Much of the Human Factors Training that occurs across the NHS would fall under the banner of ‘raising awareness’, as it is absolutely vital as nothing changes or improves without awareness. So can we be ‘aware’ enough of how errors occur in order to prevent us making such errors?
I would like to hope that I have a pretty good understanding of cognitive biases, being a key topic when looking at any form of human, team or organisational performance. One of the most famous is confirmation bias - the brain’s tendency to lock onto information that confirms what we think, this being particularly true when we become invested in a particular course of outcome.
I must have run hundreds of training sessions and coaching interventions looking at the various forms of cognitive bias and their influence on performance and safety, so I should be pretty good at noticing when I am subjected to my own biases, right?
At the end of last summer my wife and I took a short holiday to the West Country, the first night of which spent in a lovely bed & breakfast on Exmoor. The weather was beautiful, and with the stunning moors right on the doorstep we decided to take a walk, with descriptive maps provided by the place we were staying.
I commented at the time (here’s the awareness kicking in) that some of the language in descriptions was a little ambiguous and open to interpretation, but the route seemed fairly straightforward (just a routine walk) so off we set! For the first couple of miles all went well, and as we ticked off the various way-points, confidence grew and we felt terribly pleased with ourselves.
A little while later the seed of doubt crept in (though interestingly, no thought of ‘I wonder which of my biases might be at work here) - you know the ‘I’m sure we should have seen the bridge by now…’ thoughts, but we pressed on, taking comfort in various other landmarks - “Oh that wiggle in the path back there must have been the Y junction in the instructions…etc”.
Can we be ‘aware’ enough of how errors occur in order to prevent us making such errors?
The path became narrower and narrower and eventually my wife enquired as to whether we should turn back? Having walked for a good 20 minutes since the first seeds of doubt appeared I was reluctant - what if we are on the right track and we waste time backtracking?! We’ve come this far now, let’s keep going! (Destructive goal pursuit anyone?) When another 10 minutes later the path disappeared among a large thorny bush I’d like to say that at this point I admitted defeat… but no, I was determined to find a way round!
Eventually, when it became apparent that the path was no longer in existence I had to concede that we were, in fact, completely lost. Cutting the rest of the story short, we backtracked and eventually found the point we went wrong and completed the walk, albeit some 2 hours later than it should have been!
When I reflect back on this mini-adventure with the benefit of hindsight (of course we are all geniuses in hindsight) I can see how ‘obvious’ it is that I was becoming progressively more invested in my course of action and was seeing what I wanted or expected to see in the landscape around me. The very nature of subconscious bias is that they are exactly that - occurring below our level of conscious awareness, and awareness of these facets of the human condition does not stop them from influencing our performance.
Confirmation Bias - the brain’s tendency to lock onto information that confirms what we think, this being particularly true when we become invested in a particular course of outcome.
Raising awareness of how we make mistakes - of human capabilities and limitations and their impact of performance - is clearly a vital starting point in any journey to becoming a high reliability organisation. But if we actually want to achieve high performance consistently, we need to design our systems to bring out the best in our capabilities and mitigate our limitations. We need to develop and train teams to bring out the best in one another, and to be able to pick up when someone heads off down the wrong path.
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