Explore Clinical Problems by Wearing Different Hats

Abstract

In a previous column (Levin, 2008), I discussed the need to describe a practice problem using both background literature and internal organizational data in order to determine whether a problem really exists and, if it does, to describe its importance to the agency and in the broader health care context. The question I posed was this: Is this really a problem that needs our attention or is it simply an infrequent occurrence or outlier that one or two clinicians thought might be an (p. 5). I gave an example of how to collect internal data to substantiate the problem. One of my colleagues, Dr. Gina Myers, shared with me at a recent meeting another way of helping clinicians hone a clinical practice problem using the Six Thinking Hats method described by de Bono (1999), which is described in this column. The Six Thinking Hats approach provides a structure to examine a problem by efficiently exploring all sides or aspects of an issue. The hats are easy to use and allow an individual or group to organize and explore a large and seemingly overwhelming situation without much effort. This method can foster a sense of teamwork and open-mindedness because each member of a team has an opportunity to put on each thinking hat and thus view a problem from multiple frames of reference. THE SIX THINKING HATS The Six Thinking Hats, or thinking styles, are the following: 1. The White Hat is neutral and objective and is concerned only with data (Just the facts, ma'am). Wearing this hat, the team or group would describe findings from the literature and internal evidence from the organization regarding the clinical problem or issue. Clinical expertise can also be included here as well as patient values and preferences from a population-based, culturally competent perspective. 2. The Red Hat symbolizes the emotional view and provides a vehicle for us to address our own preconceived notions or feelings. 3. The Yellow Hat is sunny and positive. When wearing this hat, one focuses on the benefits or pluses of a decision. 4. The Black Hat is the devil's advocate. Although some may consider this hat negative and gloomy, paying attention to potential negative consequences of a decision can be important. 5. The Green Hat is associated with fertile growth, creativity, and new ideas. With this hat, clinical expertise and innovative ideas can be discussed. 6. The Blue Hat is cool and calm and helps to organize discussions and orchestrate decision making. The Blue Hat should be worn at least at the beginning and end of a discussion. The group facilitator often wears this hat while simultaneously wearing the others in turn. The first Blue Hat will determine why a group is together, what is being looked at, and the desired end point. Roles, such as timekeeper or scribe, may be assigned at this time to keep the discussion organized. As the last hat, blue also gives an opportunity to review achievements and summarize the group's conclusions. It is here that the next action steps are determined. USING THIS METHOD How can this method help us decide on the clinical problems to be studied? First, identify a clinical situation you want to address. The situation may be a burning clinical question, a process or system issue that is not working well, or the desire to enhance outcomes. …