Oops! Why things go wrong – a blog by Niall Downey

Summary

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.

In this blog, Niall Downey talks about his book, Oops! Why Things Go Wrong, which explores why error is inevitable, how it affects many different industries and areas of society, sometimes catastrophically, how it is sometimes actually quite efficient from a physiological standpoint and, most importantly, what we can do about it.

Content

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 while still running on caveman software!

This dichotomy is the essence of what I explore in my book, Oops! Why Things Go Wrong. 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.

Society is also, unfortunately, very intolerant of error, especially in others. We need to change this mindset.

Error is nothing to be ashamed of. The only way to even come close to avoiding error is to be so cautious and risk averse that we stifle innovation and, in healthcare, avoid 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 around 10% of hospital admissions suffer an adverse event with around 5% of these causing or contributing to their death. Error is estimated to cost about 10% of a country’s healthcare budget despite up to 70% being considered preventable. In the UK alone, that’s over £15 billion.

When I moved out of healthcare and retrained 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 around 3.000 people while currently figures 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 70s.

Twelve years ago I started to convey the lessons from aviation to a healthcare audience with limited success. However, recently 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. For instance, agriculture has the highest mortality rate amongst workers in the UK and Ireland. UK figures show deaths consistently running at twenty times higher than other industry averages. 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 the information to influence everything from how citizens vote to what shampoo they use. Perhaps it’s time to teach people how to analyse information to try to separate the wheat from the chaff.

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!

About the Author

Niall Downey attended St. Columb’s College in Derry and qualified as a doctor from Trinity College, Dublin. After twelve years of medical training, Niall decided to change course and retrained as an airline pilot with Aer Lingus, initially combining aviation with medicine by working as an Accident & Emergency doctor before focusing full-time on aviation.

He currently operates on Aer Lingus’ Airbus A330 fleet flying on their transatlantic network. Niall provides courses and speaks at major conferences on the topic of error management, in particular how it relates to the healthcare industry. He lives with his family in Newry in Northern Ireland.