Health Care Leadership, Cognitive Biases, and Decision Making — Study Notes

Overview and classroom logistics

• Instructor emphasizes fairness: after noticing error on quiz, credited all students for question 5 and added a partial credit adjustment (half a point) for those marked wrong, to avoid unnecessary conflict. Next class plan: review on Tuesday.
• Chapters five and six are short; plan to cover them quickly next week. Discussion will include an article from a health care publication rather than a case study from the textbook.
• Announcement: ACHE (American College of Health Care Executives) information shared via email; focus on professional development opportunities.

American College of Health Care Executives (ACHE): structure and relevance

• ACHE is a national professional society for health care leaders committed to improving health.
• National site: ache.org. Do not mispronounce as "ache"; reflects common mispronunciations.
• New Jersey chapter site: acheNJ.com (referred to as ache nj in class).
• Vision and purpose: threefold mission to advance health care with integrity and lifelong learning; maintains diversity and inclusion materials and free perspectives in its learning center.
• Career development opportunities: on-demand courses, webinars, and credits; some offerings are significant in price; example given: a holistic health care fundamentals bundle priced around $450$ for non-members, delivering a broad perspective on topics like successful organizations and building trust.
• Example topics in ACHE materials: successful organizations, how community health improves outcomes, strategies for building trust, optimizing care, and other related topics aligning with material in this course.
• Membership options: student membership offered at a discount (New Jersey chapter mentions a student membership at $75$). Professionals pay higher dues.
• Networking and mentorship: ACHE runs a mentoring program pairing students with health care leaders for about ten weeks; nationally about 50–75 students matched with 50–75 leaders.
• Organizational impact: ACHE hosts fall congresses with panels including C-suite executives; opportunities to earn in-person education credits (e.g., around $4.5$ credits) and to network with hospital leaders.
• Saint Peter’s affiliation: Saint Peter’s approved to be part of ACHE’s Higher Education Network, enabling access to special services and information through ACHE.
• NJ chapter events: fall congress planned for October at Rutgers (date given as Oct 8) with three main topics: risk issues in daily roles, quintuple aim, and using social media to build consumer trust.
• Career pathways: ACHE provides resources for students in non-healthcare majors (e.g., English, political science, etc.) who aspire to leadership roles in health care; emphasizes cross-disciplinary opportunities (press releases, governance, policy, etc.).

Quintuple Aim in health care

• Quintuple aim refers to five pillars of health care improvement:
  • $ext{Patient experience}$
  • $ext{Population health}$
  • $ext{Lower costs}$
  • $ext{Health equity}$
  • $ext{Provider well-being}$
• The course will read about the quintuple aim and connect it to class readings and discussions.

Fall congress details and topics

• Date/location: Rutgers campus, October 8, 10:00–16:00 (10am–4pm).
• Topics/panels include:
  • Risk issues faced in daily roles in health care.
  • Quintuple aim and its application in health care leadership.
  • Using social media to build consumer trust and engagement.
• Credentials: members can earn 4.5 in-person education credits; continuing education for credential maintenance.
• Sponsors for New Jersey chapter events include major hospitals, indicating strong industry engagement.
• Guest speakers: Andrew (past president of the New Jersey chapter) will participate in the panel; opportunity to meet CEOs and other leaders.

Career and membership logistics for students

• ACHE has a New Jersey student membership option at $75$ (discounted) versus professional rates.
• Saint Peter’s College is part of the Higher Education Network, enabling access to national materials and events.
• Events include webinars that are free for members or non-members, offering broader access to topics like chronic pain and job search strategies.
• The fall congress and related events provide a hands-on way for students to earn credits and engage with health care leadership.

The four key roles of health care managers (in this course context)

• Information provision: managers supply and verify information;
• Information distribution: ensure the right information reaches the right people;
• Decision making: invest or not invest; prioritize resources;
• Interpersonal/interorganizational role: manage relationships and symbolize leadership; build external alliances.
• The speaker emphasizes that these roles are not purely theoretical; they are practiced in real-world healthcare settings (including planning events like the ACHE congress).

Foundations of thinking and cognitive biases (central theme of the session)

• The instructor asks students to reflect on how thinking happens, particularly on unconscious processes and biases that shape perception and decision making.
• Core idea: people exhibit unconscious shortcuts and heuristics, which can distort judgments and lead to error if not checked.

A core demonstration: unconscious perception and bias in everyday life

• Barry Schwartz exercise: students were asked to describe an unnamed person after hearing the name; typical first impressions included gender, occupation, and ethnicity based on name alone; prompts like short, male/female, etc. reveal automatic biases and social stereotypes.
• The point: even with no knowledge of a person, people form quick judgments based on names, appearances, and social cues.
• This illustrates social cognition: our brains use rapid, automatic processing that can mislead us about people’s abilities and roles (e.g., assuming a person named Barry Schwartz is male and an accountant without evidence).

Examples illustrating unconscious biases and social cognition

• Diana the firefighter example: preconceived notions about a small woman’s ability to be a firefighter illustrate how social cognition shapes initial judgments; later reveals that Diana can perform tasks that defy stereotypes.
• Age and ability video (millennials vs. older adults): younger participants warehoused as tech-savvy; older participants perceived as less capable; later experiments show teaching between generations can alter perceived capabilities.
• Population aging: by 2040, the population 60 or older is projected to exceed 2,000,000,000; raises implications for health care demand and workforce planning; the instructor uses this to emphasize that perceptions about age and capability can be biased against older adults who remain capable and active thinkers and workers.
• The Hudson Miracle (Miracle on the Hudson) example: a pilot faced with an extreme decision in a time-critical scenario; the conventional expectation would be to return to an airport (think slow/analytic), but he chose an unconventional option to land on the Hudson to save lives; demonstrates the necessity of balancing fast and slow thinking and sometimes breaking conventional constraints under pressure.

Mental models, biases, and stereotypes

• Mental models (automatic shortcuts) help interpret information but can produce distortions if left unchecked.
• Common patterns include:
  • Halo effect: assuming someone from a prestigious institution (e.g., Harvard) is brilliant, even if not universally true.
  • Stereotypes: broad generalizations about groups (e.g., “Latinas dance well” as a stereotype) that may not apply to individuals.
  • Confirmation bias: seeking information that confirms preconceptions and ignoring evidence to the contrary.
  • Implicit biases: biases that operate unconsciously and influence judgments of people based on appearance, name, accent, or other cues.
• Social-emotional intelligence: the ability to perceive, understand, and manage emotions—both one's own and others'—to navigate social interactions effectively.

Preconceptions, dress codes, and impression formation in professional settings

• Dress and appearance: “overdressed is better than underdressed” in many interview contexts; implicit biases about attire can affect perceived competence.
• Example: the perception that a person’s role or capability is tied to their title (e.g., calling a non-doctor a ‘doctor’ in correspondence) reflects social roles and status bias; the speaker emphasizes treating peers as equals regardless of formal titles.
• Implicit evaluation in interview settings: interviewers may project traits onto candidates based on non-performance cues; suggesting the need to recognize and manage biases in hiring and mentoring.

Heuristics and their role in decision making

• Heuristic definition: shortcuts or rules of thumb that reduce cognitive load in decision making.
• Not all heuristics are negative, but they can lead to systematic errors and misjudgments if not checked.
• Examples discussed:
  • Fitting a candidate to a familiar institution (e.g., Saint Peter’s) as justification for hiring, while forgetting to consider the full pool of potential candidates.
  • Halo effect: assuming excellence from a prestigious background, without evidence of current capability.
  • Stereotypes and their impact on decisions in health care leadership and policy.

The four-step model of thinking (as described in the course material)

• Step 1: Notice, acquire, and call up the right information (attentiveness and perceptiveness).
• Step 2: Organize information (categorization and structuring).
• Step 3: Decide (evaluate options, identify the problem, and ask clarifying questions).
• Step 4: Act (implement the chosen option and reflect on results).
• The model emphasizes the need to be deliberate and to override automatic biases when necessary.

Think fast vs think slow; System 1 and System 2 (as discussed in class context)

• Think fast: automatic, fast, low-effort thinking; used in time-critical or habitual situations (e.g., driving, emergency evacuations).
• Think slow: deliberate, effortful, analytical thinking; used when evaluating complex problems or seeking to avoid bias.
• The instructor argues for a balanced approach: practice deliberate thinking (System 2) while also developing the ability to react quickly when necessary; avoid knee-jerk reactions that lead to errors.

How to apply these concepts in real-world health care leadership

• Recognize that biases and heuristics shape perceptions of patients, colleagues, and policies.
• Use empathy and perspective-taking to mitigate biases and understand others’ positions (empathy, compassion, and perspective-taking are encouraged).
• Practice the four-step thinking process and deliberately slow down when evaluating high-stakes decisions (e.g., staffing, budget, patient safety, and ethics).
• Consider the quintuple aim when evaluating programs and policies to ensure alignment with broader goals beyond cost reductions.
• Use data and diverse perspectives to validate assumptions (e.g., not all people in a group share the same traits, capabilities, or beliefs).

Ethical and practical implications discussed

• Equality and inclusion: avoid making sweeping generalizations about groups; challenge stereotypes and halo effects in hiring, promotion, and leadership.
• Equity and access: address disparities in health outcomes and access to care; emphasize the importance of health equity as part of the quintuple aim.
• Professional integrity: maintain humility about the limits of one’s knowledge; seek mentorship and cross-disciplinary collaboration (ACHE and Higher Education Network as channels).
• Responsibility of leaders: use information responsibly, avoid mislabeling or mischaracterizing individuals, and balance efficiency with compassion in management decisions.

Quick recap of key numbers and dates

• Student ACHE membership in New Jersey: $75$ (discounted for students).
• On-demand health care fundamentals bundle: up to $450$ (member vs non-member pricing may vary).
• Fall congress date: $October ext{ }8$ (Rutgers campus) with a schedule spanning approximately $10:00-16:00$ and potential for $4.5$ in-person credits.
• ACHE national presence: around ninety years in existence (as stated in the lecture).
• Mentorship program: about $50-75$ students paired with $50-75$ health care leaders over roughly ten weeks.
• Health care workforce projection: by 2040, the population 60 or older is projected to exceed $2.0 imes 10^9$ people.

Connections to prior concepts and real-world relevance

• The session ties cognitive psychology concepts (bias, heuristics, social cognition) to health care leadership and decision making, underscoring how systematic errors can affect patient care, policy, and organizational performance.
• Real-world examples (Barry Schwartz exercise, Diana, age-related biases, and the Miracle on the Hudson) illustrate how quick judgments can misfire and how deliberate thinking can avert tragedy or misjudgment.
• The discussion of ACHE and the Higher Education Network demonstrates practical pathways for students to engage with health care leadership, gain credentials, and build professional networks that can influence real-world outcomes in health systems.

Practical takeaways for exam preparation

• Be able to define and distinguish: heuristics, implicit biases, halo effect, stereotypes, social cognition, and social-emotional intelligence.
• Explain the difference between fast (System 1) and slow (System 2) thinking and give examples from the lecture (e.g., driving, decision-making under pressure, interviewing).
• Articulate the four-step decision-making process and how to apply it in a health care leadership context.
• Describe the quintuple aim and why equity and provider well-being are included alongside patient experience, population health, and cost.
• Recognize the role of professional societies (ACHE) in career development, mentorship, and lifelong learning, and identify how students can leverage these resources.
• Be able to discuss the ethical implications of biases in health care leadership and strategies to mitigate them (empathy, perspective-taking, and evidence-based decision making).

Quick note on style and presentation (for study use)

• Use the four-step decision framework when approaching case studies or policy questions.
• Practice identifying potential biases in sample scenarios (interviews, reader responses, or hypothetical patient cases).
• Consider how the quintuple aim would guide decisions about program funding, staffing, and community health initiatives.
• When discussing leadership development, reference ACHE resources and the broader ecosystem of professional networks as a practical pathway to career advancement.

End of notes