Welcome to Episode Six of the Ausmed Handover Podcast. The delivery of competent care has always been one of the core objectives of the nursing profession, but why is it that incompetent staff always seem to get promoted? In this episode, we’ll be looking closely at how an incompetent person thinks, why managers choose to ignore all the warning signs that an incompetent person is, well, incompetent, why they promote them into positions that are clearly beyond their ability, and why once the incompetent steps up onto the career ladder, their ascent to the top is virtually guaranteed.
Hello and welcome to the Ausmed handover podcast. My name is Darren Wake, and today, we are going to examine one of the most bewildering mysteries ever to have confronted the human race.
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If you wander along to the NASA website and search their image database for image number STS088 – 724 – 66, you’ll find a picture of a satellite that is in polar orbit around the earth that NASA cannot explain. What’s so difficult to explain about it? Well, for a start, it was first photographed in 1960, when neither the Americans nor the Russians had the technology to enable polar orbits for their satellites, it is so large that no rocket booster – past or present – could have lifted it into orbit, yet it clearly shows signs of being manufactured, and – even more bizarrely – constant streams of complex and heavily encrypted radio data have been traced to the very spot occupied in space by this satellite since 1924. Since it’s so extraordinary, inexplicable and downright creepy, virtually every government chooses to deny its existence or send a satellite into its orbital path to make contact, despite the wealth of photographic evidence that it actually exists. So it remains one of the great unsolved mysteries of the modern age.
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But, that’s not as puzzling as the mystery we’re going to explore today: why is it that clearly incompetent staff always seem to get promoted?
You know exactly what I mean: I’m talking about those people where there is no identifiable relationship at all between their confidence, knowledge and practical ability.
In nursing, it’s fair to say that there are three broad domains of competence: clinical, interpersonal and managerial.
Incompetence, in my humble opinion, occurs when someone is undertaking one or more of these roles, and their actual performance, understanding of what they are doing and level of confidence are so estranged and that they could pass each other in the street and not recognise that they are supposed to be part of the same household.
And for the incompetent, confidence will ride roughshod over knowledge and ability on every possible occasion.
It’s the nurse who gives the suicidal patient the fifth floor room with the lovely sunny balcony. It’s the nurse in charge of the shift who can only communicate information by screaming, shouting and threatening staff. It’s the manager who thinks it’s a good idea to roster all the grads on an evening shift to foster their sense of independence, ‘cause that’ll work out well.
It’s all those nurses who make you think “why the bloody hell did they just do that?”
It’s all those people whose actual ability and knowledge is quantifiably dismal, yet have a sense of self-worth, ego and confidence that sits somewhere in the stratosphere not far below our alien visitor.
And despite the number of times they clearly screw up the lives of patients, the good work of their colleagues or the stability of the ward, they always seem to get promoted.
Always. And subsequent to every one of these promotions, the entire crew of competent nurses left behind scratch their heads and wonder “how the hell did that just happen?”
However, unlike our orbiting extra-terrestrial visitor, science has plenty of good quality hard evidence on the nature of this phenomena. The promotion of clearly incompetent staff happens so frequently that countless volumes of research has been conducted into just how and why it happens, for it seems so utterly perplexing and counterintuitive.
It seems it’s largely related to something called heuristics, for the misuse of these ‘heuristics’ leads to cognitive biases, and… Oh, more about that in a minute.
First let’s look at some of the research into the incompetent themselves, because it reveals a lot about the inner workings of their odd little minds.
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There’s been a lot of research conducted into the thought processes of the incompetent across a whole range of professions, including nursing and medicine, and the findings are consistent. The research pioneers in this speciality discipline are two psychologists, David Dunning and Justin Kruger, who were originally inspired to investigate the psychological origins of incompetence after watching a news report about a man who robbed a bank after smearing himself head to toe in lemon juice. The reasoning behind this very odd approach to larceny was that since lemon juice is used by kids as invisible ink, if the robber coated his body with the stuff, he assumed he would be invisible to the banks surveillance cameras.
Dunning and Kruger’s methodology is similar to all subsequent research. A group of individuals in a workplace were asked to rate their own abilities across a wide spectrum of tasks. Then they were asked to rate their peer’s abilities for the same tasks, and the final results were tallied. Those who were rated by others as competent in certain areas tended to underrate their own abilities in relation to the rest of the group, and those that were universally identified by their peers as being wholly incompetent at a range of tasks rated their own abilities as far superior to everyone else’s.
This research ultimately came up with what is now referred to as the Dunning-Kruger effect, and it essentially codifies the four principal vices of the incompetent:
For God’s sake don’t look around the room while you are listening to this podcast!
That pretty much defines the incompetent in a nutshell, but how is it that they seem to get promoted so quickly? I mean, isn’t it normally sensible to promote the competent?
Sensible yes. Does it happen in the real world? No.
As I mentioned before, it’s all largely down to something called heuristics.
A heuristic is a kind of quick and dirty rule our subconscious forms in order to solve problems quickly without needing to refer to the available evidence. They’re really accessible and handy for getting through our day, for solving the trivial problems of everyday life, and researchers have discovered that we formulate and use a lot of them.
The problem is, because they ignore the available evidence, sometimes they’re wrong, and when they are routinely wrong, they become a cognitive bias.
You can think of a cognitive bias as being akin to someone routinely making a decision that flies in the face of the evidence that lay before them. The evidence I am talking about usually suggests that the opposite of their decision would have been a far better outcome for everyone concerned.
That just doesn’t seem like logical behaviour does it? Well, that’s because it’s not, it’s closer to the instinctual than anything else, and what has become clear to researchers is that heuristics, and their resultant cognitive biases are so deeply ingrained into our psychology and so powerful that they are virtually impossible to shake. They are like trains that can never leave their tracks.
OK, I’m going to give you an example that illustrates just how powerful heuristics are: a little maths problem that invokes a common substitution heuristic. How you respond to this is important, because it will illustrate just how dominating heuristics can be in your thought processes, and how they become cognitive biases.
QUIZ SHOW INTRO (0:10)
A bat and a ball cost $1.10. The bat cost one dollar more than the ball, how much did the ball cost?
CLOCK TICKING (0.:05)
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Alright, how much did the ball cost?
Did you say 0:10c?
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Well, I’m sorry to say that you are wrong. You are the weakest link.
You’ll have to listen to the end of the podcast to find out what the right answer is. But I’ll bet that if you did say 10c, you’re wholly reluctant to concede that you’re wrong, and in fact, when I tell you the right answer at the end of the show, you’ll still jump up and down, scribble out all kinds of fancy maths on paper to prove your case and invoke all kinds of esoteric logic, and you’ll probably lose your temper.
But you’ll still be wrong.
That’s how difficult it is to shake a cognitive bias. They are like train tracks that you just can’t get off. And your reaction, if you got that question wrong, is important, because it’s the very same substitution heuristic used by managers when they hire staff, so you’ll start to understand just how the incompetent seem to rise up the career ladder so fast, and why managers don’t try and stop them, despite all the available evidence pointing to incompetent practice.
Let’s first briefly examine how the incompetent manage to find themselves in a position where they are being interviewed for a promotion in the first place, because in the orthodox work environment, you generally need to apply for a job and be interviewed before you are promoted.
It’s a pretty simple combination: remember the attributes of the incompetent person I mentioned earlier? Despite the lack of any viable proof, the incompetent think themselves way better than anyone else they work with, and, conversely, the same studies show that the competent tend to underplay their abilities. How that pans out when a promotion comes up is that the incompetent are usually also confident, and the competent tend to be more humble. So the incompetent but confident staff member tends to put up their hand quicker when the opportunity arises to move upwards into a position that they believe is more suited to their cappuccino froth of intellect and ability. Of course, you, I, and everyone else knows that they can’t even perform adequately in their current role, so they are clearly going to be a disaster in something that requires even more advanced skills. But, like bunny rabbits and bright lights on a highway, incompetents and promotion seem to be hopelessly destined to come together.
That’s because virtually every incompetent individual incorporates something called the overconfidence heuristic into their thought processes to the point where it becomes ingrained as a cognitive bias. This heuristic – which is much more common in males than females by the way – basically compels the belief that if you believe you can perform well in one task, there is no reason you shouldn’t be able to perform just as well in a more complex, advanced task too, without the need for additional training, and even if the more advanced task is completely unrelated to to the skills required in the current role.
Think singers who embark on political careers.
So I think we can see a perfect bubbly strawberry and melon frappe of incompetence coming together. We have an incompetent, over-confident person who thinks that because, in their opinion, they perform so well their current role, there’s no reason they shouldn’t be able to transfer that degree of breathtaking yet entirely unsubstantiated ability into a more complex role with greater responsibilities.
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But that’s the heuristic that drives them to the point of interview. How is it, then, that management fail to see through the froth, cinnamon and bubble and end up actually employing and promoting them them (again and again and again).
Let’s look at the fundamental heuristic error that virtually all managers make when hiring staff or promoting people. This is where it all starts, and this error happens all the time, and I mean all the time, and in literally all cases it’s a cognitive bias in action: there is usually no evidence at all to support the assumption that informs the heuristic.
It’s a form of substitution heuristic, which is similar to the heuristic you used to try and solve the bat and ball problem, and it goes something like this:
If a candidate performs well at interview, then surely those interview skills will translate into practical abilities in their new role.
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Now, the received wisdom is that a candidate should be appointed on the basis of experience, the quality of their references and their performance at interview. Unfortunately, that’s not the case in the real world. Statistics garnered from very large studies now show us that although a good resume and application letter will get your seat on the interview chair, 70% of all jobs will be awarded on the basis of interview alone, with the decision to appoint made within the first 15 minutes of meeting the candidate. References don’t seem to come into the picture at all.
And confidence is the deciding factor.
So, if an incompetent twit sits before an interview panel, looks and sounds profoundly confident and talks up their abilities for a good 15 minutes, it’s very likely the substitution heuristic will come into play as a cognitive bias, and the panel or interviewer will assume the candidate’s confidence will translate directly into the skills and abilities needed for their new job.
Which is rarely the case, and once again, workplace studies have shown repeatedly that there is only the most tenuous relationship between performance at an interview and performance in a job, with the findings showing that around 90% of successful candidates will usually fail to perform as well as managers predicted after they were interviewed.
So, why do managers persist with this heuristic? And why don’t they get rid of the appointee during the probationary period as soon as their lack of ability becomes evident.
Becomes evident: there’s your clue.
It’s because of another heuristic, a really, really powerful cognitive bias that also has a protective function for the appointing manager’s ego.
It’s called a confirmation bias and in many ways, it’s the main reason managers seem to be unable to reconcile their use of the substitution heuristic in the initial interview with the subsequent poor performance of the candidate.
This heuristic, like all heuristics is not done consciously, but you will have probably seen it happen over and over again. And have you ever tried to convince a manager that an appointment was the wrong choice? It does not go down well! There’s a reason for that.
Picture this scenario:
A colleague of yours who is clearly not competent applies for a senior clinical job in your hospital. Your unit manager interviews them, their confidence at interview impresses them, and despite all the subtle warnings from yourself and your colleagues, they decide that this degree of confidence will translate nicely into an ability to perform their new job well.
Unfortunately, this is often not the case.
The incompetent staff member is appointed, their ego, confidence and self-belief multiplies exponentially, but their competence does not, and since they have even greater responsibilities, they screw up over and over again and literally bring disaster down upon your heads.
Everyone complains. But the unit manager seems not to listen, and despite all the evidence of incompetent practice being placed before them, they continue to trumpet to their own managers and anyone that will listen that the decision to appoint the suspect staff member was, in fact, an excellent choice.
And they remain immovable. And it’s the fault of the confirmation bias.
Why? Well, the confirmation bias compels them to look for just a single piece of evidence to confirm that the incompetent appointee has actually done well and they made a good choice, no matter how trivial that piece of evidence is. And no matter how incompetent a staff member is, you can usually find one thing that they do reasonably well. Although virtually everything else is about as badly done by them as you can get.
If the manager finds one thing that they did well, then the confirmation bias not only leads them to use that one thing as proof that they indeed made an excellent choice in promoting them, but the manager tends to become victim of the substitution heuristic as well, where the benefits of that one single, trivial example are extended to flavour the outcomes of everything that they do, no matter how abysmal their performance or outcomes.
Suddenly, to the manager, everything the staff member does is looking pretty darn rosy, and confirms to them they made the right choice in the appointment. It’s selective blindness.
And they remain blind to any other suggestion, despite all the evidence laid before them by the other staff that clearly suggests the managers darling is incompetent.
Once this starts, once the incompetent has become the managers darling, then their path upwards on the career ladder is virtually guaranteed.
Whilst everyone is sitting on the ward scratching their head and wondering what just happened, the manager is usually singing the virtues of their decision to the higher echelons, and soon enough, after what will seem like only the blink of an eye, the incompetent will apply for another promotion, and their manager, eager to validate their original decision will provide a glowing reference. There’s an interview, the candidate once again beams confidence, the substitution heuristic comes into play and the whole sorry upwards progression starts again.
It’s one of the reasons why some people, despite a breathtaking lack of ability, seem to be able to rise up into a senior managerial level within just a few years of graduating, driven simply by their self-belief and confidence.
I guess because they lack substance, they are virtually weightless.
And where does it stop? Well, you should do your own reading on this, as it’s been thoroughly researched. I suggest you start by reading about a topic called the Peter Principle.
Alright, now if you got my quiz question wrong, I want you to reflect on how fiercely you defended you answer.
It’s so obvious: how could I be wrong: it’s you that made the mistake!
But you were indeed, wrong (or at least half of you were), despite the simplicity of the puzzle.
Such is the power of the substitution heuristic.
Now I want you to think about the last time someone made a suggestion to one of your managers that perhaps the staff member they had promoted or employed were perhaps not entirely competent to do their job. No matter how politely you put it out there, I’m guessing that the manager refused to concede that they had made a poor choice at all, and absolutely refuted any suggestion the person lacked competence.
The same degree of disbelief was probably expressed by your manager when you challenged their decision, and you when I revealed that 10c was in fact wholly incorrect.
Cognitive biases are like train tracks that you can’t get off.
Heuristics are powerful things, and cognitive biases are one of the main reasons incompetent staff routinely get promoted, and continue to rise up the ladder until, as the Peter principle expresses it so concisely, they rise to their level of maximal incompetence.
The problem is, of course, what happens when they get to the top of the career tree, and land in a job that is three four or five rungs above their level of competence.
Well, that’s when you get whole health systems breaking down, unfortunately.
The promotion of incompetent staff in the nursing profession has always been a problem, but no more so than any other profession. Heuristics, especially heuristics that become cognitive biases are largely responsible for this phenomena, and in reality defy all reasoning, so don’t try and work out the logic of a decision to promote a seriously deficient colleague: there isn’t any reason to be found.
Is there good news? Well, it depends if you split the upwards movement of staff between clinical and managerial roles. Gallup polls in the United States, using the same methodology as Dunning and Kruger strongly suggest that only around 48% of all managers across a whole spectrum of professions and businesses actually understand the principles of management. That means around 52% aren’t suited to their roles. Read, probably not competent to manage.
However, when you look at clinical roles, that figure changes significantly. Competency standards for managers are rarely expressed as clearly as the competency standards required for clinical practice, and are rarely policed, so incompetent managers can languish in their jobs for years or even decades, and continue to rise up the ladder to spread their own special brand of love.
Clinical practice standards on the other hand, are far more rigorously policed, and it’s rare for a nurse to survive in a clinical position for too long before they are ‘outed’ by either a major error, by their peers or because they simply fail their mandatory competencies.
Or they apply for a promotion and move into management.
This is the Ausmed Handover Podcast, my name is Darren Wake. If you’ve found this podcast interesting, then subscribe for future episodes and tell your friends about us, and don’t be shy about leaving comments.
OK, time to pack up. Oh. Sorry.
You want to know the answer to the bat and ball question.
Well, I can’t tell you. Illuminati and all that.
Oh stuff it: I’ll risk it. The answer’s 5c.