Fixed Versus Growth Mindset

Mindsets

Learners fall into two camps in their beliefs about intelligence and ability. One group thinks intelligence is fixed for life. People are born smart or born dumb depending on lucky or unlucky genes. The other group believes that intelligence is gained bit by bit through effort and strategy.

These are mindsets. The fixed mindset believes that intelligence is set for life. The growth mindset thinks intelligence can be earned.

The two mindsets lead to different goals and different outcomes. The growth mindset produces people who strive for success, especially in the face of failure. Mistakes are seen as signals from the universe that more work is needed. The growth mindset realizes that failure does not contain a value judgment. For these people, knowledge is the goal to be fought for and won.

The fixed mindset produces the opposite: people who feel caged by the dose of IQ they received. They are performance oriented and fear looking bad. They pass up learning opportunities that might reveal their lack of knowledge. They are far more likely to cheat than people who hold the growth mindset because their goal is not achievement but looking smart.

The Source of a Fixed Mindset

Early in a child’s development, negative messages from parents, teachers, and peers can produce the fixed mindset. Perversely, praise for intelligence also encourages this mindset and is therefore quite handicapping. Although it’s normal and intuitive to encourage children, when a child is told they are smart, the trap of a fixed mindset is being set. Instead, teachers and parents should always reward effort and strategy rather than highlighting the intelligence of the child.

When kids from grade school through college are tested on how mindset affects learning, they show equal intellectual capacity until the tasks become more challenging. Then the fixed mindset reveals itself, and kids performing well to that point begin to give up, take too much time, make excuses, or choose the easiest tasks to work on. This makes sense if you think that capacity is fixed and you don’t want to reveal a deficit. The irony is that the fixed mindset produces a focus on performance and status that ultimately makes its adherents less likely to achieve either. The fixed mindset rarely allows the opportunity to learn from failure because faking it is better than failing.

Changing a fixed mindset

People tend to hang onto their mindsets for life. Mindset is stubborn psychology, deep in the mental schema and worldview of its adherents. There are, however, encouraging experiments showing that the fixed mindset can be transformed into the growth mindset.

First, education about the brain’s plasticity—its ability to grow and change and form new synaptic connections with learning—can convince people that intellectual horsepower comes through the effort of learning and practice.

Second, showing examples of a growth mindset in cultural heroes like Edison, Lincoln, and Einstein can persuade students that it takes hard work over time to get smart and do well. Einstein was a patent clerk who worked on his equations every night for years. Lincoln did his homework with charcoal when pencils were scarce. And Edison famously said that he never failed at any of his experiments leading to the electric light; rather, he discovered 995 ways how not to make a light bulb.

“Most interesting, our research has demonstrated that those who avoid challenge and show impairment in the face of difficulty are initially equal in ability of those who seek challenge and show persistence.” —Carol Dweck, A Social Cognitive Approach to Motivation and Personality

How Efficient are Your Organization’s Learning Tools?

People are conservative; they like the old ways. It’s no surprise that we use learning techniques that go back hundreds of years.

Recent research reveals far more efficient methods of learning. Efficiency in learning involves three key variables: Retention, Time spent learning, and Time to mastery.

Retention and Time Spent Learning

Time is money. Organizations lose money when employees dedicate time to learning only to forget the information. The learning efficiency for that knowledge is zero. In an ideal world, employees should retain important information for 1-12 months. The “Forgetting Curve” shows how information is forgotten overtime, as studied by the German psychologist, Hermann Ebbinghaus.

Time to Mastery

Beyond retention, there is a more permanent and productive knowledge state known as mastery – a combination of confidence and correctness. When your employees achieve mastery, your organization reaps the rewards in the form of increased efficiency and revenue growth.

Mastery is achieved only when all misinformation is absent. Amplifire’s research has shown that employees confidently hold large amounts of misinformation (25-35%) – that no amount of traditional learning can wipe from their minds. Amplifire calls this Confidently Held Misinformation.

Is Your Organization’s Learning Strategy Efficient?

Learning Efficiency = (time spent learning) X (retention over time) X (costs)

If you’ve been spending time and money on inefficient learning, it’s time to consider other options.

Amplifire’s algorithm is tuned to the different ways forgetting occurs overtime – as discovered through 700 million learner interactions. For example, when misinformation is repaired by Amplifire, the system calculates its reappearance at different times in the future. It sends micro-bursts of focused learning at the time information is being forgotten.

It’s really that smart.

Is Your LMS Underperforming For Your Healthcare System?

Transforming Healthcare Training

Despite all of the time and money spent on healthcare training, it can be ineffective, a waste of time, not memorable, and create an illusion of knowledge where none may exist.

But it doesn’t have to be.

There are new learning technologies that make knowledge stick and easier to recall. Learning systems that eliminate misinformation that leads to patient harm.

Take our quiz below and see how well your LMS system is performing.

Quiz:

1. Does your LMS contain analytics demonstrating clinician learning gains?
2. Does your current LMS tell you specifically which of your physicians and nurses carry inaccurate information or maintain incorrect practices that pose risks to patients?
3. Does your LMS validate each learner’s mastery of a topic and monitor, maintain and report on their knowledge over time?
4. Does your current LMS provide ROI projections and measure efficacy on the courses it delivers?
5. Which of the following statements best describes your current LMS (choose one):
   a. Our LMS is a human resource system that monitors the completion of mandatory training by staff.
   b. Our LMS provides our learners with a broad range of clinical and non-clinical courses to maintain their competency and track their completion of mandatory training.
   c. Our LMS is driven by organizational performance goals and provides evidence of physician and staff knowledge and actionable data to managers to help their physicians and staff deliver on those performance goals.

Results:

If you answered “no” to any questions 1-4, or answered (a) or (b) to question 5, your LMS is underperforming.

Amplifire Heatmaps – A Quick Orientation

You can think of the heatmap as a visual proxy for the pattern of neurons that represent information in the minds of clinicians. Furthermore, think of confidence as the precursor to the decision making that leads to behavior. When you are confident, you act. When you are confident yet wrong, a mistake becomes far more likely.

The Amplifire algorithm is based in the cognitive psychology of learning and memory and adapts to each learner. If a learner is confident and correct on a question, they never see it again. If they are confident and wrong, the system will show them concise explanations and ask them the question again later in the module. Everyone gets to confident and correct along their own unique path.

After Amplifire

The algorithm does not allow a learner to escape until all confidently held misinformation and uncertainty are eliminated. The heatmap on the right represents a state of mastery. Is it permanent? Sadly, no.

CHM is made up of neurons that are connected in a strong pattern, and this pattern will return. Regression is a topic we consider elsewhere, but suffice to say that our analysis of over a million learners in Amplifire indicates that about 75% CHM is permanently eliminated but 25% CHM returns within a month. Amplifire refreshers are designed to reduce regression over time. CHM can be tamed, but the brain’s architecture and processes mean that a 100% instantaneous fix does not appear possible.

Despite this reality, 100% confident and correct across all topics is indeed possible, as we regularly see that state in our refresher heatmaps. Like most things, it just takes some work to get there.

10 Tips for Engaging and Aligning Physicians

30%. $2.4 trillion. 12 minutes. 1.8 million.

What do those numbers have in common? The answer is physicians:

• 30% of resources spent on healthcare have no impact on patient care, according to the Dartmouth Atlas Study.
• $2.4 trillion, or 80% of the annual US healthcare spend, is allocated based on decisions made by physicians.
• 12 minutes is the average amount of time that a typical physician spends per patient.
• 1.8 million scientific academic articles are published annually, and only half are read by anyone other than the author and the journal editor.

Getting and keeping physicians’ attention is critical, and very challenging. Influencing their decisions is even harder. Regardless, aligning physicians to make decisions that reduce variation and achieve the “Triple Aim” of delivering high quality, cost-effective care that meets patients’ expectations is a challenge every hospital or health system is faced with.

Most health systems know the challenge of physician alignment, but struggle to meaningfully engage their physicians. Most have physician liaison programs, web portals, forums with the chief medical officer, medical staff newsletters, and meetings, which provide part of the solution. What is often missing, however, is a scalable and sustainable way to keep physicians engaged.

Technology has the potential to serve as the spine of physician alignment because of its mobility, flexibility, personalization, dynamic modality, and immediacy. Used in combination with a well thought out strategy and effective engagement methods, technology offers a cost-effective, highly-scalable way to enable effective engagement and alignment.

But before you ask a physician to look at a mobile phone, download an app, read an email, open a file, attend a meeting, or change anything they’re doing, realize that there is a secret handshake among them, a password or algorithm that holds the key to getting and keeping their attention and making them open-minded to doing something differently.

Call it empathy, but we’ve learned through trial-and-error that there are 10 questions that physicians ask themselves before deciding to invest their limited time and attention:

1. Is it brief? Driven by throughput targets and other time-based pressures, a physician’s or provider’s day is lived in 12 minute increments. Make sure what you’re asking them to do isn’t too time consuming.

2. Is it credible? Whoever is asking for their time and attention must be a credible, recognized expert on the topic being addressed.

3. Is it current? The massive scope and rapid turnover of information that drives physician decisions requires that you understand the shortening shelf-life of what is considered current.

4. Is it engaging?  If it’s true that physicians don’t have time to read, engage their other senses and use tools and methods to get and keep their attention. And remember, there is no better indication that a physician is engaged than when he or she is typing or talking. Ask yourself what will inspire him or her to do either.

5. Is it practical? If something asking for physicians’ time and attention is not action-able, and therefore not practical or relevant, it will be dismissed. Physicians don’t have time for theory.

6. Is it convenient? Don’t make them come to you. Make it easy for them to engage within their hectic and demanding day.

7. Is there too much?  There are nearly 6,000 medical “apps”, 40,000 medical journals, 1 million medical blogs, and 12 million medical websites all vying for physicians’ attention. Hence, less is more.

8. Is it important? When everything is important, nothing is important. Physicians are desensitized to urgency, so understand what they consider to be urgent and why.

9. Is it transparent? Physicians are adept at percieving hidden agendas. Tell them what you want and why.

10. Is it safe? When they invest their time and attention, they want to know that their interests are protected—their reputation, personal information, and financial security.

Integrating these tactics into your engagement strategy will help align physicians in achieving the “Triple Aim” of healthcare.

Reducing nurse onboarding time by over 25%

Amplifire reduces misinformation and onboarding time for new nurses.

• Reduced misinformation
• Reduced onboarding orientation time by over 25%
• Decreased cost of orientation
• Lowered insurance premiums

One of the largest Integrated Delivery Networks (IDN) in the U.S.¹ was struggling with onboarding nurses, errors, and liability.

Orientation was extremely time consuming and estimated costs to train a nurse, including the expense associated with turnover, exceeded $15,000. Making matters worse, training required nurse mentors to teach and verify the skills of new hires, while at the same time caring for a full load of patients. This “on-the-job” method of teaching and validating knowledge led to the dissemination of inconsistent knowledge and misinformation.

The client needed to:

• Reduce the time to competency during nurse orientation
• Facilitate a process that clearly identified issues
• Balance requirements with rapid learning and user friendliness
• Demonstrate improved clinical outcomes
• Create an emotional connection to competency development

Amplifire reduced onboarding orientation for new hires by more than 25% and had the additional benefit of reducing risk insurance premiums when its insurer found a significantly less exposure to employee errors and legal costs.

1. The Amplifire health alliance never releases identifiable healthcare data.

Finding and fixing 32% misinformation in national demo

Amplifire finds and fixes 32% misinformation in national demo.

15 U.S. health systems¹ participated in an amplifire demo. The demo module used a “sampler” of topics, including decision making, patient safety, and financial/administrative issues.

Knowledge and Misinformation: Before starting, learners knew (with confidence) approximately 50% of the material. 32% of their knowledge was Confidently Held Misinformation (CHM) which was remediated by the amplifire algorithm.

Struggle: Learners did not “struggle” with the content. 139 of the respondents showed less than 0.2 struggle. Only two learners had high struggle scores of .67 and an alarming 1.50. As a group, hospitalists are excellent learners.

Variation by Health System: Health System 4 had the most CHM (39%), while Health System 8 had the least CHM (25%).

Variation by topic: CMS Regulations had the most CHM at 48%, while Communications had only 4%.

Variation by clinician: Within Health System 1, Clinician 1 had the most CHM at 50%, while Clinician 13 had 0%.

Clinician Experience: 87% of respondents provided a rating of “good” or higher. 74% of hospitalists indicated they were likely to change how they would manage a complex patient like the one presented in the module.

1. The Amplifire Healthcare Alliance never releases identifiable data.

Increased pass rate on the MCAT

With Amplifire, student MCAT scores moved from the 90th to the 95th percentile.

• Over 58,000 learners have prepped for the MCAT with Amplifire.
• Students using Amplifire have answered 53,192,000 questions.
• Students have spent more than 900,000 hours of learning in

Most of the time, when people analyze the effect of an optional educational activity, they run into a correlationversus-causation problem. For example, using flash cards is associated with higher exam scores. But it’s harder to say whether the higher exam scores are because of the flash cards. It’s easy to imagine that the type of student who would make flash cards is also the type of student who would earn a high score on the exam; the flash cards might not have anything to do with it.

To avoid this problem when estimating the effect of Amplifire, we compared people to themselves. On simulated MCAT exams, learners were correct almost 15% more often when questions were related to what they encountered in Amplifire before the test (where they had no control over which concepts were tested). Completing all of Amplifire translates to several points—and a significant percentile boost—on the MCAT. For example, a learner in 2016 who would have gotten a 513 would instead earn a 516 by completing the offered Amplifire modules. That learner would move from the 90th to the 95th percentile, moving past half the students above her.

Increasing the pass rate on the restaurant food safety exam by 18%

Amplifire increased the pass rate on the restaurant food safety exam by 18% while reducing the failure rate by 34%.

• Industry: Trade Association
• Large food service association
• 500,000 restaurants

Every student in culinary arts must pass the food and beverage safety certificate exam in order to begin a career in the restaurant business. Their coursework usually takes place at a community college, and includes topics like Sanitation and Safety.

Amplifire’s efficacy was tested at a large community college in North Carolina with an enrollment of more than 40,000 students. Amplifire was added to the curriculum in 2015. The food and beverage safety exam pass rates were then compared with those from the year before. Students who used Amplifire were 18% more likely to pass the exam—and 34% less likely to fail it.

Learners were aware of this benefit, with 100% of them agreeing that Amplifire helped them learn and remember the material.

“It gave me the chance to see what I knew and to get help along the way.”
“Amplifire was extremely helpful, repeating the question until I was 100% sure.”

Telecom

Company-wide savings with Amplifire at full implementation estimated at $2.5 million per month.

• Razor thin margins and penalties for repeat truck rolls
• 1% change in the repeat truck roll rate equals an estimated
• $1 million savings per month
• Amplifire lowered the defect rate by 2.5%

Professional fulfillment companies are contracted to install satellite TV, cable, and security systems. If you’ve ever had DirecTV installed at your house, chances are that the installer was this company.

It is crucial for technicians to perform these installations and other services properly. This company pays penalties for installations that incur a service call within 30 days of its original installation or for service calls incurred on other service calls. However, they receive incentive payments if the service call rate is sufficiently low. The margin between chargeback and incentive is razor thin—less than 2% overall. As a result, for every tenth of a percent change in the company-wide defect rate, the company stands to gain or lose $100,000, monthly.

This provider began using Amplifire in combination with instructorled and on-the-job training for their new hires. Compared to employees who went through their existing training, the “amped” technician’s service rate within 30 days was a full percent lower.

In the service on service metric, the reduction was 1.5%. Once fully implemented, the cost savings to be realized are estimated as a $2.5-million-dollar boost to the bottom line…every month.