Timing isn’t the main thing, it’s EVERYTHING!

Timing isn’t the main thing, it’s everything.

Daniel Pink’s new book, When: The Scientific Secrets of Perfect Timing, presents a wealth of new data demonstrating how timing affects healthcare delivery. We do not realize how our biological clocks determine the outcomes of our actions. Seconds, hours and weeks are human inventions- fences our ancestors built to corral time. When should be make important decisions? Morning or in the afternoon?

The earliest recording of time rhythms occurred when a prominent French astronomer noticed how a mimosa plant in his window opened its leaves at night. He followed his curiosity about such behavior by placing his plant in total darkness over several days, and to his amazement sunlight had no effect on the plant behavior. From that simple experiment, an entirely new science of biological rhythms bloomed.

For us humans, there is a tiny group of cells in the hypothalamus which control our built-in clock. It governs the rise and fall of body temperature, regulates our hormones, helps us to fall asleep at night and to wake up in the morning. In an analogy, we are like the plant, we open and close at regular times each day.

Our moods and emotions are an interval state between waking and sleeping, but they affect us and others externally. Try as we may to conceal our moods and emotions, they leak and others respond to them.

One measure of the world’s emotional state can be achieved by studying messages posted on Twitter. There are one billion people with accounts posting 6,000 tweets per second. Studies done at Cornell University show people use more positive words in the in the AM regardless of race or ethnicity. Across the globe “tweeters” were more positive in the morning. On weekends, they start later but still, the patterns held true.

Scientists began measuring the effect of time of day on brainpower more than a century ago. The research led to three key conclusions: 1. Cognitive abilities do not remain static over the course of the day. 2. The daily fluctuations are more extreme than we realize.   In other words most of us “peak” in the mornings.  Performance between the daily high point and daily low point can be equivalent to the effect of drinking the legal limit of alcohol. 3. How we do depends on the task we are performing. The best time to perform a task depends on the type of task.

Early in the day our minds are more vigilant. We are better at keeping distractions out of our thinking. Vigilance does have its limits. We tire as we stand for long periods of time without a break, and our powers of analyzing diminish.

But all brain-work is not the same. Many people have what we call “flashes of insight” where a systematic, step by step process doesn’t work but instead of frustration at not solving a problem, other thinking takes place which sees the answer.

We all have a personal circadian rhythm influencing our physiology and psychology called a “chronotype”.   Chronotypes are different giving us “night owls” and “early birds”. About 60 percent of us fall somewhere in the middle.

What does this mean for your life? The importance of chronotype is the pattern of your life. Are you a “night owl” or an “early bird”? You perform your best when you are in sync with your chronotype. You should put your most important work into the peak and push your second- most important work into the rebound period.

If we apply this to healthcare timing, we can find many anomalies.  For example, afternoons are the Bermuda Triangle of our day in healthcare.  Chances of a misadministration of anesthesia drugs at 9 AM is about one percent and at 4 pm it increases to 4 percent, indicating decreasing vigilance.  Research demonstrates that in colonoscopies fewer polyps use are found as the day progresses. Doctors are more likely to prescribe antibiotics for acute respiratory infections in the PM than they do in the AM.

A 2015 Study on hand-washing found out of 4,000 caregivers, the afternoon and evening shifts were less likely to be diligent in their hand washing. This lack of vigilance can be attributed to the peaks and troughs of the day, but it can be interrupted. A system of more frequent and intentional breaks with integrated tools such as checklists, poster boards, whiteboards, or paper forms can be successful in improving performance. In surgical suites, the “time out” before anesthesia is administered, and another “time out” before the surgeon begins is very effective in reducing errors. A paper form accompanying a patient transported from hospital room to treatment site is another example of an effective deterrent to lack of vigilance.

These facts spread across the range of activities of education, safety, and healthcare. In high-stress occupations like healthcare, social and collective rest breaks not only minimize physical strain and cut down on medical errors, they also reduce turnover and retain staff.

At the end of the day, timing is merely a function of finding the right balance between your natural peaks and troughs and planning your work and play accordingly. Recognition of your chronotype assists in planning your tasks.  Incorporating your peaks into your daily tasks increases the success rate.  Remember, timing isn’t the main thing, it’s everything.


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