Complacency at play in healthcare

How many of us consider ourselves to be better than average drivers? 78% of people on the roads think they are better than average. If you've got a mathematical bent, work that one out!

But what's the biggest killer on the roads? Probably complacency.

There's a great quote by Captain E J Smith, the captain of RMS Titanic. "I never saw a wreck and never have been wrecked nor was I in any predicament that threatened to end in disaster of any sort." Now does that ring any bells?

The number of times we meet people - and I've been doing this job for 30 years - and they tell me they don't need a checklist, or they don't need to change their approach. That's complacency at work.

It's almost like famous last words. We witness this a lot, where people kick back and say, "Why do I need a checklist? Why do I need to do briefings?" But when you look back at the root cause analysis of incidents, did everyone involved know what was going on?

That leads us to consider the whole idea about naturalistic decision making and pattern matching, with most decisions made during the day taking place without really thinking. We make decisions about what to wear or what to eat, without much thought at all. The same goes for walking, breathing, eating; doing the vast majority of things everyday. OK I accept the more stylish of you do think about what you're going to wear, but look around you. Plenty don't!

There's a bit of a danger in healthcare, where people have been told they should be so good at their job, that they can do it without thinking. In that respect, human factors concepts become heresy. Because what we're suggesting is that, you should always engage your brain and not make assumptions.

May I suggest that the high-performing professional is always thinking, "Is there something here which tells me I could be wrong?" Is there a contrary indication?

In over words, we need to look to overcome confirmation bias; the belief that, once we've made a subconscious decision, we're right. Humans tend to disregard anything that doesn't fit that initial pattern matching, our naturalistic decision making. It goes a long way to explain why complacency is such a factor because we're all sure that we're right.

I recently experienced complacency at work in an operating theatre. There was a change in the order of the list, with a patient elevated to the front of the queue because they were in greater need of surgery.

But instead of rubbing out the names on the whiteboard, the theatre team just reversed the order of the numbers listed alongside the names. It was worse than that, in fact; rather than erasing and rewriting the numbers, they added the revised order of numbers in a different colour.

As I watched this take place, I thought, "Why wouldn't you just rub out the numbers so there is no chance the order can be confused?"

Next time you come across someone who seems unduly pedantic and almost obsessive on checking everything. I almost guarantee that they'll be someone who found out the hard way and they really don't want to go there again.

Where does complacency play a role in your professional life, and what steps can you take to stamp it out?

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