Background: Georgetown professor Cal Newport coined the term “deep work” to describe the type of focus that allows high performance on cognitively demanding tasks that is only possible when one is free from distraction. High levels of attention and focus have been tied to increased creativity, improved work satisfaction, and higher quality of work. Some propose that attention is a limited resource, and that hospital working environments and staffing practices could be designed in order to maximize healthcare provider attention and focus. While there has been much writing on attention in various fields including the cognitive and behavioral sciences, economics, and business literature, there has been relatively little dedicated discussion of the ecology of attention in the hospital environment or in the health care literature, and no dedicated performance improvement efforts targeting the ecology of attention in the hospitalist workplace.

Purpose: We are conducting a single-site project to improve the ecology of attention in the hospitalist workplace. We are researching which elements of communication, workflow, work environment, and staffing models most significantly impact hospitalists’ ability to focus during their shift. At the same time, we are conducting real-time continuous improvement projects targeting those elements of the work environment that contribute most to distraction and loss of focus.

Description: We are creating a measurement suite for monitoring continuous improvements in the ecology of attention. Data sources include focus groups and daily provider surveys that include NASA’s Task Load Index, provider perceived performance, self-reported measures of patient volume and throughput, and provider satisfaction. We are correlating provider reported qualitative data with EMR data including patient outcomes, operational measures such as length of stay, and EMR metadata. We will implement interventions based on qualitative information from focus groups and based on our theoretical framework. Interventions might include modifying task allocation, minimizing task switching, altering triaging structures, and optimizing methods of communication between hospitalists and their multidisciplinary team.

Conclusions: Early qualitative results from focus groups and surveys have identified key factors contributing to distraction during nocturnist shifts, including:1. Suboptimal use of pages and EMR instant messaging, including high volumes of low-priority messages and inability to triage messages by urgency 2. Lack of clarity around provider roles during education, transitions of care, and emergencies3. Unpredictability in the flow of workAs we deploy interventions to address these issues, including reforms of EMR-based instant messaging, experiments with the responsibilities of different roles during the nocturnist shifts, and EMR changes, we will track the effect of these changes on provider focus and satisfaction using our qualitative survey tool and post-intervention focus groups.