语言认知偏差_我们的认知偏差正在破坏患者的结果数据

语言认知偏差

How do we know if we are providing high-quality care? The answer to this question is sought by a multitude of parties: patients, clinicians, educators, legislators, and insurance companies. Unfortunately, it’s not easy to determine. There is no single score or report that provides a definitive benchmark of quality, but various measures can help paint the picture. One of the measures garnering a lot of attention is outcome tools.

我们如何知道我们是否提供高质量的护理 ？ 众多团体都在寻找这个问题的答案：患者，临床医生，教育者，立法者和保险公司。 不幸的是，这并不容易确定。 没有单一的分数或报告可以提供确定的质量基准，但是各种测量方法可以帮助您了解情况。 引起广泛关注的措施之一是结果工具。

成果数据的价值和好处 (The Value and Benefits of Outcomes Data)

Outcome tools provide value in many areas. We can use them to:

成果工具可在许多领域提供价值。 我们可以使用它们来：

• track information and then disseminate it to employees;
  跟踪信息，然后将其传播给员工；
• integrate quality data into the culture of our organizations;
  将质量数据整合到我们组织的文化中；
• develop continuing education courses and seminars;
  开展继续教育课程和研讨会；
• facilitate conference participation and research projects;
  促进会议参与和研究项目；
• guide mentorship, residency, and fellowship programs;
  指导指导，居留和研究金计划；
• support marketing efforts; and
  支持营销工作； 和
• develop quality improvement initiatives to improve recruitment and employee retention.
  制定质量改进计划，以改善招聘和员工保留率。

Outcome tools have practice-wide benefits as well. At PT Solutions, for example, we use our outcomes data to:

结果工具在整个实践中也有好处。 例如，在PT Solutions，我们将结果数据用于：

• foster research collaborations with universities;
  促进与大学的研究合作；
• negotiate with payers; and
  与付款人协商； 和
• educate the public.
  教育公众。

Imagine how much influence we could have if the whole profession joined together and used outcomes data with a unified approach?

想象一下，如果整个行业联合起来并以统一的方式使用结果数据，我们将产生多大的影响？

While outcome tools are valuable and definitely represent a piece of the care quality puzzle, they are often met with resistance by clinicians. Outcome tools can elicit negative emotional reactions, as clinicians may feel attacked and scrutinized. As Danielle Ofri wrote in What Doctors Feel, “the desired practical outcome is smothered by the emotion cost.” While this is certainly true if the outcomes are treated as the only indicator of clinical quality, writing them off completely can remove objective data and accountability from the care equation.

尽管结局工具很有价值，并且肯定代表了护理质量难题的一部分，但临床医生经常会遇到抵制。 结果工具会引起负面的情绪React，因为临床医生可能会感到受到攻击和审查。 正如丹妮尔·奥夫里(Danielle Ofri)在《 什么医生的感觉 》中写道，“期望的实际结果被情感成本所扼杀”。 如果将结果视为临床质量的唯一指标，则肯定是正确的，但完全销毁这些结果可能会从护理等式中删除客观数据和问责制。

数据分析中的偏见 (Bias in Data Analysis)

Unfortunately, we are bound to be heavily biased in our assessments of care quality. I experienced this challenge at PT Solutions, where I serve as the National Director of Quality and Research. In 2015, we rolled out Focus on Therapeutic Outcomes (FOTO), a system of outcome measures, to track clinical outcomes and patient satisfaction. Unfortunately, it was not a smooth undertaking.

不幸的是，我们在对护理质量的评估中必将有很大的偏见。 我在PT Solutions担任国家质量和研究部主任时经历了这一挑战。 2015年，我们推出了“关注治疗结果”(FOTO)这一结果评估系统，以追踪临床结果和患者满意度 。 不幸的是，这不是一件容易的事。

I immediately sought to discover and correct the issue, as I knew we gave high-quality care. While recognizing we always have room for improvement, the results we were obtaining were not consistent with our other quality metrics, such as cancellation rates, online reviews, and patient-generated referrals.

我知道我们提供了高质量的护理，所以我立即寻求发现并纠正问题。 尽管认识到我们总是有改进的余地，但我们获得的结果与我们的其他质量指标(例如取消率，在线评论和患者生成的推荐人)不一致。

What I found is that the rapid rollout of FOTO resulted in a poor understanding of how to use the tool. Clinics were failing to complete surveys at regular intervals, especially on or near discharge. This resulted in a large “days between status and discharge” value. We treated patients for 10 visits, but the final score obtained was on visit six. Essentially, we were treating patients and improving them without getting proper credit in our outcome scores. I spent months beating the drum that the tool was being used incorrectly. Enter the law of unintended consequences.

我发现FOTO的快速推出导致对如何使用该工具的理解不深。 诊所未能定期完成调查，尤其是出院时或临近出院时。 这导致了很大的“状态到排放之间的天数”值。 我们对患者进行了10次访视，但最终得分为6次访视。 从本质上讲，我们在治疗患者并改善他们的能力时并未获得对结果评分的适当认可。 我花了几个月的时间殴打鼓，说该工具使用不当。 输入意想不到的后果的法律。

By placing a large emphasis on our incorrect use of the tool, I created a narrative that quickly became a convenient excuse when results plateaued — any poor outcomes or satisfaction values from that day forward were attributed to an issue with the surveys themselves. At this point, I started seeking alternative explanations and strategies to improve our outcomes processes.

通过重点强调我们对工具的不正确使用，我创建了一种叙述，当结果停滞不前时便Swift成为一种方便的借口-从那天起任何差劲的结果或满意度值都归因于调查本身的问题。 在这一点上，我开始寻求替代性的解释和策略来改善我们的结果流程。

I started researching and reading about decision-making and critical thinking. Soon, I stumbled across one of the most influential books I have ever read. Thinking, Fast and Slow by Daniel Kahneman opened my eyes to the world of biases and cognitive fallacies. The pieces fell into place, and I started to understand many of the issues impeding the use of quality data.

我开始研究和阅读有关决策和批判性思维的文章。 很快，我偶然发现了我读过的最有影响力的书之一。 丹尼尔·卡尼曼(Daniel Kahneman)的《 思考，快与慢》让我看到了偏见和认知谬论的世界。 各个部分就位了，我开始理解许多阻碍质量数据使用的问题。

Now, I’ll walk through the key cognitive fallacies our practice has encountered in our attempt to improve our use of outcomes and satisfaction data. I have fallen victim to each of these and can attest to their power. The goal is not to abolish these biases — after all, it’s impossible to rid ourselves of them completely — but rather to generate awareness so we can more effectively recognize and navigate these cognitive traps.

现在，我将逐步介绍我们的实践在尝试改进成果和满意度数据的使用中遇到的主要认知谬误。 我已经成为每个人的牺牲品，可以证明他们的力量。 目的不是要消除这些偏见—毕竟，不可能完全摆脱它们—而是要产生意识，以便我们可以更有效地识别和克服这些认知陷阱。

确认偏差：支持既定信念 (Confirmation Bias: Supporting Established Beliefs)

The first bias to address is arguably the most common. Confirmation bias is when people seek data that are likely to support the beliefs they currently hold. We focus on what we know and neglect what we do not — which makes us overly confident in our beliefs. In the clinical world, this commonly occurs when supporting our treatment decisions. A quick PubMed search often reveals a host of studies supporting my viewpoint. So, I just conveniently ignore the ones refuting it. We see similar approaches regarding quality metrics.

解决的第一个偏见可以说是最常见的。 确认偏差是指人们寻找可能支持他们目前持有的信念的数据。 我们专注于我们所知道的而忽略了我们所不知道的-这使我们对自己的信念过于自信。 在临床领域，这通常在支持我们的治疗决策时发生。 快速的PubMed搜索通常会发现许多支持我观点的研究。 因此，我只是方便地忽略了那些反驳它的人。 我们看到有关质量指标的类似方法。

As clinicians, we will naturally defend our treatment decisions and clinical quality. We don’t go into work thinking, “Today my aim is to be exceptionally mediocre at treating.” Therefore, when looking at quality data, we are likely to focus on the information that supports our current beliefs: “I don’t care what FOTO may say; look at how low my cancellation rate is!” This is exacerbated when adding new measures — like our practice did with the rollout of FOTO — as it invites additional cognitive fallacies.

作为临床医生，我们自然会捍卫我们的治疗决策和临床质量。 我们不投入工作思考，“今天我的目标是在治疗方面表现平庸。” 因此，在查看质量数据时，我们可能会关注支持我们当前信念的信息：“我不在乎FOTO会说什么； 看看我的取消率有多低！” 当添加新的措施时(如我们在FOTO推出时的做法那样)，这种情况会加剧，因为这会引起其他认知方面的谬论。

理论导致的失明：坚持一种思维方式 (Theory-Induced Blindness: Clinging to One Way of Thinking)

Theory-induced blindness, a term coined by Daniel Kahneman, essentially means that once you have accepted a theory and used it as a tool in your thinking, it is extraordinarily difficult to notice its flaws. Our theoretical beliefs are robust, and it takes much more than one embarrassing finding for established theories to be seriously questioned. If I have accepted certain quality measures (like the cancellation rate or the number of patient-generated referrals), I am more likely to cling to those. This remains true even if new data comes to light that calls into question previous beliefs. We see this when clinicians fail to adopt new treatments or assessments because they have had success with previously accepted approaches. Changing how we conduct and assess our job is uncomfortable and difficult. This is exacerbated if we are working with limited information.

理论性失明是Daniel Kahneman创造的一个术语，从本质上讲意味着，一旦您接受了一种理论并将其用作思考的工具，就很难发现其缺陷。 我们的理论信念是有力的，要对既有理论进行认真质疑，不仅仅需要一个令人尴尬的发现。 如果我接受了某些质量衡量标准(例如取消率或患者生成的转诊数)，则我更有可能坚持执行这些措施。 即使新数据曝光并质疑先前的信念，情况依然如此。 当临床医生由于采用先前接受的方法取得成功而未能采用新的治疗方法或评估方法时，我们会看到这种情况。 改变我们的行为方式和评估工作是不舒服和困难的。 如果我们只使用有限的信息，则会加剧这种情况。

可用性偏差：仅使用容易获得的信息 (Availability Bias: Using Only the Information that Comes Easily)

Compounding the issues of confirmation bias and theory-induced blindness is a failure to procure all relevant information. It’s very easy for us to cherry-pick information, both intentionally and unintentionally. The availability bias is the process of passing judgment by the ease with which instances come to mind. If we constantly assess our cancellation rate or our visits per referral, then those numbers will more easily come to mind. If practice leaders frequently refer to those same metrics, then their perceived importance will increase. Another piece of the availability bias is knowing when to draw conclusions.

使确认偏差和理论上的盲目性问题复杂化，是无法获得所有相关信息的问题。 对于我们而言，有意和无意地挑选信息非常容易。 可用性偏差是通过想到实例的难易程度来进行判断的过程。 如果我们不断评估取消率或每次转诊的造访次数，那么更容易想到这些数字。 如果业务负责人经常引用这些相同的指标，那么他们的重要性就会提高。 可用性偏差的另一个原因是知道何时得出结论。

I employed an availability bias when I was hyper-focused on the FOTO data for one of our flagship clinics. Following months of training and no discernible improvement in the outcomes data, I was certain there was an issue in the quality of care. However, once I looked at the entire picture and recognized our great cancellation rate, visits per referral, self-discharge rate, patient-generated referrals, Net Promoter Score® (NPS®), online reviews, and patient satisfaction numbers, I had to concede that clinical quality was not a concern. As it turned out, a single clinician was artificially impacting the scores by prematurely closing cases in FOTO to avoid the hassle of collecting and monitoring outcomes data. So, we must always ask ourselves, “Do I have all the information necessary to draw a conclusion?”

当我过度关注我们一家旗舰诊所的FOTO数据时，我采用了可用性偏差。 经过几个月的培训，结果数据没有明显改善，我确信护理质量存在问题。 但是，一旦我查看了整个图片并意识到我们的取消率，每次转诊的造访率，自我出院率，患者产生的转诊， Net PromoterScore®(NPS®) ，在线评论和患者满意度数字，我就不得不承认临床质量不是问题。 事实证明，只有一名临床医生通过过早关闭FOTO中的案例来人为地影响评分，以避免麻烦的收集和监视结果数据。 因此，我们必须始终问自己：“我是否拥有得出结论所必需的所有信息？”

晕轮效应：过分依赖第一印象 (The Halo Effect: Relying Too Heavily on First Impressions)

The second issue we faced regarding available information was the halo effect. The halo effect is when we increase the weight of first impressions, sometimes to the point that subsequent information is mostly wasted. It can affect subsequent performance assessments. How does this pertain to outcomes?

关于可用信息，我们面临的第二个问题是光环效应。 晕轮效应是当我们增加第一印象的权重时，有时甚至会浪费大量后续信息。 它可能会影响后续的绩效评估。 这与结果如何相关？

An example of the halo effect is assuming all clinicians in your practice — simply because you hired them — provide high-quality care, even if you have not seen them treat or reviewed their metrics. Even as we gain more information through co-treating and training, the initial conclusion drawn during the hiring process heavily influences our perception. Assuming we are great and the tool is wrong will stunt clinical development.

晕轮效应的一个例子是，假设您未曾见过所有临床医生(只是因为您雇用了他们)就提供了高质量的护理，即使您没有看到他们对待或评估过他们的指标。 即使我们通过共同处理和培训获得更多信息，但在招聘过程中得出的初步结论仍会严重影响我们的看法。 假设我们很棒并且工具错误，则会阻碍临床发展。

沉没成本谬论：利用先前的投资来证明未来的努力 (The Sunk-Cost Fallacy: Using Previous Investment to Justify Future Efforts)

As you will notice, this progression is akin to the five stages of grief. Let’s now explore three biases that comprise the search for excuses. The first is the sunk-cost fallacy. This occurs when individuals continue a behavior or endeavor as a result of previously invested resources (time, money, or effort), regardless of the outcome. In rehab therapy, we often see this when clinicians cling to a particular treatment approach — regardless of the efficacy and literature support — because of previously invested resources. It can blind our acceptance of outcomes, as we assume the number of resources invested should be proportional to the quality of care.

您会注意到，这种进展类似于悲伤的五个阶段。 现在，让我们探索构成找借口的三个偏见。 首先是沉没成本的谬论 。 当个人由于先前投入的资源(时间，金钱或精力)而继续行为或努力而不管结果如何时，就会发生这种情况。 在康复治疗中，由于先前投入的资源，临床医生在坚持特定治疗方法时，无论疗效和文献支持如何，我们经常会看到这种情况。 因为我们认为投入的资源数量应与护理质量成正比，这可能会使我们对结果的接受蒙蔽。

成果偏见：过于关注负面结果 (Outcome Bias: Focusing Too Heavily on Negative Results)

The second fallacy is the outcome bias. The outcome bias occurs when we blame decision-makers for good decisions that worked out poorly and give them too little credit for successful moves that appear obvious only after the fact. For example: “My cancellation rate is great because I have implemented more open and frequent communication with patients. The poor satisfaction score is outside my control. I have had a large influx of Medicaid patients and my new clinician is struggling.” Or perhaps: “Of course Sarah has great outcomes; her clinic is in an affluent area, and all of her patients are young, athletic, and seeking care during the acute stage. Meanwhile, my clinic is in a different part of town, and all my patients are in chronic pain and have been using opioids.” While these facts may be true, there is a lack of ownership, and no actionable tasks are being developed to address the outlined issues.

第二个谬误是结果偏见 。 当我们责怪决策者做出的糟糕的决策时，就会产生结果偏见，而他们却对成功的举动给予过少的赞誉，这些举动只有在事实发生之后才显而易见。 例如：“我的取消率很高，因为我与患者进行了更加开放和频繁的沟通。 差的满意度得分超出了我的控制范围。 我有大量的医疗补助患者涌入，而我的新临床医生正在苦苦挣扎。” 也许：“当然，莎拉有很大的成就； 她的诊所在一个富裕的地区，她的所有患者都年轻，运动且在急性期就医。 同时，我的诊所在城镇的另一部分，我的所有患者都患有慢性疼痛，并且一直在使用阿片类药物。” 尽管这些事实可能是正确的，但缺乏所有权，并且没有为解决所概述的问题而制定可操作的任务。

损失厌恶谬论：有利于现状 (The Loss Aversion Fallacy: Favoring the Status Quo)

Lastly, we have the loss aversion fallacy. Loss aversion is a powerful conservative force that favors minimal departure from the status quo. We experience stronger regret if a poor outcome results from action rather than inaction. For example: “I knew I shouldn’t have discussed recent cancellations with my patient. Now they are uncomfortable and won’t come back. I should have stayed quiet.” We are more prone to seek excuses and reasons to prevent action than to seek it. When presented with poor outcomes or satisfaction data, we are less likely to implement strategies to improve the results because of loss aversion.

最后，我们有损失厌恶谬误 。 厌恶损失是一种强大的保守力量，它倾向于尽量减少偏离现状。 如果不采取行动而不是不采取行动导致不良结果，我们将感到更加遗憾。 例如：“我知道我不应该与患者讨论最近的取消事宜。 现在他们很不舒服，不会回来。 我应该保持安静。 我们比寻求行动更倾向于寻求借口和理由来阻止采取行动。 当呈现不良结果或满意度数据时，由于厌恶损失，我们不太可能实施改善结果的策略。

文化与表演之间的联系 (The Connection Between Culture and Performance)

At this point in my journey, buy-in started to take hold, but the results were inconsistent and region-specific. Ultimately, we found that culture had a substantial influence on results. The regions that were more stable, more open and honest with feedback, and more driven by internal competition consistently outperformed the others. Now that we had sufficient training in FOTO usage and cognitive bias awareness, we needed to determine which tool to use for promoting improved performance: carrots or sticks.

在我旅途中的这一点上，买入开始占上风，但是结果并不一致且针对特定地区。 最终，我们发现文化对结果有重大影响。 在那些更加稳定，更加开放和诚实的反馈以及受内部竞争推动的地区中，这些地区的表现始终优于其他地区。 既然我们已经在FOTO使用和认知偏见意识方面进行了充分的培训，我们需要确定使用哪种工具来提高性能，即胡萝卜还是木棍。

奖励积极成果 (Rewarding Positive Results)

The research is clear that reward for improved performance works better than punishment for mistakes. Note that I say reward and not financial incentive. The evidence is mixed regarding the effectiveness of financial incentives compared to other types of rewards, which could include:

研究清楚地表明，提高绩效的报酬要比对错误的惩罚更好。 请注意，我说的是奖励，而不是金钱上的激励 。 与其他类型的奖励相比，关于财务奖励的有效性的证据不一，其中包括：

• verbal or written recognition,
  口头或书面认可，
• promotion,
  促销，
• awards, and
  奖项，以及
• additional responsibility.
  附加责任。

However, the question is not simply a matter of how large a bonus the high-performing clinics should receive; it is whether the focus should be on the high-performing clinics or low-performing ones.

但是，问题不仅仅在于高绩效诊所应该获得多少奖金。 是将重点放在绩效较高的诊所还是绩效较低的诊所。

Some of you may disagree with focusing on reward, citing your experiences with the opposite effect, but that is often a result of the regression to the mean phenomenon. If someone exceeds expectations, future results are likely to be relatively worse, despite the initial praise. The reverse is seen with unexpected dips in performance and subsequent punishment. We need to assess trends before drawing conclusions on the effectiveness of our interventions.

你们中的有些人可能会不同意以奖励为中心，但会以相反的效果为例，但这通常是回归到平均现象的结果 。 如果某人超出了预期，尽管最初受到赞誉，但未来的结果可能会相对较差。 相反的情况是，表现意外下降并随后受到惩罚。 在得出干预效果的结论之前，我们需要评估趋势。

残酷诚实 (Getting Brutally Honest)

Once the biases have been addressed and the method of feedback has been established, it’s time to improve our outcomes assessment process and plan for the future. We need to be both reactionary and proactive. An interesting consideration is the difference in motivation between meeting goals and exceeding them.

解决了偏见并建立了反馈方法后，就该改善我们的结果评估流程并为未来计划。 我们必须既反动又积极主动。 一个有趣的考虑是实现目标与超越目标之间动机的差异。

We work a lot harder to meet goals than to exceed them. One is the difference between success and failure while the other is the difference between success and, well, more success. We saw this with our quality data. If we meet the goal of 98% patient satisfaction, it is no longer discussed. We no longer develop plans to improve it further — despite 2% of patients remaining unhappy — and we instead focus on other issues. If the goal is not a stretch goal — something difficult but still attainable — we often fall short of our potential. Additionally, we will have a handful of clinics simply meeting the goal and a handful missing the mark. So, on average, the group is still below the goal.

为了实现目标，我们要付出更大的努力。 一个是成功与失败之间的区别，而另一个是成功与更多成功之间的区别。 我们通过质量数据看到了这一点。 如果我们达到98％患者满意度的目标，将不再讨论。 尽管2％的患者仍然不满意，我们不再制定进一步改善它的计划，而是专注于其他问题。 如果目标不是一个艰巨的目标，虽然这是一个困难但仍然可以实现的目标，那么我们往往没有达到我们的潜力。 此外，我们将有少数几个诊所仅能达到目标，而少数诊所则无法实现目标。 因此，平均而言，该小组仍低于目标。

积极主动与积极主动 (Being Proactive Versus Reactive)

“Using distributional information from other ventures similar to that being forecasted is called taking an ‘outside view’ and is the cure to the planning fallacy.” — Bert Flyvbjerg

“使用来自其他合资企业的分布信息与预测的相似，这被称为“外部观察”，是解决计划谬误的良方。” —伯特·弗里夫比约

The planning fallacy was the last major hurdle we needed to clear while reshaping our culture on clinical outcomes. We needed to shift from strictly reacting to data from past treatments and start looking forward to proactively address potential concerns. The planning fallacy is the tendency to underestimate potential complications and time needed for future projects. This often occurs in patient care. We may not consider the impacts of a patient’s diet or sleep hygiene. We may not account for the influence of understaffed front offices or the time it will take a new graduate to assume a full caseload. To combat this fallacy, we need to aggregate multiple perspectives.

计划谬误是我们在根据临床结果重塑文化时需要清除的最后一个主要障碍。 我们需要从对过去处理的数据严格React转变为开始积极期待解决潜在问题。 计划谬误是低估潜在复杂性和未来项目所需时间的趋势。 这通常在患者护理中发生。 我们可能不会考虑患者饮食或睡眠卫生的影响。 我们可能无法考虑到人手不足的前台部门的影响，也不会考虑新毕业生承担全部案件所需的时间。 为了克服这种谬论，我们需要汇总多种观点。

Aggregating assessments add to the collective pool of information. This allows the decision-maker to take “the wisdom of the crowd” and formulate a more well-informed opinion. This can be accomplished at the treatment level and at the overall practice assessment level. Ask your colleagues to review a recent evaluation to look for any potential missed data, incorrect assessments, or likely future pitfalls in the prognosis and plan of care. Work as a leadership team to assess all relevant data and bring your individual perspectives to determine why a clinic or region is struggling with clinical outcomes. Regardless of the level of the issues — be it individual patient care or clinic-wide — look at the big picture. Looking at cases in isolation leads to more quick, emotionally-driven reactions.

汇总评估增加了集体信息库。 这使决策者可以“吸取众人的智慧”，并制定更明智的意见。 这可以在治疗水平和总体实践评估水平上完成。 要求您的同事回顾最近的评估，以寻找任何可能的数据遗漏，评估不正确或在预后和护理计划中可能出现的陷阱。 作为领导团队，评估所有相关数据并带入您个人的观点，以确定为什么诊所或地区在临床结果方面苦苦挣扎。 无论问题的严重性如何(无论是个人患者护理还是整个诊所)，都应放眼全局。 孤立地审视案件会导致更快，更受情感驱动的React。

总结思想 (Closing Thoughts)

As Orfi pointed out in her book, outcome measures and similar quality metrics don’t provide a full understanding or measure of quality. They provide valuable information, but we cannot determine if quality care was provided solely from the outcomes data. The same can be said for patient satisfaction measures. Emotion and bias can influence a patient just as it does a clinician. For example, even if a patient’s primary issue is a long wait time prior to the appointment, the patient is likely to give a 1-star rating across the board, when the wait time has no influence on the care provided.

正如Orfi在她的书中指出的那样， 结果量度和类似的质量量度无法提供对质量的完整理解或量度。 它们提供了有价值的信息，但是我们无法确定是否仅从结果数据中提供了优质的护理。 可以说患者满意度测度也是如此。 情绪和偏见会像临床医生一样影响患者。 例如，即使患者的主要问题是预约前的漫长等待时间，但当等待时间对所提供的护理没有影响时，患者仍可能获得一星评级。

In my role, quality assessment is a key responsibility. Previously, I homed in on problems and expected excellent results. I also heavily weighed outcomes data and assumed that if the numbers were poor, then the care was poor. Through reflection, feedback, and assessment, I now have a more refined understanding of the value outcomes and satisfaction data provide. I also realize I was previously mistaken in my weighing of their value, and that I caused undue stress, frustration, and potentially even shame among my colleagues. We must hold one another accountable to high-quality care, and we have a variety of tools to make assessments of said quality. But we must also ensure we do not pull each other down when making those assessments.

作为我的角色，质量评估是一项关键责任。 以前，我研究问题并期望获得出色的结果。 我还对结果数据进行了权衡，并假设如果数字很差，那么护理就很差。 通过反思，反馈和评估，我现在对提供的价值结果和满意度数据有了更精细的理解。 我还意识到我以前在权衡其价值时被误认为是我造成了不适当的压力，挫败感，甚至有可能使我的同事蒙羞。 我们必须对高质量的护理负责，并且我们有多种工具可以评估所述质量。 但是，我们还必须确保在进行这些评估时，我们不会彼此拉低。

Outcome tools can provide substantial value for your practice and the profession. While we may not solely rely on outcomes to tell a story, we can maximize their value by using the tools correctly and obtaining employee buy-in. The biases I covered are not all cognitive fallacies you will run across in clinical care, but they are highly prevalent. As stated earlier, the goal is not to eliminate them, but to have an awareness and to navigate potential cognitive traps. It will take practice. There will be struggles and resistance, but it will be well worth the effort.

成果工具可以为您的实践和专业提供实质性价值。 尽管我们可能不仅仅依靠结果来讲述故事，但我们可以通过正确使用工具并获得员工的支持来最大程度地发挥其价值。 我所涵盖的偏见并不是您在临床护理中会遇到的所有认知谬误，但它们非常普遍。 如前所述，目标不是消除它们，而是要有意识并驾驭潜在的认知陷阱。 这将需要练习。 会有斗争和抵抗，但这是值得的。

Zach is a physical therapist, researcher, and educator whose mission is to challenge the way clinicians think and close the information gap between clinicians and laypersons. Receive a biweekly newsletter containing his latest blog posts, recent research and articles on critical thinking and healthy living, and recommended books at zacharywalston.com.

扎克(Zach)是一位物理治疗师 ，研究员和教育家，其任务是挑战临床医生的思维方式并缩小临床医生与非专业人员之间的信息鸿沟。 在zacharywalston.com上每两周接收一次新闻通讯，其中包含他的最新博客文章，近期研究和有关批判性思维和健康生活的文章以及推荐书籍。

翻译自: https://medium.com/swlh/our-cognitive-bias-is-ruining-patient-outcomes-data-105f49cec03

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