The Halo Effect

By now, many of you have started to read Why Hospitals Should Fly: The Ultimate Flight Plan to Patient Safety and Quality Care by John Nance. If not, you are in for an engaging read that starts by sharing the unfortunate story of the worst accident in commercial aviation which occurred at the Tenerife airport in 1977, killing 583 passengers aboard two different 747s and influencing cultural changes to aviation and other high reliability organizations around the world.

The author’s assessment of this event told through his character Dr. Jack Silverman, highlights the communication and cultural missteps that contributed to the unfortunate outcome–one of which being The Halo Effect. The Halo Effect, defined by psychologist Edward Thorndike’s empirical research, is the cognitive bias where people seen as knowledgeable or highly respected in a given area are given deference across the board. In the Tenerife example, neither the co-pilot nor the engineer challenged the highly decorated pilot, because he was “who he was” even though it is thought they had information that could have changed the outcome.

While aviation has changed dramatically over the past 30+ years, evolving into an exemplary model of what a high reliability organization looks like, health care still has a long way to go. The Halo Effect is just one aspect of the predominant healthcare culture which remains hierarchical in nature, and often devalues the contribution of those less experienced or lettered even though all involved in a patient encounter–patient, family, nurse, allied health professional, pharmacist, student and physician–have something of great value to offer.

Can you share an example of a time you had something to offer to a patient encounter, but held back because you thought an attending or senior physician would not welcome your comments? Or because you thought they must know better? Was there a time you pressed on in light of the perceived consequences? How did your choice impact the patient’s experience?

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3 Responses to The Halo Effect

  1. Reading about the halo effect really stuck with me — I like now having a name for something I see all too often when teaching students in the sim lab. When our 3rd year medical school rotate in the ED we place 2 medical students in a simulated ED scenario with 2 nursing students they’ve never met. Invariably as I watch from behind the 1-way mirror I hear a nurse shake their head subtly in disagreement or whisper to another nursing student a correct treatment or approach that is not being taken by the medical student(s) leading the scenario. I think this phenomenon is somewhat common because often our local nursing school often enrolls second career nursing students, often with CRNA/LPN/EMS background. When we debrief I always make it a point to ask why the nursing student didn’t speak up when they saw a treatment algorithm being pursued that they felt wasn’t appropriate, and the answer always centers around the concept of ‘because he/she is the doctor’ (I at this point laugh and clarify that they are NOT, and are but young medical students!). This is just a reminder to all of us that the bad habit of the halo effect is ingrained EARLY and in some ways before we even begin our training in our respective fields. It’s our job as young physicians to recognize our clinical partners when they make a great save, contribution, or treatment idea that benefits the patient — and ultimately break bad cultural habits 🙂

  2. Carey Candrian says:

    Today, Paul Levy said learning involves three steps: interest, distress and pleasure. I love it because I think it is so illustrative of any culture or communication change initiative. After the session finished today, I still had some questions about our smaller discussion around delivering bad news and the costs of communicating (time). Habits, like communication, become routine, perfected, standardized and naturalized thereby often precluding change, or even discussions from occuring. These habits, however, like the halo effect endlessly shape and is shaped by culture. So I am always struck by the question, “how do we delivery bad news?” in part because in asking it, already makes it separate from everyday communication between patients, families and providers. Moreover, it separates it from giving good news, listening to a difficult story, being present with one patient who had a broken toe after you just consoled a family member 15 minutes earlier, managing your own fears while caring for someone else…These all require the same skills. The culture surrounding “bad news” is powerful, so much that it often makes people unable to respond, similar to the halo effect. Therefore, learning how to give bad news in a meaningful way is part and parcel of developing a more generative, open and honest vocabulary. In doing so, old patterns are let go, new skills like immediacy, concreteness, acknowledgment and ownership, are acquired. Yes, this is uncomfortable, because the learning of anything new often is, just like learning to dribble with the opposite foot or hand. Towards this end, during the end of the movie, I was taken aback with how Helen didn’t mention anything specific about what the surgeon said; rather, it was her hearing him cry that produced a new and different response. There was no script. It was open, honest and it made a difference given the circumstances. How can we design contexts that engage each other rather than silence one another? How can we design contexts that enable interaction rather than restrict it?

  3. davidmayer33 says:

    Margaret,
    Thanks for sharing – excellent point for all to remember.

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