Books

To err is human. Divining how to react is what matters

Society is intolerant of error. We need to change this mindset. A doctor turned pilot applies his expertise to the problem

Niall Downey: "My training as a doctor focused primarily on not making mistakes. When I retrained as an airline pilot, I was somewhat disorientated by a completely different approach to error."

Niall Downey
Wed Jul 26 2023 - 10:25

Our heavily curated Instagram society has become very intolerant of error. In an era where everything we present is airbrushed, tweaked, filtered and polished before being released into the wild, we labour under the misapprehension that the real world is similar. We are sadly mistaken. The real world is messy, imperfect and error-prone. My book, Oops! Why Things Go Wrong, explores why error is inevitable, how it affects many different industries and areas of society, sometimes catastrophically, and most importantly, what we can do about it.

It’s Not Your Fault

Society’s development has accelerated at warp speed over recent decades and shows no signs of slowing down. Unfortunately, our brains have had trouble keeping up and are trying to function in a highly complex, rapidly changing environment whilst still running on caveman software!

This dichotomy is the essence of what I explore in my book. The mismatch between the fast-paced environment and our inability to respond appropriately results in errors inevitably occurring. This is merely an inconvenience in many areas, but in safety critical industries such as aviation and healthcare it can literally mean life or death.

READ MORE

Society is, unfortunately, quite intolerant of error, especially in others! We need to change this mindset. Error is nothing to be ashamed of. The only way to come close to avoiding error is to be so cautious and risk averse that we stifle innovation altogether, and in healthcare that would mean avoiding intervention in any but the easiest of cases.

Your Good Health

I was sitting at the nurses’ station on a ward in a major Belfast hospital. The bed closest to me had the curtains pulled. The ‘crash’ team had just left and behind the curtains was an elderly lady who had just died from irrecoverable cardiac failure, precipitated by me prescribing her more intravenous fluids than her ailing heart was apparently able to handle. I had just killed my first patient!

My training as a doctor focused primarily on not making mistakes. They were considered unacceptable and something not to be discussed, especially if you hoped to progress up the career ladder. However, sticking our heads in the sand is not the answer. In developed countries, for example, it is estimated that about 10 per cent of hospital admissions suffer an adverse event with about 5 per cent of these causing or contributing to the patient’s death. Error is estimated to cost about 10 per cent of a country’s healthcare budget despite up to 70 per cent being considered preventable. In the UK alone, that’s over £15 billion!

When I jumped ship to retrain as an airline pilot, I was somewhat disorientated by a completely different approach to error. It was seen as inevitable and therefore something to be dealt with, not to be ashamed of. It took me quite a while to come to terms with this different mentality, but over time I realised what a valuable approach it was.

Again, the statistics are clear: total deaths globally in commercial jet aviation in 1977 numbered about 3,000 people while figures now are less than 1,000 annually despite an almost 10-fold increase in passenger numbers. Indeed, in 2017 the number of deaths globally was zero! This is due largely to our focus on human factors since the late 1970s.

Twelve years ago I started to convey the lessons from aviation to a healthcare audience with limited success. Recently, however, the mindset seems to have changed. Staff appear more accepting of the inevitability of errors regardless of how hard they work. Patients too no longer expect their doctors to be perfect, but when mistakes do occur most want truthfulness, an apology and signs that steps are being taken to avoid a recurrence. Healthcare administrators also need to play their part as currently a defensive stance means patients have no alternative but to lodge a complaint or even instigate legal action in order to get answers, which generally leads to a sub-optimal outcome for all involved.

What About Everyone Else?

Other industries are by no means immune from error. Agriculture, for instance, has the highest mortality rate among workers in the UK and Ireland. UK figures show deaths consistently running at 20 times higher than other industries. Errors in the financial industry led to a global meltdown of financial markets in 2008, the effects of which are still being felt.

Error has even become a commodity in recent times. Fake news sites have proliferated to the point where fact and fiction have become increasingly difficult to differentiate. This has been exploited by groups manipulating data to influence everything from how citizens vote to which car to buy. Perhaps it’s time to teach people how to analyse information to try to separate the wheat from the chaff.

The criminal community is hoping that doesn’t happen, though, as they focus their efforts on, among other things, misleading unwary citizens into divulging sensitive information such as banking details to side-step online security measures. If caught, they may be relieved to know that our justice and policing systems are as error-strewn as other areas of society.

In short, we can add error to death and taxes on our list of inevitabilities in life.

So What Can We Do About It?

The good news is that the problem of error is, at least in part, solvable. Using the toolbox of tried and proven error management strategies, we can make major inroads to reduce its occurrence as well as its impact, greatly improving outcomes for us personally and society generally. The pace of change may have out-run our brain’s ability to manage successfully, but we can fight back. Given that technological developments show no sign of slowing down, it’s time we got started!

Oops! Why Things Go Wrong: Understanding and Controlling Error by Niall Downey is published by The Liffey Press.

LATEST STORIES