So if we teach them - they will do it right!
So the second blog, thanks to those of you who read the first and an in particularly to the person who noted if they printed it off it stopped a table wobbling ......
I have thought a bit about what to write as my second blog - not because I'm stuck for ideas but exactly the opposite there are loads of things that I am really keen to blog about - I could have done a follow up to the first blog and expanded that but I wanted to start some where else with the view to start to merge and see how all the blogs start to weave together.
So in this blog I want to focus on error and in particularly those subconscious - human errors. Personally I feel in health care we are fairly immature in our response and understanding of error. All to often the automatic reaction is why did they do that unfortunately even today all to often that is nearly as quickly followed by the offer of retraining to teach the person how to do it properly.
Errors are still seen as something careless that other people do, this is a cultural, social and professional viewpoint with the assumption that an error either is due to poor performance or lack of knowledge or maybe both. In some ways it feels our behaviouristic and academic process even further encourage this - we test people to see if they have remembered the knowledge and fail them if that have not.
Have a look at this youTube clip does the table on the left look longer than the table on the right. This is actually an optical illusion called Shepherd's Tables which leads us to a few conclusions about this illusion and how we process information.
- Everyone sees it the same way, the illusion is predictable and is due to the way our brain interprets and processes information
- It is not an active process but a subconscious one
- At a basic level the error can not be unlearnt and interestingly it can not be learnt - all we can do is to recognise that if we see something like this that looks different it may be the same
Although this is an optical illusion parallels can be seen with cognitive biases, these elements that are hardwired into our brains and affect our decision making in everything we do.
So are these biases common? - well we will have heard of some of them like confirmation and hindsight bias are there more? well this really helpful graphic has been put together to demonstrate just this - the cognitive bias codex has categorised 175 bias, additionally it groups them into four themes i.e. where we process too much information, need to act fast, do not having all the information and because of the limitations of what we can remember.
Remember as well, these bias are not just present in our clinic teams but also in those investigating errors, those writing and designing systems in fact anywhere the human is.
So in summary what does this mean?
- Subconscious human errors are often caused in part by these predictable biases that are programmed into our brains
- Teaching about the biases will not remove this hard wiring
- Having a well written policy or procedure will not remove the hard wiring
- It is only having system that recognise these elements and are designed to capture the errors caused by human bias we can prevent harm
I have thought a bit about what to write as my second blog - not because I'm stuck for ideas but exactly the opposite there are loads of things that I am really keen to blog about - I could have done a follow up to the first blog and expanded that but I wanted to start some where else with the view to start to merge and see how all the blogs start to weave together.
So in this blog I want to focus on error and in particularly those subconscious - human errors. Personally I feel in health care we are fairly immature in our response and understanding of error. All to often the automatic reaction is why did they do that unfortunately even today all to often that is nearly as quickly followed by the offer of retraining to teach the person how to do it properly.
Errors are still seen as something careless that other people do, this is a cultural, social and professional viewpoint with the assumption that an error either is due to poor performance or lack of knowledge or maybe both. In some ways it feels our behaviouristic and academic process even further encourage this - we test people to see if they have remembered the knowledge and fail them if that have not.
Have a look at this youTube clip does the table on the left look longer than the table on the right. This is actually an optical illusion called Shepherd's Tables which leads us to a few conclusions about this illusion and how we process information.
- Everyone sees it the same way, the illusion is predictable and is due to the way our brain interprets and processes information
- It is not an active process but a subconscious one
- At a basic level the error can not be unlearnt and interestingly it can not be learnt - all we can do is to recognise that if we see something like this that looks different it may be the same
Although this is an optical illusion parallels can be seen with cognitive biases, these elements that are hardwired into our brains and affect our decision making in everything we do.
So are these biases common? - well we will have heard of some of them like confirmation and hindsight bias are there more? well this really helpful graphic has been put together to demonstrate just this - the cognitive bias codex has categorised 175 bias, additionally it groups them into four themes i.e. where we process too much information, need to act fast, do not having all the information and because of the limitations of what we can remember.
So in summary what does this mean?
- Subconscious human errors are often caused in part by these predictable biases that are programmed into our brains
- Teaching about the biases will not remove this hard wiring
- Having a well written policy or procedure will not remove the hard wiring
- It is only having system that recognise these elements and are designed to capture the errors caused by human bias we can prevent harm
Is wilful awareness the only difference between subconscious bias and unconscious bias?
ReplyDeleteHi Gary,
DeleteSo wilful awareness would suggest it is neither subconscious or unconscious - but conscious i.e. a conscious decision. Most of the time subconscious and unconscious are used interchangeable, though experts may argue they are slightly different i.e. subconscious being easier to access and less primal than unconscious. However like all thee things the boundaries are probably blurred.
The subconscious element is potentially what makes these so interesting i.e. we feel we operate of our own free will but inherently our processing is being manipulated by these elements