Monday, September 30, 2013

Duke Medical Center offers online training module "Anatomy of an Error"

@Whatsthepont pointed me to this online training module from Duke University Medical Center. Entitled "Anatomy of an Error," the course intends to teach hospital employees about the types of error they can expect and show them how to reduce error and avoid catastrophic outcomes through human factors and well-designed processes.

This is a very important piece of evidence that error and mistake awareness is becoming more prevalent in complex environments, such as health care, where it is badly needed. The Duke module is a good step forward. That being said, I have some criticisms of the course, which I will cover in a future post. For the moment, let's share the Duke definition of an error, which is aligned with the definition of a mistake from the introduction to the book:

Dr. James Reason, a Professor of Psychology who has published extensively on the nature of human error, describes error as circumstances in which planned actions fail to achieve the desired outcome.

Our definition of a mistake is: an unexpected result proceeding from faulty judgment or inadequate knowledge.

The Duke module is a very useful introduction to error and how it works in complex environments. But don't view it as the complete story - there are some significant missing components that I will discuss this week.

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