podcast in advance of the publication of his latest book, Noise. The podcast host Krista Tippett asked Kahneman about Systems 1 and 2, the main structure in his 2011 book, Thinking Fast and Slow.
System 1 is our fast-thinking system, guided by experience and intuition. System 2 is our slow-thinking system, able to use rules of logic and explicit step by step reasoning.
On the podcast, Kahneman illustrated the difference between the two Systems by arithmetic questions: If you are asked ‘what is 2+2?’, most of us immediately respond ‘4’. If you are asked ‘what is 24 x 17?’, most of us engage System 2 to figure out the answer using a multiplication algorithm or reaching for a calculator.
We can’t survive in the world by insisting on exclusive use of System 2. Our System 1 produces integrated judgments and conclusions apparently with little effort. System 1 enables decisions and actions to flow quickly.
“One of the main functions of System 2 is to monitor and control thoughts and actions ‘suggested’ by System 1, allowing some to be expressed directly in behavior and suppressing or modifying others.” (Thinking, Fast and Slow p. 44. Farrar, Straus and Giroux. Kindle Edition.)
While potentially able to guide decisions that avoid negative consequences of snap judgments by System 1, System 2 is ‘lazy’.
System 2 will fail to engage when System 1 is running the show: “…when people believe a conclusion is true, they are also very likely to believe arguments that appear to support it, even when these arguments are unsound. If System 1 is involved, the conclusion comes first and the arguments follow.” (p. 45).
Link to Plan-Do-Study-Act (PDSA)
A complete PDSA cycle includes a prediction in the Plan step: what do you think will happen when you run the cycle? Stating a prediction combats after-the-fact rationalizations, a hallmark of System 1 in action. Prediction in the Plan step and comparison of prediction to actual outcomes in the Study step invite you to engage in deliberate checking, a feature of strong System 2 thinking. Without prediction, you run the risk of having your thinking always dominated by System 1. Developing the habit of prediction will help you strengthen your System 2.
A PDSA cycle of PDSA
In a current project, we are testing the benefit of asking busy clinicians to slow down just a few minutes a day to reflect on their practice. The clinicians are learning to provide ‘age-friendly’ visits in an ambulatory setting. We will ask the clinicians to use the Plan-Do-Study-Act model as the means of reflection, to explicitly focus their attention on the age-friendly visit. We will ask them to make predictions about visits: do they think they can accomplish the visit according to their organization’s definition of age-friendly care? How many minutes will the visit take? We also will ask them to assess their confidence in being able to deliver age-friendly care before and after each visit.
We predict that clinicians will be able to substantially increase the number of age-friendly visits relative to their own baseline performance and relative to peers in the organization.
Our first full tests will run this summer; I intend to report lessons and insights in future posts.
