The soft stuff is the hard stuff


So, we have a bias towards negativity: we see error without trying, and we have a preference to criticise and focus on others’ errors and misfortunes.  If you don’t believe me, check out the most read news stories on any ‘news’ media source and count the ratio of negative to positive stories. Hardly reflective of reality is it? Click here for the BBC most read stories today.  While I’m on the subject, I should also point you to Kahneman’s work on loss aversion. We value loss more than the equivalent amount of gain. Weird but true.

But here’s a paradox: it’s actually easier to give sincere praise than criticism. It takes less effort, and it makes us feel better (both giving and receiving). This is especially true in face to face encounters.

So what does this mean for patient safety? In my opinion the “safety 1” culture (reacting to error and harm) has got out of hand. Learning from error is important but the agenda is being driven by a ‘movement’ which gives no acknowledgement to loss aversion. Mistakes happen, and will always happen. But it is time to attribute the correct value to them and to acknowledge the value of excellence. Then we may be able to open the doors to the immensely fruitful study of learning from what goes well.

Safety 2 is a great start. Read about it here. But where are the tools to use this approach? Learning from Excellence  (or positive event reporting in any form) is our offering.

In case you think this is all a bit ‘soft’, consider this: doctors and nurses are leaving their jobs, getting sick and killing themselves.  So I would argue that the ‘soft’ stuff is the ‘hard’ stuff.

Why all the negativity?


We have an innate negativity bias.  Our ancestors survived, in part, because of their ability to spot inconsistencies.  Our sense-making, automatic brain is excellent at spotting patterns, and inconsistencies in those patterns.  This happens before our conscious brain is even made “aware”.  This means that, most of the time, we can’t stop ourselves spotting mistakes.  Therefore we have to look a little harder at our world to spot excellence.  This bias may have helped our ancestors survive, but it is probably not helpful for our organisations.  It takes a slight, but significant, change of mindset to start actively noticing excellence to the point where we can capture it.

So, I urge you to take the plunge and start looking intently for excellence.  When you see it (and you will!), please take the time to inform the individual or team who performed it.