Cognitive flow in health care settings: A systematic review

Abstract

Introduction The state of cognitive flow, colloquially known as being ‘in the zone’, has been linked with enhanced performance, happiness, career satisfaction and decreased burnout. However, the concept has not been adopted strongly in health care training, continuing professional development, or daily practice. A systematic review with a narrative synthesis was undertaken to map the evidence for flow in health care. Methods A search was conducted in MEDLINE, PsycInfo, and EMBASE in July 2019 and updated in October 2020 for manuscripts discussing flow in all health care disciplines. Articles published between 1806 and 13 October 2020 were included. Two authors independently reviewed titles and abstracts (and subsequently full texts where necessary) for inclusion. Disagreements were resolved by consensus. Data were extracted on location, manuscript type, population and context, measures, and key findings. Results A total of 4923 unique abstracts were initially retrieved, and 15 articles were included in the final review. We report on the experience, benefits and strategies to support flow in health care. Flow may benefit providers by enhancing career enjoyment, wellness and performance, while mitigating exhaustion, burnout, and stress. Although research from other domains has focused on supporting flow through individualised training, our results highlight the importance of system and environmental factors. Conclusions Supporting professional and trainee flow in health care requires a holistic approach, including individual training and system‐level interventions.

The anatomy of enjoyment: the flow experience and cardiac surgery

“…Although no explicit research has been completed on flow in cardiac surgery, this is a special surgical discipline that is composed of mainly high acuity cases that require extreme concentration, thereby creating optimal flow environments and challenge-skill scenarios. A recent systematic review on flow in healthcare outlined that healthcare workers ranging from surgeons to speech language pathologists, not only experience flow but also have plentiful opportunities for flow because of the ‘just right’ challenge-vs.-skill scenarios and the intrinsically rewarding nature of the careers, all of which is evident within cardiac surgery [21 ▪ ].…”

“…protected spaces and increased resources), and strategies that work at the intersection of individuals and systems (i.e. how work cultures influence individual experiences) [21 ▪ ]. Surgeons should be able to pursue intrinsically rewarding activities, practice stress management, and seek new challenges, all within a system of supportive work cultures and adequate resources.…”

Going with the cognitive (load theory) flow

“…In this issue of Medical Education , McQueen and colleagues report their systematic review of ‘cognitive flow’ in healthcare settings 1 . While cognitive flow has eight specific components, it may be more intuitively described as ‘being in the zone’ and has positive correlations with job satisfaction, happiness and performance in fields outside the health professions.…”