‘First catch your error’
We all make small errors daily, but how could we make fewer and do better?
One sort of error we make is knowledge-based, eg not knowing how to use a bit of technology properly, like a computer at work. Training can help reduce these errors as people acquire the knowledge to use it better. However, sometimes training is inappropriate for certain devices, eg walk-up and use ticket machines, and training can be expensive, so we need to reduce the need for this through intuitive design.
Training also has other limitations, namely, in reducing ‘slip errors’. For example, if you want to remember to post a letter when you next leave the house you’d do well to recognise that you might forget it. So, what could you do to help you remember it? Well, you could leave it near your front door in the hope that you’ll see it and pick it up on your way out.
A good strategy to increase the chances that your letter gets posted isn’t ‘more training’ but ‘better resilience’ – leaving the letter by the door is a good and simple example of a resilient strategy. Recognising our own vulnerabilities to simple daily errors is the first step in developing resilient strategies to reduce them. Many people have a check list when leaving the house so they don’t forget something important, or get locked out later: Mobile phone? Keys? Wallet? Travel card?
‘You’re doing it wrong’
There are a number of ways to get something wrong – if you don’t know what you’re doing (lacking the relevant knowledge) then errors are a likely outcome and training can certainly help here. But people also make ‘slip’ errors – they know exactly what to do but interruptions or a lack of attention helps errors flourish. In one of the examples above the worst outcome is forgetting to post a letter, but the outcome can be much more serious in a medical setting if a patient gets the wrong dose of a drug or the wrong drug. How can we build in resilience here?
Good design can help – and it doesn’t have to be complicated. A simple modification to a process, eg having cash machines that return the card before they give you your money, can make a big difference to the outcome.
In this three minute CHI+MED film from Dr Dominic Furniss we hear from Dr Jonathan Back on how psychologists classify errors, and how resilient strategies can be employed to mitigate their effects. Interspersed with clips showing someone avoiding errors in their daily life Jonathan sets the scene for the problem that CHI+MED scientists are addressing – making interactive medical devices safer.
(This short clip ‘Human Error, Resilient Strategies & Device Design’ is part of a 15 minute short film called ‘Man-Machine Nightmares: Chaos buttons, human error and healthcare’ which is available on our website).
- Understanding interruptions – Jonathan’s work with other CHI+MED scientists on the cognitive processes involved in recovery (or not) from an interruption
- Resilient medical systems – Dom and Jonathan’s work on understanding ‘what goes right‘
Back J, Brumby DP and Cox AL (2010) Locked-out: Investigating the effectiveness of system lockouts to reduce errors in routine tasks Paper presented at CHI-2010: 28th ACM Conference on Human Factors in Computing Systems.
Furniss D, Back J, Blandford A, Hildebrandt M and Broberg H (2010) A resilience markers framework for small teams To appear in “Reliability Engineering and System Safety”
Furniss D, Back J and Blandford A (2010) Resilience in emergency medical despatch: Big R and little r Appeared in Proceedings of “Workshop on Interactive Systems in Healthcare“, Atlanta, GA.
See more CHI+MED research publications here