Sitting back at home listening to Mark Knopfler on the stereo, faced with the immediate decision of who I should listen to next. It’s been snowing here in Stow and Mo has been doing the heavy work of snowblowing the driveway. I’ve just been sitting here on the couch, sipping a banana smoothie, and dealing with the light stuff like phone calls and writing emails.

I have several articles on medical system safety to get through and am trying to get my thoughts in order about how to address the topic from the inside. The specific role of the patient in the medical team is clearly dependent on the patient himself/herself. Obviously, some patients, by nature of their condition, may be unable to do anything; but others may, by cultural conditioning, have developed an attitude that doctors are infallible and that a doctor’s pronouncements are not to be questioned. Such patients may believe that providing information not explicitly asked for during the interview period, or indeed at any time, will only confuse the issue. Unfortunately, whether intentionally or not, some doctors may encourage this attitude. As with pilots in the related aviation domain, you have to have a bit of an ego to be a doctor. You hold the life of the patient (passenger) in your hands. A doctor’s (or pilot’s) error may result in an accident and everyone will know it.

It is this mode of thinking that system safety contradicts. It says, in essence that people don’t mean to make errors, that accidents don’t happen because of a single error, and that blaming the person on the “sharp” end is both unfair and ineffective in preventing further accidents. The goal of system safety therefore is to figure out why people make errors and what to do about it. A good deal of the writing that I’ve seen about system safety seems to focus on the design of the system, and forgets that that there are two other aspects of safety that need to be considered:

1) People often prevent accidents. Even the best engineered system can fail. Case in point: this morning when Mo started the snowblower she did not realize to let out the choke. She came and fetched me and I showed her what to do and everything appeared OK. A little later however, during a break in the Mark Knopfler CD, I became vaguely aware of an unnatural beeping. After wandering through the house I tracked it down to the CO detector in the basement. The exhaust from the snowblower had drifted from the garage to the basement. Mo was not aware of the problem because of the noise of the snowblower, and I was slow to react. Note to self: Buy CO detector for garage!

2) Technology advances, but this advance is often both to the detriment as well as to the benefit of safety. Using a process not suited to the current technology can actually introduce additional risk. Technology often introduces another potentially confusing layer between the operator and the intended result. For example, while in hospital hooked up to the IV, I would often lie there helplessly, awaiting a nurse, while the infernal infusion pump beeped at me, not knowing whether the beep signified a serious malfunction or not. A simple gravity feed I can handle – when the bag is empty I’m done – but I have yet to figure out the buttons and settings on the pumps.

Bottom line, as all good engineers know, engineering is about people, process, and tools. May Allah protect us from pointy-headed process engineers!