Mary Logan: Whose World View Do We Use to Define and Manage Risk?

I’m fascinated by the wide variety in how people in healthcare technology define, view, manage, and tolerate risk. I have added to my reading list on this topic a recent article by Malcolm Gladwell on auto recalls, “The Engineer’s Lament.” In our world of healthcare technology, Gladwell’s piece helps all of us, engineer or not, think harder about how we view risk.

Cars are not perfect, and in theory we all accept the imperfections and compromises. We would never be able to afford a car that was perfect. And yet, the Toyota “sticky pedal” story could be renamed the “cars must be perfect” story. It’s rare for us as car operators to believe that the problem is in the driver’s seat. We always want to jump to the conclusion that the problem is the car itself. Try to tell us we are wrong, and we dig in like a “man convinced against his will.”

Gladwell contends that the public approach to auto safety reflects a preoccupation with what might go wrong mechanically with the vehicles we drive. However, he makes a powerful argument that that the chief factor in advancing auto safety is not what we drive but how we drive. Yes, airbags save lives. But does a massive recall for a sticky pedal save more lives than the increasing the number of police on the road, staying sober, obeying speed limits, wearing seatbelts, or removing distractions as we drive?

Our collective desire to make healthcare technology easier to use, foolproof, and more human centric is important. The pressure to add new safety features akin to airbags also matters, and such pressure can help to drive innovation.

At the same time, Gladwell’s point about the focus of our attention with automobile safety warrants discussion in the context of safety with healthcare technology. In healthcare delivery, we often cut corners on training, push to do everything faster, add more and more distractions, and tolerate odd “driving” techniques and shortcuts. Beyond piling on the pressure to improve the technology itself, we need to pile on the pressure to improve the environment of care and consider how we use and support that technology.

In the end, I believe that all of these factors matter. Engineers must continue to see risk as a series of specifications and tolerances, and rely on the numbers. That alone isn’t enough, though. We do need to pay attention to the social context of how devices are operated, and to the whole environment of care. Keeping all of these voices in balance is a challenge—not listening too much to the engineers; not listening too much to the medical officers and nurses; not listening too much to the patient or the patient advocate; and not listening too much to the money guys. Each view is a little bit of right and a little bit of wrong. The only truly shortsighted view is the one that thinks that the only problem is everyone else.

Mary Logan, JD, CAE,  is the president of AAMI.

One thought on “Mary Logan: Whose World View Do We Use to Define and Manage Risk?

  1. It is about the rational allocation of resources and whose resources they are. In the auto case, I don’t think we want to let the manufacturers off the hook because of driver issues they aren’t going to invest in.

    All of our resources cannot be expended on all of our risks as we have discussed here before. But there is so much resistance, even hostility, when someone is told that their issue is not the most important issue. A recent replay of that discussion has been the risk of someone hacking an infusion pump in order to do evil. Even accepting that there is a theoretical potential for this to happen, today’s patient using a PCA pump has more to worry about than the pump being hacked.

    We are good at identifying risks. We aren’t that good at comparing them and prioritizing.

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