It happens in every interview. One of the foundational interview questions for case managers goes something like this: "What are the skill sets that a case manager must have?" I have yet to have an interviewee miss the skill of "multitasking" in their list. And they wear it quite proudly-I did too (once upon a time).

Newer research on multitasking and the popularity of mindfulness is turning the tide. And, to be perfectly transparent, I also wonder if our aging case managers do not have a hand in the change. Be honest. Do you find it more difficult to be interrupted with staff at your door and pings on your e-mails, while you are attempting to concentrate on a difficult task?

The research is no longer new. In 2005, my September/October Editorial was about multitasking (Powell, 2005). In the Journal of Experimental Psychology: Human Perception and Performance, published by the American Psychological Association (Rubinstein, Hughes, Meyer, & Evans, 2001), researchers at the Federal Aviation Administration and the University of Michigan, Ann Arbor, studied four groups of young adults. The subjects were requested to carry out a series of tasks, and switch between different tasks; some of these tasks were complicated, and others were easier and/or more familiar. A participant's performance speed was measured as the tasks were carried out. The research demonstrated that the hidden costs of multitasking can mount up: that carrying on several tasks at once may, in fact, reduce productivity, not increase it (Anderson, 2001). The study confirmed that, for all types of tasks, subjects lost time when they had to switch from one task to another.

More recently, in "The Singletask Sensation," Ms. Zach goes so far as to say that, "Multitasking is a myth. The brain is hard wired to do one thing at a time. When we think we're multitasking we are actually engaged in what neuroscientists call 'task switching'-switching rapidly between tasks" (Zach, 2015, p. 13).

But it gets even scarier. She goes on to say that studies have shown that attempting to multitask lowers IQ, shrinks the gray matter, and lowers productivity by 40%. (Shrinks the gray matter? YIKES! Someone should study the brains of case managers!).

The frontal lobe houses the "executive system" of the brain; it decreases in volume as we age. This region helps the brain decide which tasks to focus on and when to suppress irrelevant information (Hamilton, 2009). The "executive system" is somewhat like a symphony conductor, telling which instruments to play, go faster, slower, louder, softer, or stop for a few measures. But, in essence, we are not paying attention to one or two things simultaneously, but switching between them very rapidly. Research says that when two tasks compete for the same part of the brain (say, when you are answering e-mails while talking on the phone-and what case manager does not do that!), interference sets in and the struggle begins.

Single tasking, on the contrary, involves focus and uses the tools and processes developed by "mindfulness" practitioners:

* working on the task or focusing on the person in front of you;

* committing to your choices; and

* living in the present.

Mindfulness research has also been done (Powell, 2014). I think you will like this better. In a longitudinal study (Holzel et al., 2011), pre-/postchanges in the brain gray matter were studied via magnetic resonance images before and after an 8-week "Mindfulness-Based Stress Reduction" program. Here is what was found: whole brain analyses identified increases in gray matter concentration in the posterior cingulate cortex, the temporoparietal junction, and the cerebellum in the BMSR group compared with the control group. In layman's terms, this improves regions involved with learning and memory processes, modulation of emotional control, and the process of awareness-or, you may have read about "neuroplasticity," which has replaced the formerly held position that the brain is a physiologically static organ; scientists now realize that the adult nervous system has the capacity for plasticity and changes in response to training.

The research leaves more questions than answers but may be a key to engaged, focused, and less-stressed staff. The business of case management necessitates clear-minded, focused thinking. To be a stellar communicator, stress-control in high-stake situations is a must. Perhaps, it is time to think of ways to create environments where the case managers can be more attentive and less interrupted. Just a focused thought...

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