In healthcare, we are preoccupied with measuring and avoiding error. Whilst, at first glance, this seems to be an entirely laudable endeavour, it may contribute to the development of a culture centred around negativity. To make matters worse, our attempts to understand the ‘root causes’ of our mistakes are based on flawed assumptions. We investigate error in retrospect: precisely the opposite temporal direction of reality. Hindsight bias results in an oversimplification of events whereby incident ‘x’ can be explained by omission ‘y’. More often than not, efforts to prevent recurrence of error result in the imposition of new boundaries, rules and check-lists. We gain control, but lose resilience.
I believe we should now start trying to measure excellence in healthcare. If we can capture it, we may start to understand how to emulate and reproduce it. Focusing on excellence may also promote innovation and improve staff morale and motivation through positive feedback of excellent performance.
I’m not saying we should stop looking at mistakes – we just need to redress the balance.