When: The Scientific Secrets of Perfect Timing(26)

For many years, teaching hospitals in the United States confronted what was known as the “July effect.” Each July, a fresh group of medical school graduates began their careers as physicians. Although these men and women had little experience beyond the classroom, teaching hospitals often gave them considerable responsibility for treating patients. That was how they learned their craft. The only downside of this approach is that patients often suffered from this on-the-job training—and July was the cruelest month. (In the UK, the month is later and the language more vivid. British physicians call the period when new doctors begin their jobs the “August killing season.”) For example, one study of more than twenty-five years of U.S. death certificates found that “in counties containing teaching hospitals, fatal medication errors spiked by 10% in July and in no other month. In contrast, there was no July spike in counties without teaching hospitals.”35 Other research in teaching hospitals found that patients in July and August had an 18 percent greater chance of surgery problems and a 41 percent greater chance of dying in surgery than patients did in April and May.36

However, in the last decade, teaching hospitals have worked to correct this. Instead of declaring bad beginnings an inevitable problem for an individual, they made it a preventable problem for a group. Now, at teaching hospitals like the one I visited at the University of Michigan, new residents begin their tenure by working as part of a team that includes seasoned nurses, physicians, and other professionals. By starting together, hospitals like this one have dramatically reduced the July effect.

Or consider babies born to young mothers in low-income neighborhoods. Children in those circumstances often suffer terrible beginnings. But one effective solution has been to ensure that mother and baby don’t start alone. A national program called Nurse-Family Partnership, launched in the 1970s, sends nurses to visit mothers and help them get their babies off to a better beginning. The program, now in eight hundred U.S. municipalities, has also subjected itself to rigorous outside evaluation—with promising results. Nurse visits reduce infant mortality rates, limit behavior and attention problems, and minimize families’ reliance on food stamps and other social welfare programs.37 They’ve also boosted children’s health and learning, improved breast-feeding and vaccination rates, and increased the chances mothers will seek and keep paid work.38 Many European nations provide such visits as a matter of policy. Whether the reasons are moral (these programs save lives) or financial (these programs save money over the long term), the principle remains the same: Instead of forcing vulnerable people to fend for themselves, everyone does better by starting together.

We can apply similar principles to the problem that some people, through no fault of their own, begin their careers in lousy economies. We can’t dismiss this issue: “Oh, that’s just bad timing. Nothing we can do about that.” Instead, we should recognize that having a lot of people earning too little or struggling to make their way affects all of us—in the form of fewer customers for what we’re selling and higher taxes to deal with the consequences of limited opportunities. One solution might be for governments and universities to institute a student-loan-forgiveness program keyed to the unemployment rate. If the unemployment rate topped, say, 7.5 percent, some portion of a newly graduating student’s loan would be forgiven. Or perhaps if the unemployment rate ticked above a certain mark, university or federal funds would be unlocked to pay for career counselors to help new graduates trek their way across the newly rocky terrain—in much the same way the federal government deploys sandbags and the Army Corps of Engineers to regions beset by floods.

The goal here is to recognize that slow-moving when problems have all the gravity of fast-moving what calamities—and deserve the same collective response.


Most of us have harbored a sense that beginnings are significant. Now the science of timing has shown that they’re even more powerful than we suspected. Beginnings stay with us far longer than we know; their effects linger to the end.

That’s why, when we tackle challenges in our lives—whether losing a few pounds or helping our kids learn or ensuring that our fellow citizens aren’t caught in the downdraft of circumstance—we need to expand our repertoire of responses and include when alongside what. Armed with the science, we can do a much better job of starting right—in schools and beyond. Knowing how our minds reckon with time can help us use temporal landmarks to recover from false starts and make fresh ones. And understanding how unfair—and enduring—rough beginnings can be might stir us to start together more often.

Shifting our focus—and giving when the same weight as what—won’t cure all our ills. But it’s a good beginning.


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* Kahn chose white males because their employment and earnings prospects are less affected by race and sex discrimination and because their career paths are less likely to be interrupted by having children. That allowed her to separate economic conditions from factors such as skin color, ethnicity, and gender.





AVOID A FALSE START WITH A PREMORTEM

The best way to recover from a false start is to avoid one in the first place. And the best technique for doing that is something called a “premortem.”

You’ve probably heard of a postmortem—when coroners and physicians examine a dead body to determine the cause of death. A premortem, the brainchild of psychologist Gary Klein, applies the same principle but shifts the exam from after to before.1