Trust your gut instincts ... or not!

IN THIS ARTICLE ...

Discover two opposing views of whether smart business exceutives should trust their intuitions or ignore their gut feelings.

Many of my clinical colleagues in medicine believe that since I went into management I've gone to the "dark side." In fact, I found that both fields can learn a tremendous amount from each other.

The recent phenomena in business of learning and focusing on systems thinking, complex science or chaos theory are all familiar concepts within medicine. Not surprisingly, the business world has been able to adapt some of the thinking from the field of science and biology to management practice.

At the same time there is much that physicians can learn from management theory and practice. Many concepts can be applied to how we interact with our patients, the populations we care for and, of course, how to operate the business of medicine.

No matter what level you're working at--as a solo practitioner or as the CEO of a integrated health system with thousands of employees and hundreds of stakeholders--the business side of your life takes specialized knowledge and understanding.

One concept that plays a major role in both disciplines is intuition.

The role of intuition

Most of us think we know what intuition is. At the same time, it's still not perfectly understood if we are born with it or learn it. People generally agree that intuition refers to the brain's process of interpreting and reaching conclusions about phenomena without resorting to conscious thought.

In 1977, the Boston Consulting Groups wrote "intuition is the subconscious integration of all experiences, conditioning, and knowledge of a lifetime including the cultural and emotional biases of that lifetime."

The debate currently raging in the business sector (and, you could argue, in the clinical world) is whether you should trust your intuition in making decisions or ignore it because of its lack of critical analysis.

The debate can best be studied through two recent authors taking opposing views about it. Gary Klein, in his recent book, Why Developing Your Gut Instincts Will Make You Better at What You Do (1), and Eric Bonabeau in his recent article, "Don't Trust Your Gut." (2)

Klein takes the view that intuition is extremely important and essential in decision making. He uses multiple examples of firefighters, intensive care nurses, marines and leaders who use their intuition to come to decisions in a rapid rammer because of their intuition skills.

We've all had "gut feelings" when faced with making choices at work. For example, you may have evaluated a job candidate when your gut told you "something" seemed wrong. Because there is no way to quantify, these hunches you dismissed them as untrustworthy, only to discover later that your intuition was right all along.

Klein demystifies the role intuition plays in the workplace and gives us permission to trust our instincts. He shows that intuition, far from being an innate "sixth sense," is an essential and learnable skill that anyone can use to improve job performance.

Klein concludes that 90 percent of all critical decisions are based on intuition. We use it all the time. It's a subconscious process that infiltrates just about every aspect of our work lives. It is as important a tool in making a decision as interpreting numbers or analyzing data.

Intuition and experience

Though it's difficult to explain where it comes from, it's based on our ability to recognize patterns and interpret cues. In addition, according to Klein, intuition can develop as we gain experience in our fields.

Klein makes a particular case for the widespread use of intuition in nursing and other clinical work. He relays how experienced neonatal intensive care nurses are able to observe and see patterns in preemies regarding their health status well before inexperienced nurses who depend on data.

When Klein studied firefighters, he noted that they don't make conscious decisions as they approach a major fire. On the contrary, the firefighters felt that they were "just acting." They did not make systematic comparisons of decisions, but acted on their intuition. The firefighters don't sit and analyze different scenarios and weigh the pros and cons. Rather, they see patterns and make decisions based on their experience.

The fact that firefighters under pressure act on intuition shouldn't surprise us. Most people would never get through the day if they had to analyze every decision before they made it, and certainly not within a highly stressful and fast-moving environment like firefighting--or caring for patients.

Intuition is an essential, powerful and practical tool. Flawed though it is sometimes, we could not survive, much less excel, without it.

Klein also discovered that the more experience people have in any particular field, the more they rely on intuition, because intuition is a natural and direct outgrowth of experience. He defines intuition as "the way we translate our experience into action." In other words, our experience lets us recognize what is going on and make decisions.

Klein asserts that there is a role for both intuition and analysis. But he also adds that the classic model of decision making (which seems appealing and reassuring) may be unsound in many situations.

The reality is, Klein states, the classic model of weighing options versus criteria doesn't work very well in practice. It works tolerably well in the research lab but not so well in the real world, where decisions are more challenging, situations more confusing and complex, information scarce or inconclusive, time is short, and stakes are high. Most real-life decisions are simply not amenable to classic, analytical decision making.

Patterns of clues

What is it that sets off alarm bells inside your head?

It is your intuition. It is built up through repeated experiences you've unconsciously linked together to form a pattern, Klein says. The pattern is a set of cues that gather together so that if you see a few of the cues you can expect to find the others. Working in any discipline, we eventually accumulate a reservoir of recognized patterns.

Experienced managers often make the mistake of assuming that their subordinates see the same patterns that are so obvious to them. (Remember being a med student and being amazed at the clinical skills of your attendings?)

Once we recognize a pattern, we gain a sense of a situation. We know what cues are going to be important and needed to be monitored. We have a sense of what to expect next. Most importantly, Klein asserts, the patterns include routines for responding, which he calls action scripts.

According to Klein, when we are faced with a familiar problem there is a good chance that the first solution we recognize is going to work, Why? Because in most settings we don't need the best option.

Instead, we need to quickly identify an acceptable option. Of course, there may be a better option, but if it takes hours to find and evaluate, then there is no practical benefit from searching for an optimal course of action. As the old saying goes, "Better is the enemy of good enough."

When we look closely at decision making, we discover that we actually evaluate a course of action by consciously imagining what would happen when it's carried out. Klein calls this process "mental simulation" because decision makers are simulating and envisioning the scenario playing out in their heads--the scenario of what they expect would happen if they implemented a particular decision.

In a recent article, Sutcliffe and Weber (3) also believe that too much dependence on looking for "more-and-more accurate data" actually can decrease performance for leaders.

"The task of leaders is to manage ambiguity and to mobilize action, not to store highly accurate knowledge about their environment. The more effective way to improve the performance of a company is to invest in how leaders shape these interpretive outlooks (intuition)."

Intuition 'fickle and undependable'

Bonabeau takes the opposite view. He explains why intuition won't work, especially the more complex a situation becomes. He believes we are deluded to think that if we are detached from rigorous analysis, intuition will be good enough. He calls intuition "a fickle and undependable guide."

It is as likely to lead to disaster, Bonabeau states, as to the successes great leaders talk about when they tell you they "went with their gut feeling." He asserts that as the complexity and rapidity of change in an environment increases intuition will actually fail more often then not.

Bonabeau believes that a lot of us want to accept the transformative power of intuition as if it were magical. According to him, we want to believe in intuition but it unfortunately blinds us to the less romantic realities of business decision making.

For every great example of a great "gut decision," Bonabeau says, there is an equal and opposite example of a terrible one.

Bonabeau refers to research studies of cognition that show a person's thinking is subject to all sorts of biases and flaws, most of which operate at a subconscious level (that is, at the level of intuition).

In fact, Bonabeau states, we naturally give more weight to information that confirms our assumptions and prejudices. How often has a physician felt a differential diagnosis led to one conclusion, and then tried to make sure that subsequent information and data fit that diagnosis? You give more credence to the data that fits your diagnosis and dismiss the data that doesn't.

We are also creatures of the status quo, drawn to conclusions that justify and perpetuate current conditions and repelled by anything that would upset the kettle. Bonabeau also points out that we are irrationally influenced by the first information we see on a particular subject. This "anchoring effect" is seen quite often clinically and in business. I've seen this many times when the story you hear first becomes the basis of all other reactions to it.

In fact, Bonabeau believes that one of the greatest flaws of our intuition is that it is deep-seated; that is, we have a basic need to see patterns. Interestingly, of course, Klein's work confirms this quality as well. Both he and Bonabeau believe it is the ability to see patterns that allows our intuition to work.

The question is, does intuition help us or does it hurt us?

Bonabeau cites research that shows our unconscious desire to identify patterns is so strong that we routinely perceive them where they don't, in fact, exist. If you try to interpret a competitive threat or market upheaval by simply squeezing it into an old pattern, you're likely to miss what makes it different and take the wrong action. As physicians know, this scenario occurs clinically as well as in the business world.

Intuition, is not a means of assessing complexity, but actually may be one of ignoring it. Bonabeau believes that the more complex a situation, the more misleading intuition becomes.

In a truly chaotic environment, cause and effect no longer have a linear relationship and the last thing you want to do is apply patterns to it. The essence of such an environment is the lack of any discernible pattern in its evolution. Indeed, the human drive to find patterns is so strong that they are often read into perfectly random data.

Modeling and evolution

If we can't depend on our intuition for complex situations, what are we then to do? Bonabeau talks about two potential technologies that are arising: agent-based modeling and artificial evolution.

More and more, technology is allowing us to feed scenarios into a software program, which then searches the data to determine the best processes. The software's ability to analyze a myriad of interactions is much greater than the human mind's. Both artificial and interactive evolution is about the optimization of processes.

This software technology will allow open-end searches, focusing the initial search on options rather than their subsequent evaluation.

New decision support systems don't eliminate human intuition, Bonabeau asserts, they harness its power while remedying its most pernicious flaws. In fact, he believes computers will impose a left-brain discipline on right-brain hunches in a way that is well beyond the computational capacity of the human mind.

He feels that intuition continues to play a key role in this scenario, allowing us to make informed decisions without short-circuiting or otherwise constraining its power. The combination may expand our creative potential. In fact, it may offer the true fulfillment of the promise of human intuition.

Pediatric surgeon and safety guru Lucian Leape also believes that the individualized, intuitive approach at the center of modern medicine is flawed, causing more mistakes than it prevents. A blind algorithm approach or clinical pathway/guideline usually trumps hunch judgment in making predictions and diagnoses.

What can medicine learn from the business world's take on the role of intuition? Well, intuition in clinical situations does come in handy. Physicians use it all the time to pick up patterns of symptoms, to get a lead to the right conclusion without having to look through thousands of bits of data.

At the same time, we need to accept that the more complex the situation, the less we can depend on intuition. Rather, we should seek out and better utilize emerging technology and other systems that help us evaluate complicated situations more effectively. This is true for the patient with multi system organ failure as well as complex business systems.

References:

(1.) Klein G. Why Developing Your Gut Instincts Will Make You Better at What You Do, New York, Currency Books, Doubleday, 2003.

(2.) Bonabeau E. "Don't Trust Your Gut." Harvard Business Review. May 2003, pg.116-123.

(3.) Sutcliffe KM, Weber K. "The High Cost of Accurate Knowledge." Harvard Business Review. May 2003, 75-82.

Phillip M. Kibort, MD, MBA is vice president medical affairs and chief medical officer at Children's Hospitals and Clinics in St. Paul Minn. He can be reached by phone at 651-220-6165 or by e-mail [e-mail]. Kibort also thanks Audrey Anderson for editing this article, and Teri Leonard for her transcription.