2. The Fallacy of Human Consistency: Ensuring “Hardwiring” as well as “Heartwiring”

The single greatest impediment to error prevention in the medical industry is that we punish people for making mistakes. - Lucian Leape

We all are complex creatures, characterized by fluctuating moods, varying levels of attention, and inevitable bouts of fatigue. These natural human traits introduce a level of inconsistency that is often overlooked in the rigid frameworks of healthcare quality systems. In this second article of the series "Rethinking Quality Systems: Untapped Human Element," we delve into the fallacy of human consistency and its implications for quality in healthcare settings.

The expectation of strict adherence to quality protocols in healthcare mirrors the impractical hope of a cat walking a straight line—both are against inherent nature. Such expectations can lead to significant discrepancies between the intended outcomes of quality protocols and the actual execution on the hospital floor. Recognizing this intrinsic human inconsistency is crucial for developing more effective and adaptable quality systems.

One of the most subtle yet profound effects of this inconsistency is the manifestation of confirmation bias among healthcare providers when individuals favour information that confirms their pre-existing practices, beliefs or hypotheses, disregarding or undervaluing evidence that contradicts them. This bias skews the objective assessment of patient care quality, leading to a selective interpretation of outcomes based on the expected rather than the actual results. This can also adversely impact protocols such as implementing care bundles for improving outcomes in Healthcare Associated Infections (HAIs) where ‘one’ missed component of the ‘bundle’ is considered ‘insignificant’ and yet it compromises the whole effort!

Consider another example - a nurse consistently overlooks deviations in protocol, believing that her team 'generally' adheres to standards, thus confirming her belief in the team's competency despite evidence to the contrary. This bias not only undermines the objectives quality assessment but also masks potential areas where critical improvements are necessary.

To mitigate the effects of human inconsistency and cognitive biases, healthcare quality systems must be designed with a deep understanding of human psychology. This means creating systems that account for human variability rather than punishing it. Hardwiring a ‘changed process’ is one such way that helps prevent slipping back to old ways. This means making it difficult to execute an erroneous process. Lucian Leape rightly said Human beings make mistakes because the systems, tasks, and processes they work in are poorly designed.

Introducing regular, unobtrusive reminders can help maintain focus and adherence without adding to the cognitive load of healthcare workers. Implementing systematic double-checks where different team members verify critical tasks can help counteract individual biases and oversights.

Furthermore, training programs that emphasize cognitive awareness can equip healthcare providers with the tools to recognize and manage their biases. By fostering an environment that encourages reflection and questioning, healthcare organizations can enhance the critical thinking skills necessary for high-quality care.

Leadership plays a pivotal role in addressing the human consistency. By acknowledging the natural limitations of their teams, leaders can foster a culture that values flexibility, supports continuous learning, and adapts protocols to better suit the context and the environments. This approach not only improves the accuracy of quality assessments but also enhances the overall resilience.

As we continue to explore the untapped human element in quality systems, it becomes evident that embracing human variability, rather than resisting it, can lead to more robust and effective healthcare practices. By designing quality systems that are as adaptable and nuanced as the humans they serve, we can ensure that healthcare remains both high in quality and deeply humane.

‘Hardwiring’ is the way to implement ‘change’, Heartwiring ensures that the change is sustained!