Reminders Through Association

Improving On-Time First Case Starts: An Integrative Review and Quality Improvement Project Plan

PURPOSE

Surgeon late arrival is the major cause of delays in first case starts. The estimated cost of these delays can reach $800,000 a year. The purpose of this integrative review and proposed quality improvement (QI) project plan was to increase the first case on-time starts through surgeon behavior modification.

DESIGN

An integrative literature review and creation of a QI project plan.

METHODS

The literature review included an independent electronic literature search between the years of 2011 and 2020 through CINAHL PLUS, PubMed, and Medline OVID databases. The search was limited to scholarly peer-reviewed journal articles in the English language, and search terms included: "operating rooms," "delay first cases start," "first case tardiness," and "operating room efficiency." The QI project plan was a three-phase process based on surgeon behavioral modification using educational material, visual reminders, and individualized e-mail notifications of habitually late surgeons.

FINDINGS

A synthesis of articles reported proper site marking and surgical consent 15 to 30 minutes before surgery increased first case on-time starts from 55.90% to 66.60% and a mean delay decrease of 9.67 minutes to 7.17 minutes. Visual cues significantly enhanced memory, 64% versus 50%, and e-mail reminders increased compliance, 77% to 86.1%.

CONCLUSION

As the need for hospital revenue dependency grows, so will the need for more efficient operating rooms. The evidence shows a positive correlation between early arrival by surgeons to the preoperative area and increased on-time first case starts.

Poison Parasite Counter: Turning Duplicitous Mass Communications Into Self-Negating Memory-Retrieval Cues

Disinformation in politics, advertising, and mass communications has proliferated in recent years. Few counterargumentation strategies have proven effective at undermining a deceptive message over time. This article introduces the Poison Parasite Counter (PPC), a cognitive-science-based strategy for durably countering deceptive communications. The PPC involves inserting a strong (poisonous) counter-message, just once, into a close replica of a deceptive rival's original communication. In parasitic fashion, the original communication then "hosts" the counter-message, which is recalled on each reexposure to the original communication. The strategy harnesses associative memory to turn the original communication into a retrieval cue for a negating counter-message. Seven experiments (N = 3,679 adults) show that the PPC lastingly undermines a duplicitous rival's original communication, influencing judgments of communicator honesty and favorability as well as real political donations.

Resisting, Recognizing, and Returning: A Three-Component Model and Review of Persistence in Episodic Goals

According to prior work, persistent goal pursuit is a continuous process where persisting is a matter of resisting the urge to give up. In everyday goals, however, persistence is often episodic, and its causes are more complex. People pause and resume pursuit many times. Whether people persist reflects more than will power and motivation, it also reflects the other goals they pursue, their resources, and the attentional demands of daily life. People can fail to persist not just because they gave up, but also because they failed to act. We propose a general model of persistence that accommodates the complexity of episodic goals. We argue that persistent goal pursuit is a function of three processes: resisting the urge to give up, recognizing opportunities for pursuit, and returning to pursuit. The broad factors that help and hurt persistence can be organized within these components. These components can also explain the mechanisms of four effective strategies for persistence: removing distractions, using reminders, using implementation intentions, and forming habits. The recognizing-resisting-returning model integrates and improves on extant theories of persistence and goal pursuit and is consistent with empirical work from laboratory and naturalistic settings.

A Dieting Facilitator on the Fridge Door: Can Dieters Deliberately Apply Environmental Dieting Cues to Lose Weight?

Individuals exposed to dieting-related environmental cues have been repeatedly shown to be better able to resist tempting food. This especially applies to restrained eaters who hold a chronic dieting goal. Thus far, mainly short-term effects of environmental dieting cues have been examined and the individuals were typically unaware of being influenced. Yet, it is unclear whether individuals can deliberately apply environmental dieting cues for themselves to facilitate the pursuit of the longer-term goal of losing weight. The present longitudinal study applied a 2 (cue: visually dieting-related vs. visually neutral cue) × 2 (awareness: being aware vs. not being aware of the cue’s facilitating influence) between-subjects design for 6 months (N = 166 participants who started the study; M_age = 47.85 years; 69.9% female; M_BMI = 29.07 kg/m²). Our results provide preliminary indications that cue, awareness, and restrained eating interact. The results suggest that high (vs. low) restrained eaters could deliberately apply environmental dieting cues for themselves to facilitate losing weight. However, further studies are needed to explore the effects of environmental dieting cues over a longer period of time.

Behavior Change

Despite rapid growth in the empirical research on behavior change, modern science has yet to produce a coherent set of recommendations for individuals and organizations eager to align everyday actions with enduringly valued goals. We propose the process model of behavior change as a parsimonious framework for organizing strategies according to where they have their primary impact in the generation of behavioral impulses. To begin, individuals exist in objective situations, only certain features of which attract attention, which in turn lead to subjective appraisals, then finally give rise to response tendencies. Unhealthy habits develop when conflicting impulses are consistently resolved in favor of momentary temptations instead of valued goals. To change behavior for the better, we can strategically modify objective situations, where we pay attention, how we construct appraisals, and how we enact responses. Crucially, behavior change strategies can be initiated either by the individual (i.e., self-control) or by others (e.g., a benevolent employer).

Varieties of graded forgetting

Forgetting is typically viewed as counterproductive in everyday life. However, it may mainly be harmful when it is complete, that is, all-encompassing and permanent, and not when it is graded, that is, partial and fluctuating. I propose that forgetting is in fact mostly graded, and that this is an essential reason that it is often helpful. I delineate three ways in which forgetting may be graded. First, it may occur with respect to one, but not another, part of a memory. Second, it may occur in one context, but not in another. Third, forgetting may be present at one point in time, but not at another. Also, I propose that different levels of forgetting are possible, based on whether an engram or a context is unavailable, silent, restricted, latent, or potent. Overall, I hypothesize that forgetting is often helpful because it can be flexible and tailored to the circumstances.

When Do Intended Performance Standards Predict Goal-Related Affect? A Motivated-Reasoning Perspective

This research used intensive longitudinal methods to examine a motivated cognition perspective on intention–behavior discrepancies. We propose that under conditions of high performance, people are more inclined to evaluate their efforts in light of their intentions; thus, discrepancies between intentions and performance should have stronger impacts on goal-related affect under conditions of high (vs. low) performance. Secondary data analyses were conducted on two daily-diary studies in which participants reported their exercise, goal-related affect, and next-day intentions across 14 days. Under conditions of low performance, people felt negative about their performance irrespective of whether they typically set low versus high intentions. On days with high performance, average intentions significantly related to affect, such that those with low average intentions experienced the greatest satisfaction. Additionally, we observed that average (between-person) affect, but not within-person fluctuations in affect, predicted daily levels of exercise behavior. Implications for self-regulatory theories of affect are discussed.

Default neglect in attempts at social influence

Current theories suggest that people understand how to exploit common biases to influence others. However, these predictions have received little empirical attention. We consider a widely studied bias with special policy relevance: the default effect, which is the tendency to choose whichever option is the status quo. We asked participants (including managers, law/business/medical students, and US adults) to nudge others toward selecting a target option by choosing whether to present that target option as the default. In contrast to theoretical predictions, we find that people often fail to understand and/or use defaults to influence others, i.e., they show "default neglect." First, in one-shot default-setting games, we find that only 50.8% of participants set the target option as the default across 11 samples (n = 2,844), consistent with people not systematically using defaults at all. Second, when participants have multiple opportunities for experience and feedback, they still do not systematically use defaults. Third, we investigate beliefs related to the default effect. People seem to anticipate some mechanisms that drive default effects, yet most people do not believe in the default effect on average, even in cases where they do use defaults. We discuss implications of default neglect for decision making, social influence, and evidence-based policy.

Academic Procrastination and Goal Accomplishment: A Combined Experimental and Individual Differences Investigation

This study examined the relationship between academic procrastination and goal accomplishment in two novel ways. First, we experimentally tested whether undergraduate students (N = 177) could reduce their academic procrastination over a course of three weeks after performing goal-related exercises to set so-called SMART goals and/or to prepare those students with specific strategies to resist their temptations (forming implementation intentions). Second, we conducted systematic regression analyses to examine whether academic procrastination at baseline uniquely predicts later goal-related outcomes, controlling for various correlated variables, including personality traits (e.g., impulsivity), motivational factors (e.g., motivation for the generated goals), and situational factors (e.g., memory for the goals). Results indicated that neither the SMART-goal nor implementation-intention intervention significantly reduced academic procrastination in the three-week interval, even when relevant moderating variables were examined. Initial levels of academic procrastination, however, were predictive of the success of accomplishing the goals generated during the initial exercises, above and beyond a wide range of other candidate correlates. These results provided new correlational evidence for the association between academic procrastination and goal accomplishment, but suggest a need for further research to understand what interventions are effective at reducing academic procrastination.