Excuse Me… Could We Please Just Stop Interrupting Each Other?

I’m sorry could I just…

Can I let you know quickly…

Are you able to help me a second…

Interruptions are part of our working lives, aren’t they? Whilst I’m pretty sure this applies across most areas of the hospital, in Emergency Medicine the problem seems to be particularly bad. According to a 2017 study⁽¹⁾ EM doctors on the shop floor get interrupted about twelve times an hour… that’s once every five minutes! Why is this happening? Well, according to the aforementioned study, the commonest cause of interruptions is actually other people.

Now, I appreciate that people work within systems and our systems certainly could do with some re-engineering, but I believe there are things we as individuals could and possibly should do to improve the situation. Here are my challenges for all of us, questions that we can ask ourselves tomorrow that might just make our workplace a little bit less… well… interrupty!

 

For those who need to interrupt others:

1) What is wrong with waiting?

Now, this seems an incredibly obvious thing to ask ourselves but I honestly believe we’ve forgotten the importance of this simple question. We live in a world of instant gratification: fast food, 4G, Amazon prime and on demand TV. We have been taught that we deserve an instant response to our desires and that waiting is bad, a failure to meet my needs. Is it any wonder then, that we don’t necessarily stop to think ‘Can I wait until this person has finished to get what I want from them?’ Taking a moment just to consider this question would, I believe, cut out a huge number of interruptions. Not only that, one of the things staff (myself included) often complain about is how busy they feel, rushing from one task to the next. Rather than considering this need to wait for a little bit an irritation, why not consider it an opportunity to pause, take a breath and consider what you’re going to do when you finish work later!

2) Why do I feel an interruption is necessary?

Now this is just my opinion but I think there is only one good reason for interrupting someone else in a clinical environment: if you feel there is a clear, urgent, life or limb threatening emergency which requires their attention. In that situation… please, please, please interrupt! Anything else, I think, usually comes back to me thinking about me, not the other person. I’m running late for clinic so I need to quickly tell you this. I want to tell you this before I forget. I have lots of jobs to get done so I don’t want to wait for you to finish. Isn’t that actually quite a selfish attitude to have? Why is your need to get what you want greater than the other person’s need to be able to concentrate on their job and finish it properly? Oh, you’re the consultant; the manager on-call; the nurse in charge of the ward! I’m sorry, just stop and think about that for a minute. Outside of the clinical emergency mentioned above, nobody’s job is so important that they can’t wait a minute for someone else to finish. So, next time, rather than pushing your own agenda, why not wait patiently for your colleague to finish and model an important attitude for everyone else to aspire to.

3) Is this really going to speed things up?

All of us are busy, I get it, I really do. In our current resource poor, efficiency obsessed environments, waiting even for a minute feels like a waste of time. However, the idea that interrupting somehow speeds things up is deeply flawed. The psychological research is clear on this, interruptions slow us down and impose a huge cognitive load on our brains. When we go back to what we were doing before the break, we have to try and remember where we were and then usually rewind a little to find our train of thought again… this isn’t quicker and is, unsurprisingly, a significant cause of errors. Allowing someone the chance to get it right first time is ultimately far quicker and safer than an interruption that might happen to save us a few seconds… let’s not do it.

4) Could I signal that I’m happy to wait?

We DO need to break in to our colleagues workflow sometimes and so need to make them aware of this but could we do it in a less disruptive way? Now, I suspect most of us have tried ‘hovering’ around someone in an attempt to catch their attention, trying to ensure they don’t ‘get away’ whilst we wait for them. It is certainly one strategy people use but it can often be met with as much irritation as an interruption! You see, when someone hovers around us we have no idea what they are waiting for. What is the problem? Is it serious? Are they happy to wait or are they just nervous or indecisive about approaching? All of these thoughts clog up our thinking, distracting us from the current task until we have no option but to break off and talk to them… interrupting us!

Now, consider an alternative approach. What if we said this when we approach?

‘I’m sorry to interrupt, I need to ask you something but it isn’t urgent and I can wait until you have finished what you are doing.’

Whilst this still breaks in to a colleague’s thoughts it signals clearly what we want, that we are happy to wait and that we appreciate their need to finish their current task. Such an approach adds very little cognitive load to their situation and encourages them to finish their current task. Isn’t that a bit better?

 

For those who get interrupted:

1) Do I encourage interruptions?

With our desire to flatten the hierarchy and be approachable is it possible that we have we actually created a problem for ourselves? If we constantly make ourselves readily available, what is the driver for staff to stop and consider whether they should be dealing with this themselves or perhaps asking someone more appropriate? Now I’m not suggesting we return to the bad old days and make ourselves intimidating or inaccessible but I do think we need to acknowledge there is a potential problem here which we need to address.

2) Is it safe to let myself be interrupted?

The psychology literature is very clear that interruptions make carrying out a task more difficult. Short of incredibly simple, almost automatic tasks, any interruption or attempt at ‘multitasking’ will result in a reduced performance. If we accept the science and are clear that we want to do our job safely, then this gives us permission to start considering saying ‘No’ to interruptions, or at the very least saying ‘Not yet’. Whether we are reviewing an x-ray, manipulating a shoulder or preparing to run a cardiac arrest, routinely allowing ourselves to be interrupted whilst ‘on task’ is not safe and is something we should aim to eliminate from our practice. During longer tasks, it might sometimes be appropriate to engineer a break between natural steps in the process, to allow an interruption to occur with less cognitive disruption.

3) Am I worried about being unhelpful or rude?

This is a very reasonable concern and one we are still aiming to overcome after years of poor performance in this area. The problem as I see it is that we don’t want someone facing an emergency to feel unable to interrupt us, nor do we want someone who requires help to feel that we are unapproachable and yet we need people to interrupt us less! Well, how about trying this?

‘Excuse me, could I just ask??’

‘Hi, yes. Sorry, could I just check, is it an emergency that you need me to help with?’

‘No’

‘Okay, that’s good. Can you just let me finish this and then I’ll be happy to help, okay?’

An alternative last line might also be…

‘Okay, that’s good. I’m going to be busy with this for the next 20 minutes, is there someone else who you could go to for help/could you try asking Dr Smith? If you don’t find anyone else though, it’s important that you do come back to me.’

I think that exchange, including the alternate final lines, deals with the concern about being rude or unhelpful. Emergencies are recognised as a priority, the need for help is acknowledged whilst being temporarily deferred or signposted and the language is polite and respectful. Would you find it rude or unhelpful to get that response?

4) Could I educate colleagues about interruptions?

A badge I started wearing on the back of my lanyard at work. Perhaps we should have something similar printed on the back of all ED scrubs?

The final thing I believe that we could do is to try and educate those who interrupt us. Why should we expect people to behave differently if nobody takes the time to explain to them that their behaviour could be problematic? Now, again it is important how this is done! I firmly believe that people are more likely to alter their behaviour if they understand why they should change rather than just what they should change. For instance…

 

‘Excuse me, could I just ask??’

‘Hi, yes. Sorry, could I just check, is it an emergency that you need me to help with?’

‘No’

‘Okay, that’s good. Can you just let me finish this, please because I’m concentrating and I don’t want to make a mistake. When I’m done I’ll be happy to help, okay?’

Adding in why we wish the person to wait helps educate them to the problem of interruptions and will help them understand why others might wish to behave in the same way. Not only that, we are once again modelling good behaviour and it gives other staff permission to defer interruptions in a similarly appropriate way.

 

I appreciate that not everyone will agree with my thoughts on this subject but I honestly believe that if we all just took a moment to consider whether we REALLY needed to interrupt someone else, it would make our workplace better for everyone.

 

Simon

 

1. Ratwani, R. M., Fong, A., Puthumana, J. S. and Hettinger, A. Z. (2017) ‘Emergency Physician Use of Cognitive Strategies to Manage Interruptions’, Annals of Emergency Medicine. Elsevier, 70(5), pp. 683–687. doi: 10.1016/j.annemergmed.2017.04.036.