It’s not uncommon in EMS and public health circles to hear talk of the Hawthorne effect. This concept explains that people under observation tend to change their behaviors simply because they are being observed.
Some of you will be familiar with the story of Hawthorne Works, an electrical factory in Cicero, Illinois. A researcher named Elton Mayo conducted experiments in the late 1920s looking at how factory lighting influenced worker productivity. Mayo, it is now concluded, was mostly wrong in his conclusions. It was instead Henry Landsberger who gave the Hawthorne effect, in the 1950s, its current meaning:
Lighting wasn’t what increased worker productivity. It was instead the simple act of being observed.
For many of us, this explanation makes sense at gut level. If someone is watching you work, you might work a little more diligently. Or you might make a mistake.
Typing out this article, for example, on a full plane, leaves me acutely aware of the woman on my left reading over my shoulder (I SEE YOU), which in turn affects not just what I type, but also how I think. Even if we don’t feel nervous per se, we feel watched. This influences our behavior and performance on multiple levels. A 2014 meta-analysis shows, basically, that as such, the Hawthorne effect is real.
The Hawthorne effect is akin to the much more widely known placebo effect. Just like a powerful placebo might bring into question a medicine’s effectiveness, a powerful Hawthorne effect makes it harder for researchers to assert that an intervention caused a given change in behavior. It may be complicated or even nullified by the effect of scientific observation.
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Beginning to see yourself
There’s another sense of the Hawthorne effect I’d like to explore now: the capacity for self-observation. Much of the time, we do things because, well, that’s just what we do. Behaviors become habitual, and then we become our habits.
Some are healthy; and others we may wish to change. Such habits might include:
- Smoking
- Drinking too much
- Isolating from family or old friends
- Overidentifying with “the job”
- Eating too much
- Not exercising enough
These are all subjective, of course. And that’s sort of the point I’m coming around to.
If we can manage to gain insight into how we see the world — the inner tendencies and workings of our mind — we might be able to understand why we do what we do. Then we may understand what’s really holding us back, allowing meaningful behavioral change.
Our own inner Hawthorne, if you will.
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Mindfulness and habit change
Judson Brewer, PhD, and his team published in 2011 a study in which they had people who wanted to quit cigarette smoking try mindfulness exercises as part of their routine. The instructions were less focused on a desired outcome (e.g., “I want to stop smoking,” “smoking is bad”) but were instead an invitation to observe their own mental machinations as they went about their day (including smoking cigarettes).
The result? Mindfulness-based smoking cessation was five times more successful than the American Lung Association program. Again: Mindfulness was five times more effective than the standard-bearer.
In interviews, Dr. Brewer has elaborated on why he thinks paying attention to our thinking can be so powerful. In sum, we tend to cling to narratives to explain or justify our habits. For example:
- “I deserve a few cocktails at the end of the day with the stuff I see at work, and at least I’m not an alcoholic like my father was.”
- “I can’t work out today with all that’s on my plate. I’m exhausted!”
- “Sure, I don’t spend as much time with the family as I used to. But the kids don’t want me around and my spouse would rather be left alone anyway.”
And so on. The stories we tell ourselves are incredibly powerful. So much so that they often blind us to the reality of our habits. For example, ingesting cigarette smoke is actually pretty revolting. With habituation, it brings no real satisfaction. But you might not see this if you’re on auto-pilot.
Moreover, if you feel judged or hassled, you might double down in defiance, meeting resistance with justification, thus reinforcing the habit. The habit becomes part of your identity.
The process of thinking
Notice that nowhere yet in this article have I used the term “bad habit.” The value of a habit is relative, depending on degree and circumstance. Is this serving me well? Smoking is a stark example because it is both highly addictive and clearly detrimental to one’s health.
But part of coming to see ourselves is to understand that much of life cannot easily be put in buckets of “good” and “bad.” This is especially the case in EMS. A lot of what you deal with could be seen as “bad,” “stressful,” “traumatic” and so forth. There are the tough calls, of course, but also the chronic challenges of shift work in a resource-depleted industry. Magical thinking will not make that go away.
On the other hand, the challenges are often what make work fun and keep it interesting. Getting away from the habit of reflectively thinking “good” vs. “bad” (or other similarly ingrained mental models) opens us up to other options. In fact, it makes good work possible. We might see what is new and novel about this particular circumstance. We might lose ourselves to the work, letting distractions go.
To truly see what’s happening in a constantly changing environment — to ourselves, our patients, in our families — we need to be present. Sometimes life can feel like one distraction leading to the next, to the point that a moment of calm sees us reaching for the next distraction. This is the definition of suffering: to find no peace. Let’s avoid this. It helps to be aware, Hawthorne-like, of our own patterns of thought as a first step.
Conclusion
So how is this done?
Well, mindfulness and meditation are the answers I often offer. But let’s leave these concepts alone for now. Broadly speaking, there are three steps.
- First, let’s simply pay a little more attention to our behaviors, internal narratives and well-worn origin stories. Are they serving you? Your patients? Your loved ones?
- Second, find yourself an undistracted, peaceful moment when you get a chance. This doesn’t require a nature retreat or spa or a weekend without obligations. A moment of peace might be hiding in your work vehicle between calls or in the early morning hours in your bedroom or while taking a walk around the block. Have the courage and presence of mind to take it in, totally. Make regular time for peace and calm. For most first responders, this is a challenge. But finding peace within ourselves is a life skill.
- Third and finally, give your best in what it is that you do. The attention you pay is your most valuable resource. The work of EMS is both hard and honorable and worthy of your full attention.
Listen to yourself, find some peace and do good work. Three simple steps. We all depend on it.
