What happens at the end of an event can disproportionately impact our perception and memory of it. In this episode, we investigate the research behind the peak end pattern and how you can use this phenomenon to improve your own experience at work (and in life).
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Research identifying a peculiar aspect of how memories and impressions are formed;
- Daniel Kahneman et al. conducted several studies identifying the “peak end pattern” where what happens at the end of an event can disproportionately impact our perception and memory of it.
- The hand in cold water study
- Study participants went through two unpleasant events involving cold water. In one, they put a hand in cold water for a minute. In the second event, they kept their hand in the same temperature water for a minute and then kept it in for 30 additional seconds with the water warmed by 1℃.
- Given the choice of which of the two events to repeat, two thirds of the participants chose the longer submersion, even though they were extending their exposure in what most would consider to be very cold water.
- What can account for this?
- Those who reported a larger decrease in discomfort when the water was made warmer chose to go again for the full 90 seconds.
- Those who didn’t notice much of a difference chose the shorter submersion.
- Most of the subjects said that the longer trial felt better, even though they had just as long a duration of unpleasantness as the shorter submersion.
- Bottom line: a peak end gave the impression of a better experience.
- The colonoscopy studies (1, 2)
- Those who had less discomfort at the end of colonoscopy reported a better experience (regardless of duration of scope in colon) and were more likely to return for 5 year follow up.
“Overall memory is created by recalling selected moments rather than an exact running total of experience. The duration of an episode has relatively small influence unless it’s highly salient or correlated with intensity.” Donald Redelmeier, MD
The peak end phenomenon is often portrayed as a bug in our operating system, but it can also be used as a feature;
- One of our coaching clients uses peak end during emergency department shifts.
- His intent going to work is to make sure his coworkers are supported and feel supported
- Some of that comes through facilitating a peak end for them, thanking them for coming in for doing the hard work, and doing what he can to make sure that they get out on time.
- He is a champion of the peak end, making the last 15% of a shift as positive as possible.
- He’s deliberate about it with his team, giving a roadmap for what the peak end time will look like. And, he starts with an early shift huddle.
- “This is the peak end plan. Let’s make it our best quality work an hour before our shift ends, let’s begin tidying up. Get the dispos done, loose ends taken care of. Any new patient that comes in 30 minutes before the end of shift, put down some orders, get things rolling, but leave it to the next team to assume care (unless it’s a critical patient, then all hands on deck)”
“Our life is what our thoughts make it.” Marcus Aurelius
Michael Jordan was a master of finishing time;
- He excelled in all areas of the game and especially finishing time, the end moments when you’re tired and depleted. A little focus and extra effort here can be a force multiplier.
Always bring your A game and in the closing minutes, bring your A+ game.
Focusing on a peak end can not only lead to a better memory of events, but possibly better patient care;
- At the end of the day, you’re often depleted and running on fumes. This doesn’t serve anyone well. Decisions at the end of the day aren’t any less complex than at the beginning.
- Build structure into the end of a shift/work day to account for this.
- Intentional self care needs to play a role. As you enter the finishing time, eat, hydrate, and set boundaries for finishing strong.
- The longer you stay, the longer you stay. More things are gonna be asked of you as you are still in the department and your presence is present. Each action begets more follow up actions.
Is there evidence that focusing on the peak end will improve job satisfaction and lessen burnout?
- There is not.
- Yet many docs find that protracted endings of the work day are a consistent negative.
There are two types of peak endings;
- Personal – what you do for yourself to end the day well.
- Collective – what you and your team do to make that last 15% shine.
“We collectively lionize martyrdom for the sake of patient care.”
Photo by Jordan Heinrichs on Unsplash
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