Last week, I made a mistake at work. My consultant asked me to check the dosing instructions of two anti-psychotic medications that a patient (“Harry”) had been given while he was in Intensive Care, and that he needed to be weaned off now that he was on our normal ward. I said ‘no problem’, noted the task on my patient list (a piece of paper with patient data on it) and intended to get to it later that day.

When I came to doing the task, I got Harry mixed up with another patient (“Ron”) and spent 10 minutes figuring out Ron’s antipsychotic medication weaning scheme instead. I thought it was a bit strange that Ron was only on 1 antipsychotic drug rather than 2, but I assumed the consultant hadn’t realised this and went on with my life.

Later that afternoon, the consultant happened to see me on the ward and asked “Have we figured out the weaning doses for Harry’s meds?”. I was very confused for a few seconds until everything clicked in my head. “Ah crap I’m sorry, I got Harry and Ron mixed up in my head, I’ll check Harry’s dosing now”.

Everything worked out okay in the end, but I was annoyed at myself for getting the patients mixed up. I thought about why it happened, and figured out pretty quickly what the problem was.

The Problem

See, that morning I’d forgotten to pack my pen in my bag. I’d arrived on the ward, picked up a printed patient list, and found some random thick pencil lying around. I thought ‘it’s not a big deal, I’ll just use this pencil today’.

By mid-morning, my sheet (which is usually quite tidy) was a mess of pencil scrawls. Because I couldn’t clearly keep track of my list on paper, I ended up juggling stuff in my head, using my brain as a storage device rather than a thinking device. When the new information about these anti-psychotic medications came in, I wrote it down correctly on the piece of paper (“Harry - check weaning doses”) but because the whole sheet was a mess, my brain had to take on the extra cognitive burden of keeping things organised, and mismatched the task to Ron.

The Solution - GOHIO

The following day, I made sure to pack my pen and kept my to-do list neat throughout the day. I even spent 5 minutes transferring my annotations from one sheet to the next when we updated and printed a new list in the afternoon. That day, everything felt more manageable, less manic and nothing slipped through the net.

In the early days of Amazon, in the year before they first hit $1 billion in revenue, Jeff Bezos instigated a year-long policy of “Getting Our House In Order” (“GOHIO”). He knew that at the $1bn mark, companies often struggled, partly because the systems that worked well when they were smaller became bloated and less fit-for-purpose. Spending a year focusing on GOHIO, on updating their internal systems so that they worked better, on organising their structure and products to be more streamlined, worked wonders, and allowed Amazon to grow into the behemoth that it is today.

I came across the story of GOHIO in a podcast the same week that I made the anti-psychotic dosing mixup. Now, whenever I find myself getting even slightly overwhelmed by the amount of stuff I need to do, or if I realise that my list isn’t as organised as it should be, I spend a few minutes on GOHIO - Getting our house in order.