Investigating only accidents and incidents takes you only to a certain minimum level of safety. To know more, you’ll have to start focusing on the days when nothing harmful happens.
Consider two hospitals. Hospital A has a clear record: no deaths because of malpractice. Looks like an class A institution. Hospital B has suffered two losses in the past. It unfortunately seems clearly like a class B hospital. With this statistic I would surely choose hospital A if was to to be operated in one of these.
But wait, this statistic includes only the fatal malpractise incidents. What do we now about potential other malpractise cases when the harm caused was something else than death? And more importantly, do we know what happened in 99,9% of cases? No we don’t. And that’s why our intuition might just fail.
Aviation is ultra-safe nowadays. The first big step was taken by improving and eliminating risks that had caused fatal accidents. This is the obvious first step and a rather easy way to take to achieve big improvement. However, investigating only accidents and incidents takes you only to a certain minimum level of safety. At that level a new problem arises: there aren’t enough cases available to study and to draw conclusions from.
There is only one solution to the situation. You’ll have to start focusing on the days when nothing harmful happens. The answer in aviation was FDM or flight data monitoring. Every flight is recorded, and statistics show the variation of certain parameters. Now we know how far safe everyday operations are from accidents or incidents. Now we know what to improve to make even further progress. Although the general public might hear the word black box used in connection to an accident, the data from the black boxes is actually used in daily quality improvement.
By now it is clear why intuition fails in our hospital A and B comparison. Hospital B failed two times, but we have no idea about either hospital’s average performance. Only recording all the operations would reveal that.
Maybe Hospital B’s mistakes were actually just isolated and easily preventable cases, while performance otherwise was at top level. Hospital A could have statistics that were nearly hitting limits on a daily basis, but luck was on their side when it comes to worst possible malpractise outcome: deaths.
Which hospital would you choose if that was the case?
The blog post is written by Mikko Määttä.
He is a Board Member at Megical Ltd producing easy-to-use digital safety and quality protocols to surgical processes and an Airline Captain at Finnair