Opportunities for Developing an Ecology of Attention in Clinical Settings.
Opportunity	Examples
Prioritize quality of communication over frequency of communication	Incorporate categories of importance and urgency into systems and communication methods. Encourage prioritization of attention (such as by triaging pages with levels of acuteness or batching messages to a designated part of the day). Incorporate hard stops or receiver-centered functionality (such as a pager setting that allows the user to batch low-acuity pages and receive them at a single time, or an improved ability to capture and retain low-acuity tasks as they arise in workflows).
Design physical spaces to foster attention in the clinical environment	Develop spaces that provide an ability to separate from noise and that contain necessary tools for clinical practice. Consider attention optimization as one of the primary design principles guiding the creation and maintenance of shared and individual work spaces.
Evaluate the effects of proposed changes on work-force roles and duties	Avoid unnecessary task switching. Consider the number and types of tasks performed in a given workday, the maximum number of patient encounters per day, and the ability for clinicians to structure their workflows. Define roles within teams to allow for periods of deeper focus during the workday.
Optimize electronic health records	Develop awareness of the cognitive burden associated with prompts (such as best-practice advisories), data-entry tasks, and switching between screens and views. Develop and disseminate customizable flow sheets with data that are frequently retrieved together. Minimize attention spent maintaining the record outside vital patient care activities.
Develop measurement tools that are sensitive to attention-mediated outcomes	Develop descriptive measures to define the type, frequency, and intensity of common distracters. Develop quantitative and qualitative measures, including measures for patient and provider satisfaction, fatigue, and burnout. Measure the downstream effects of productivity goals on the ability for deep, focused work and on quality- and safety-related outcomes.
Integrate attention into organizational culture	Consider the downstream effects of resource allocation. Evaluate scheduling of shifts and tasks. Provide clinicians with tools and language to prioritize attention in their daily practice.