Yesterday I gave a talk to some students on science communication and public engagement with a particular focus on what we’ve been doing on the CHI+MED project.
One of the themes running through our work is the idea that human error is pervasive and that ‘more training’ is rarely the most appropriate response to an error, even a medical error happening in a hospital setting. We’ve used “Errordiary” as a way of collecting examples of everyday errors, and as a way of involving people in our research (join in! Share your errors on Twitter with the hashtag #errordiary, or on the website linked above).
Different kinds of errors (giving a patient the wrong drug, mistyping the dose into an infusion pump) have counterparts in the everyday world (trying to brush your teeth with shaving foam instead of toothpaste, mistyping a telephone number) and we’ve been using our collection of these to highlight how often we err.
Take this example, from Andy Gimblett
If this had happened in a medical setting his error could have caused patient harm but it’s not clear that retraining him would help in avoiding such an error in future. It’s also difficult to see how training would stop you from PULLing a door marked PUSH. We slip in and out of doing the wrong thing, but most of the time it doesn’t cause too many problems.
“I proudly include myself in the idiot category. Idiocy in the modern age isn’t an all-encompassing, twenty-four-hour situation for most people. It’s a condition that everybody slips into many times a day. Life is just too complicated to be smart all the time.
The other day I brought my pager to the repair center because it wouldn’t work after I changed the battery. The repairman took the pager out of my hand, flipped open the battery door, turned the battery around, and handed the now functional pager back to me in one well-practiced motion. This took much of the joy out of my righteous indignation over the quality of their product. But the repairman seemed quite amused. And so did every other customer in the lobby.
On that day, in that situation, I was a complete idiot. Yet somehow I managed to operate a motor vehicle to the repair shop and back. It is a wondrous human characteristic to be able to slip into and out of idiocy many times a day without noticing the change or accidentally killing innocent bystanders in the process.”
So if ‘more training’ isn’t always the answer, what is? Accepting that error is part and parcel of life is a good place to start along with making ourselves more resilient against making an error in the first place, or reducing the error’s effects. A blog post by Dom Furniss gives several examples of resilience strategies created by nurses as they give medication to patients – What ‘resilience strategies’ help medical professionals reduce error and improve performance? and we’ve also covered the topic of resilience on this blog: Human error, resilience strategies and device design.
However sometimes ‘more knowledge’ might be useful of course and I think we’d all agree that this tweet below, in which a man took rather drastic steps to rid himself of ants, would fall into that category.
If you are beset with ants, do not set fire to your home – perhaps try a pest controller. Please think of this as a public service announcement from all of us here at CHI+MED 🙂