PAPod 522 - Remix - Unveiling the Future of Safety and Resilience with Eric Hollenagle

WEBVTT 00:00:00.017 --> 00:00:03.377 Sit back and relax. It's a big podcast day. This, my friends, 00:00:03.717 --> 00:00:06.897 is the Eric Hollenagle Show. We'll be right back.

00:00:07.920 --> 00:00:19.120 Music. 00:00:19.097 --> 00:00:23.657 Howdy, everybody. It's Todd Conkron, and this is the Pre-Accident Podcast. How are you today?

00:00:24.257 --> 00:00:27.357 Good, I hope. Hey, it's a big show. This will be kind of exciting. 00:00:27.357 --> 00:00:34.677 If you've not heard of or ever been a part of a discussion around the ETO principle, 00:00:34.917 --> 00:00:37.417 E-T-T-O, Efficiency, Thernus, Trade-Off, 00:00:37.877 --> 00:00:43.077 or Safety 1, Safety 2, or the FRAM, the Functional Residence Model, 00:00:43.397 --> 00:00:47.297 or, gosh, I could just go on for months, months, I tell you.

00:00:47.737 --> 00:00:51.477 Then if you haven't ever had those kind of conversations, today's going to be 00:00:51.477 --> 00:00:55.517 a really exciting day for you because everything's going to be new and shiny 00:00:55.517 --> 00:00:57.157 like a penny found on the street. 00:00:57.597 --> 00:01:02.237 And if you have, you're probably even more excited because if you had had these 00:01:02.237 --> 00:01:06.937 conversations today, you're going to get to talk to somebody who is just quite amazing. 00:01:07.117 --> 00:01:12.977 Eric Hall and I roll and Eric is just a fine human being. Let's start with there.

00:01:13.897 --> 00:01:18.037 And I didn't think I would get him on the podcast, but I kind of tricked him. 00:01:18.377 --> 00:01:23.157 I'm not saying I blackmailed him. I tricked him. It's more it's it's less severe 00:01:23.157 --> 00:01:26.957 than blackmail.

But he had to introduce me at a conference a couple of weeks 00:01:26.957 --> 00:01:32.357 ago, and he asked me to write some things down for the introduction. And I said, I'd love to. 00:01:32.517 --> 00:01:35.137 I'll give them to you when we record a podcast. 00:01:35.757 --> 00:01:38.737 And he fell for it.

I mean, he totally fell for it. Just hook, 00:01:38.837 --> 00:01:42.417 line, and sinker. Boom. I had him.

So that is how that started, 00:01:42.477 --> 00:01:43.597 and we'll get to that in a minute. 00:01:43.997 --> 00:01:47.877 Let's bring you up on the speed of light in the world around us. 00:01:47.977 --> 00:01:51.557 It's, you know, it's an exciting day. I've 00:01:51.557 --> 00:01:54.437 had tremendous amounts of things go 00:01:54.437 --> 00:01:57.197 on and many things to talk to you about but probably 00:01:57.197 --> 00:02:00.097 the big one I should talk to you about is the power of 00:02:00.097 --> 00:02:02.777 resilience and the reason I'm going to tell you about the 00:02:02.777 --> 00:02:08.937 power of resilience is because I spilt not a coke not a diet coke but in fact 00:02:08.937 --> 00:02:15.477 a coke zero sugar pretty much a full-blown coke zero sugar I spilled from the 00:02:15.477 --> 00:02:20.257 little plastic tray on the back of the airline seat into my briefcase.

00:02:21.167 --> 00:02:25.407 And luckily for me, my briefcase was holding my computer. 00:02:25.587 --> 00:02:30.787 And luckily for me, my computer was standing upright. So like on the skinny 00:02:30.787 --> 00:02:33.447 end, it was standing up because, you know, it was in the briefcase. 00:02:33.767 --> 00:02:40.507 And even more luckily for me, I'd put the top of the case, not the keyboard 00:02:40.507 --> 00:02:47.647 where the clamshell closes, but the back hinge where the vents are for cooling the laptop.

00:02:47.647 --> 00:02:56.107 So when I did spill that Coke Zero sugar, it did travel into my briefcase and 00:02:56.107 --> 00:02:58.107 directly down into my computer. 00:02:58.387 --> 00:03:04.867 Yes, it's true. I lost it all. It was gone.

It was a sad day for my computer. 00:03:05.547 --> 00:03:10.707 Oh, so sad. And it's kind of non-recoverable, although I did take it to the 00:03:10.707 --> 00:03:13.647 computer place because they said it's worth taking it to the computer place. 00:03:13.647 --> 00:03:19.287 But I'm pretty sure if the Coke can live through, I mean, well, I'm sure the Coke lived.

00:03:19.447 --> 00:03:28.127 If the computer lives through the Coke Zero Sugar bath, I will be amazed because not a lot. 00:03:28.367 --> 00:03:31.967 I mean, it's just one of those little, you know, it's an airplane. 00:03:31.967 --> 00:03:33.367 You've been on a million of them. 00:03:33.567 --> 00:03:36.767 One of those little plastic cups on that little tray.

00:03:36.987 --> 00:03:43.227 And see, you probably can just lean that tray out and casually work on it. 00:03:43.227 --> 00:03:47.087 For me, I have to kind of suck in a little to bring the tray down, 00:03:47.087 --> 00:03:52.047 and I moved around, and it turned the tray, and it went up, and you can write the ending. 00:03:52.247 --> 00:03:55.407 I kind of wish that the Coke would have gone in the magazine pocket, 00:03:55.407 --> 00:03:59.547 because I don't really own the magazine pocket, nor do I care much about it. 00:03:59.907 --> 00:04:02.427 But alas, it went into my briefcase.

00:04:03.280 --> 00:04:09.280 But there's good news. Yes, I have good news for you. And the good news is, is I back it up. 00:04:09.660 --> 00:04:16.300 And that is the power of resilience.

I can't control when I'm going to spill a Coke in my briefcase. 00:04:16.580 --> 00:04:22.000 Clearly, I think I've proven that beyond a shadow of a doubt that that I clearly cannot control. 00:04:22.000 --> 00:04:24.840 But what I can control is my 00:04:24.840 --> 00:04:28.460 response to a coke being spilled in 00:04:28.460 --> 00:04:31.680 my briefcase and my response was that I 00:04:31.680 --> 00:04:36.720 had a backup and I had to get a new computer you knew that was coming and I 00:04:36.720 --> 00:04:41.920 plugged it into the little thing and it said do you want to start new or do 00:04:41.920 --> 00:04:46.680 you want to copy off your old computer and I clicked copy off your old computer 00:04:46.680 --> 00:04:50.240 and 45 minutes later probably even that long. I probably made that up.

00:04:50.640 --> 00:04:54.800 A little period of time, let's say 45 minutes, that's kind of an estimate later, 00:04:55.160 --> 00:04:56.800 it looked just like my last computer. 00:04:56.960 --> 00:04:59.680 It was just, you know, a little bit. 00:05:00.060 --> 00:05:05.220 I lost some notes that I'd taken, and I lost an article I brought down about 00:05:05.220 --> 00:05:07.400 the school bus driver in Chattanooga. 00:05:07.540 --> 00:05:11.120 But I think I can still find it, because I was really interested in that school 00:05:11.120 --> 00:05:15.300 bus driver, because they're saying he was on the phone, but he's saying he was 00:05:15.300 --> 00:05:17.640 not on the phone.

There was another truck involved. 00:05:17.820 --> 00:05:22.280 So it's getting the stories now starting to build around culpability. 00:05:22.560 --> 00:05:25.520 Well, it's already, I would say, built around culpability. But now it's starting 00:05:25.520 --> 00:05:28.940 to it's moving into sort of lawyer speak.

And so that's interesting as well. 00:05:29.080 --> 00:05:31.660 That is my giant story. That took a long time to tell. 00:05:32.620 --> 00:05:37.920 But the good news is The reason I'm not so upset about it And I'm really not 00:05:37.920 --> 00:05:40.040 It's just a computer, right?

00:05:40.460 --> 00:05:44.960 Is I think because it was backed up And that really is that emphasis around 00:05:44.960 --> 00:05:48.620 The notion of resilience that I think Makes the biggest difference in the world 00:05:48.620 --> 00:05:51.180 So that is kind of what we're going to talk about Now, 00:05:51.300 --> 00:05:54.500 to get started on this podcast I'm going to jump right in because I've already 00:05:54.500 --> 00:05:58.520 probably Taken too much of your time telling that stupid story Eric and I sat down, 00:05:59.301 --> 00:06:06.121 And the first thing I ask him is what's the future look like, 00:06:06.141 --> 00:06:10.521 which is normally a question I kind of saved till the end, but I was really 00:06:10.521 --> 00:06:14.261 curious to see what he had to say. So let's jump into this podcast. 00:06:14.521 --> 00:06:18.501 This is Eric Hallnagel and Todd Conklin on the Pre-Accident Podcast. 00:06:18.941 --> 00:06:23.061 Listen carefully because the first thing he's going to say is kind of what he's 00:06:23.061 --> 00:06:24.381 thinking about is happening next.

00:06:29.301 --> 00:06:35.101 On the next three or four years, I don't think we'll see much real difference. 00:06:35.321 --> 00:06:36.481 We'll see growing interest. 00:06:36.721 --> 00:06:40.201 But I mean, if you see it playing out in the sense of having an impact, 00:06:40.801 --> 00:06:45.061 you're talking 10, 15 years or even more. 00:06:45.581 --> 00:06:47.901 Look at the paradigms that we have now.

00:06:48.621 --> 00:06:56.601 I don't know where it will be going. I know what I'm interested in is to actually 00:06:56.601 --> 00:07:02.661 try and get rid of the word safety and the term safety and to look at system performance. 00:07:03.181 --> 00:07:07.601 Safety is an aspect of system performance, but I'm interested in how systems 00:07:07.601 --> 00:07:14.541 organizations function and to understand that functioning and to be able to 00:07:14.541 --> 00:07:15.921 manage that functioning. 00:07:16.581 --> 00:07:22.881 And safety in the classical sense is the part of that, but so is quality, so is sustainability, 00:07:23.421 --> 00:07:30.521 so is customer satisfaction, so is efficiency, see so many environmental impact 00:07:30.521 --> 00:07:33.421 or, I mean, there's so many things that are part of that.

00:07:33.581 --> 00:07:39.861 And really, I want to see them together and want to understand how they work together. 00:07:40.081 --> 00:07:43.361 But isn't that close to sort of blasphemous? I mean, does that, 00:07:43.521 --> 00:07:46.961 do you get pushback when you talk about that outside of the academy? 00:07:48.210 --> 00:07:55.030 Actually, I don't talk much about it in the academy.

I'm not really an academic anymore. 00:07:55.570 --> 00:08:01.670 But no, in fact, people are very interested in that because I think you must 00:08:01.670 --> 00:08:02.730 have seen that yourself, 00:08:02.990 --> 00:08:09.750 that people feel that they are stuck in silos and they treat safety as if you 00:08:09.750 --> 00:08:13.550 could treat it isolated from whatever else happens in an organization. 00:08:13.610 --> 00:08:15.750 And we all know you can't. 00:08:16.470 --> 00:08:23.790 It's just that we don't have the concepts and the terminology and the ideas 00:08:23.790 --> 00:08:26.130 really to bind it all together.

00:08:26.330 --> 00:08:32.870 And I think that's, for me, what's interesting and what I'm trying in my own 00:08:32.870 --> 00:08:35.450 feeble way to work a little at. 00:08:35.550 --> 00:08:40.270 But I don't know whether that's where it's going. I do see we have in healthcare 00:08:40.270 --> 00:08:45.630 had over the last conferences in resilient healthcare, a number of papers that 00:08:45.630 --> 00:08:49.870 sort of tried to dissolve the difference between quality and safety. 00:08:50.530 --> 00:08:52.810 And I think that's certainly the right way to go.

00:08:53.810 --> 00:08:56.970 Tell us about your journey. How did you get to where you are? 00:08:57.110 --> 00:08:59.690 What led you to think about these ideas? 00:09:01.110 --> 00:09:07.290 That's a question I find very difficult to answer because the honest answer is it just happened.

00:09:07.290 --> 00:09:12.710 I mean, it wasn't a journey as in retrospect, yes, you can see I have sailed 00:09:12.710 --> 00:09:17.590 these waves and then changed course here and there, but it wasn't pre-planned 00:09:17.590 --> 00:09:20.450 in any way. It just happened. 00:09:21.450 --> 00:09:25.410 What started your interest? I mean, what made it start to happen?

00:09:25.730 --> 00:09:29.150 Was there an accident? Did somebody include you in a failure? 00:09:29.430 --> 00:09:32.410 I mean, where'd this kind of take its origin? Yeah.

00:09:33.726 --> 00:09:41.546 Hard to say. I mean, of course, I was working with nuclear control room design 00:09:41.546 --> 00:09:44.686 and human machine systems when Tremont Island happened, 00:09:44.846 --> 00:09:48.746 of course, and that focused everybody's interest in a certain direction. 00:09:49.486 --> 00:09:55.986 And as a psychologist, I was always a bit skeptical about the idea of human 00:09:55.986 --> 00:10:03.306 error as a separate cause and a special cause and looking at things that go wrong all the time. 00:10:04.046 --> 00:10:10.366 So, I think it's more or less that by working with the issues and by talking 00:10:10.366 --> 00:10:16.386 with, discussing with colleagues, good colleagues, I mean, one of the people I met in, 00:10:16.606 --> 00:10:19.326 I think before TMI in 78, 00:10:20.006 --> 00:10:24.786 was David Woods and he was a young brash boy at the time and we had a lot of 00:10:24.786 --> 00:10:27.206 interesting discussions and I think talking with David, 00:10:27.426 --> 00:10:32.586 talking with other people and And hearing that and sort of when you sit down and talk, 00:10:32.746 --> 00:10:37.486 you say, well, what about this and what about that and could it be and it gradually 00:10:37.486 --> 00:10:42.646 starts to develop and you think that you find that some things are interesting, 00:10:42.846 --> 00:10:47.046 other things aren't and you follow that and it's a passage.

00:10:47.326 --> 00:10:51.306 I mean, it ended here. It could have ended anywhere else. Yeah. 00:10:52.019 --> 00:10:57.379 So it's just serendipity, really.

So you could be like a really famous author 00:10:57.379 --> 00:11:03.139 around baking cakes, if cakes would have been the serendipitous outcome of this outcome. 00:11:03.719 --> 00:11:10.779 Probably. I like making cakes, actually. I haven't created any new cakes on 00:11:10.779 --> 00:11:14.019 my own, but I like to bake cakes and pastry.

00:11:14.259 --> 00:11:21.519 But, yeah, I mean, listen, if you ask me 10 years ago or even certainly 20 years 00:11:21.519 --> 00:11:25.299 ago, where would I be today? I would never have said I would be sitting here 00:11:25.299 --> 00:11:27.899 and talking to you. I wouldn't even have known who you were. 00:11:28.479 --> 00:11:32.379 And I wouldn't have known this world.

And it just happened. I mean, 00:11:32.499 --> 00:11:34.079 it's not planned in any sense. 00:11:34.399 --> 00:11:37.599 And yet you've had this remarkable impact. I mean, and you know this, 00:11:37.739 --> 00:11:43.379 although you may not know, but the impact you've had has been very powerful.

00:11:43.999 --> 00:11:50.479 In really starting a conversation, at least in industry, around the trade-offs 00:11:50.479 --> 00:11:55.559 between being efficient and being thorough, being safe and being productive. 00:11:55.919 --> 00:12:00.119 And what's so interesting about that is I think that's always existed, 00:12:00.119 --> 00:12:06.399 but I think you brought it to the conversation in a way that allowed both operations 00:12:06.399 --> 00:12:11.799 people and academics to come together and see a ray of light. 00:12:11.799 --> 00:12:20.279 That notion of that trade-off has, I think, really changed the way we look at reliable systems. 00:12:20.759 --> 00:12:22.519 And that's powerful.

00:12:23.359 --> 00:12:27.679 What started all that? I mean, was that a bolt of lightning one day? 00:12:29.119 --> 00:12:34.899 Well, it's the same Hans has before. I don't really know.

I should say what 00:12:34.899 --> 00:12:42.299 I'm probably trying to do all the time is trying to make sense out of things for myself. 00:12:43.539 --> 00:12:46.839 And so then I think I understand what's going on. 00:12:47.139 --> 00:12:51.079 And this idea about the trade office is, of course, very old in psychology. 00:12:51.079 --> 00:12:56.859 And it just turned out to me that this seems like a useful thing.

00:12:56.859 --> 00:13:00.919 And I noticed that I work with people, work with industries. 00:13:00.919 --> 00:13:08.319 And it's just like you get an idea and you begin to look for it and you suddenly see it everywhere. 00:13:08.519 --> 00:13:11.479 And that's where you have to be a bit cautious because you shouldn't take over. 00:13:11.759 --> 00:13:16.099 Because it is just an idea.

It's not a psychological mechanism. 00:13:16.099 --> 00:13:18.719 It's just a convenient way of describing things. 00:13:18.899 --> 00:13:24.499 And any convenient way of describing things will capture something that's essential 00:13:24.499 --> 00:13:28.639 and throw away things that also potentially could be essential. 00:13:28.639 --> 00:13:33.659 And that's why you have to be very careful all the time about how you describe things.

00:13:34.459 --> 00:13:39.579 But again, don't ask me how I came to think about that. 00:13:39.719 --> 00:13:44.099 It just happened someday for some reason. 00:13:44.299 --> 00:13:48.059 I may have read something somewhere or heard something. I don't know.

00:13:48.787 --> 00:13:54.867 That, I think, is the amazing part of it is that I think you hit on it perfectly. 00:13:54.947 --> 00:13:56.767 It's the way you see the world. 00:13:57.127 --> 00:14:02.747 And I think what you bring to the table or to the discussion is a very, 00:14:02.927 --> 00:14:04.787 very interesting worldview. 00:14:05.087 --> 00:14:10.307 And that's, I mean, it's really apparent when you read your books, 00:14:10.487 --> 00:14:11.547 the writing you've done.

00:14:11.547 --> 00:14:17.267 I mean, the remarkable way you really try to look at complexity and the way 00:14:17.267 --> 00:14:20.787 you look at sort of causation models, it's been really powerful. 00:14:21.067 --> 00:14:27.867 And really, you're kind of maybe a one-man campaign to sort of expand the world's 00:14:27.867 --> 00:14:28.947 understanding of cause. 00:14:29.087 --> 00:14:34.727 Has that served you well or has that been a rough road to hoe? 00:14:37.167 --> 00:14:41.067 I don't feel I'm on a campaign to do anything.

things. 00:14:41.147 --> 00:14:49.147 Sometimes I do feel I'm a one man, not quite alone because others think and 00:14:49.147 --> 00:14:54.767 act in the same way, but I'm not really trying to make a campaign for anything. 00:14:54.907 --> 00:15:00.327 As I said, and this is really honest, I really try to understand things myself, 00:15:00.487 --> 00:15:04.147 to make sense of things myself and the world, 00:15:04.327 --> 00:15:11.167 whatever happens in the world, and that needs sometimes concepts and ideas that 00:15:11.167 --> 00:15:14.427 I can't find, and then I stumble upon them, 00:15:14.587 --> 00:15:19.527 or we talked about, apropos, podcasts and reading, 00:15:19.727 --> 00:15:23.727 and I mean, I've read a lot, I still read a lot, and I think a lot of what I've 00:15:23.727 --> 00:15:28.527 read over the years, it's there in the back of my mind, and the mind works in 00:15:28.527 --> 00:15:33.507 a weird and wonderful way, and you read something else and something clicks and say, 00:15:33.687 --> 00:15:38.627 isn't that a bit like it reminds you of and then something pops up. 00:15:38.687 --> 00:15:40.647 You can't really explain it.

It just happens. 00:15:41.107 --> 00:15:47.147 But I think you can, I wouldn't even say I prepare it, but I have a pleasure 00:15:47.147 --> 00:15:52.807 in reading many different things, many different sciences of books of all kinds. 00:15:53.087 --> 00:15:57.287 And I think there are sort of nuggets there that, I mean, one thing, 00:15:57.447 --> 00:16:03.887 the term I've used and many others have used is what you look for is what you find. 00:16:04.107 --> 00:16:07.527 But sometimes what you look for is not what you're conscious you look for, 00:16:07.607 --> 00:16:13.327 but you still look for it because the brain has this ability to relate what 00:16:13.327 --> 00:16:17.787 you perceive to what's in there, even though you can't remember what's in there.

00:16:18.167 --> 00:16:24.267 And then sometimes a little signal pops up and you work a bit on it and it turns 00:16:24.267 --> 00:16:26.847 out to be useful and that's how it works. 00:16:26.967 --> 00:16:32.187 But I mean, it's a mystery to me. If you were to advise people... 00:16:33.529 --> 00:16:39.089 The books that you've written to read, what do you think you'd have them read?

00:16:39.269 --> 00:16:47.349 What are the books that you think you're most proud of, you're most effective with? 00:16:48.149 --> 00:16:51.069 That's a good question, I know. That's an answer to a question. 00:16:51.889 --> 00:16:56.989 Well, you mentioned the Eto'o principle, and I think that I'm pretty proud of that.

00:16:57.109 --> 00:17:03.249 I think that was a neat way of formulating an idea that had been existing for a long time. 00:17:03.529 --> 00:17:09.449 Others have thought of before, but being fortunate to be able to come up with 00:17:09.449 --> 00:17:14.309 examples to illustrate that, I think that's very important when you write something 00:17:14.309 --> 00:17:15.549 to be able to illustrate it. 00:17:15.629 --> 00:17:21.049 So I think the etta principle is something I feel is a nice piece of work. 00:17:23.409 --> 00:17:28.349 And I mean, the two other ones that are really, I don't want to say I'm proud 00:17:28.349 --> 00:17:35.549 of them, but that I really think are decent works are Fram and Safety 1 and Safety 2.

00:17:36.049 --> 00:17:40.429 I think Fram in particular, Safety 1 and Safety 2, is not that original because 00:17:40.429 --> 00:17:44.949 this idea about you can look at things in different ways has been around for many times. 00:17:45.309 --> 00:17:49.729 And the ideas of Fram, of course, has also been around, but not sort of put 00:17:49.729 --> 00:17:51.549 together in a single place before. 00:17:51.809 --> 00:17:56.749 And I think that is perhaps a bit original, but I'm not sure how much. 00:17:58.209 --> 00:18:02.949 And the frame is something I was still working on and still developing and still being extended.

00:18:03.369 --> 00:18:08.729 I think your framework, at least for my career at the National Laboratories 00:18:08.729 --> 00:18:14.429 in the United States, that book changed the way we really thought about learning 00:18:14.429 --> 00:18:16.509 technically across the board. 00:18:16.709 --> 00:18:20.209 It was a powerful tool for us. 00:18:20.269 --> 00:18:23.629 And the timing seemed really right. And it really was, 00:18:23.909 --> 00:18:33.309 as odd as this sounds, at the time it was somewhat controversial to talk about 00:18:33.309 --> 00:18:36.829 cause other than sort of monocausal phenomena.

00:18:37.269 --> 00:18:44.029 And that surprises me. But maybe it surprises me just because of work you've 00:18:44.029 --> 00:18:45.409 done and others like you. 00:18:45.569 --> 00:18:48.849 We've sort of moved beyond the fallacy of monocausality. 00:18:49.029 --> 00:18:52.829 But it's a powerful force.

And you see it in industry. I mean, 00:18:53.229 --> 00:18:55.269 that's what we try to tackle. 00:18:55.949 --> 00:19:03.429 What advice would you give a person who's managing work, who's actually out 00:19:03.429 --> 00:19:07.369 in the field doing this new work? 00:19:07.669 --> 00:19:12.749 What would you tell them to think about or to listen to or to read?

00:19:13.994 --> 00:19:20.394 Well, can I just come back to one thing you said? Absolutely. The word timing. 00:19:21.194 --> 00:19:26.954 I mean, because I think maybe I've just been lucky I've come up with some ideas 00:19:26.954 --> 00:19:30.334 and the environment has been receptive to them.

00:19:30.454 --> 00:19:34.534 Others have come up with the same ideas at a time when the environment was not receptive to them. 00:19:34.634 --> 00:19:39.974 So it's very much about timing you sort of the right thought at the right time. 00:19:40.254 --> 00:19:43.354 And you can't control that. That's just sheer luck.

00:19:44.434 --> 00:19:51.054 It happens. Well, if I may, I would also suggest that the way you package the 00:19:51.054 --> 00:19:57.494 ideas and the way you create analogies and discussions and case studies and examples, 00:19:57.694 --> 00:20:03.574 I think actually makes these rather esoteric concepts more impactful. 00:20:03.734 --> 00:20:08.414 I think that's one thing you bring to the field is a remarkable way to look 00:20:08.414 --> 00:20:14.734 at pretty woolly ideas and make them have realistic applications. 00:20:15.314 --> 00:20:18.994 Well, I'm flattered that you say so.

00:20:19.274 --> 00:20:24.434 As I said, I'm really trying to explain it to myself, to make it understandable to myself. 00:20:25.194 --> 00:20:29.994 And, of course, by doing that, you can hopefully also make it understandable to others. 00:20:31.474 --> 00:20:34.754 I've always admired people who write, Jim Reason in particular, 00:20:34.814 --> 00:20:38.994 who writes really, really well, and I still admire his writing. 00:20:39.914 --> 00:20:42.454 And there are a lot of other people who don't write so well.

00:20:42.554 --> 00:20:48.794 I shan't mention the names here, but I think I've just been lucky that I have 00:20:48.794 --> 00:20:52.674 the ability to write in an understandable way. 00:20:53.714 --> 00:20:56.494 I don't know how it happened, but that's how it is. 00:20:56.494 --> 00:21:00.234 But to come back to your question, there is 00:21:00.234 --> 00:21:11.254 a famous samurai in Japan called Miyamoto Musashi in the 17th century and was 00:21:11.254 --> 00:21:20.194 sort of the undisputed master and ended his life peacefully as a Zen philosopher, a Zen monk. 00:21:20.194 --> 00:21:25.354 And he wrote a book which has been translated into English, it's quite famous, 00:21:25.474 --> 00:21:30.414 it's called The Book of Five Rings, and it's been used on Wall Street as sort 00:21:30.414 --> 00:21:31.934 of a management Bible also.

00:21:31.934 --> 00:21:40.034 But he made some observations about what you need to do to be able to be successful 00:21:40.034 --> 00:21:44.474 in his case as in the thought fight, but in general also. 00:21:44.614 --> 00:21:50.434 And one of the advices he gives is to perceive the things that cannot be seen. 00:21:51.444 --> 00:21:54.204 And I think that's what I think a good manager should do. 00:21:54.464 --> 00:21:57.924 He should perceive the things that cannot be seen, that is the things that are 00:21:57.924 --> 00:22:03.784 not obvious or do not attract attention by themselves, but which are still there, 00:22:03.944 --> 00:22:07.624 which is sort of hidden in the background because they can be very, very important.

00:22:07.804 --> 00:22:09.904 And I think that's a skill you have to learn. 00:22:10.524 --> 00:22:15.764 And again, to come back to the etude, that's an efficiency-thorough trade-off 00:22:15.764 --> 00:22:21.004 because you have to spend some time looking at things that seemingly are unimportant, 00:22:21.004 --> 00:22:24.284 but which actually, in many cases, turn out to be very important. 00:22:24.404 --> 00:22:31.164 So in the long run, the efficiency is reduced by spending time on that. 00:22:31.304 --> 00:22:37.564 But in the short run, the efficiency is reduced because you spend time on being more thorough.

00:22:37.724 --> 00:22:41.604 But in the long run, it actually improves efficiency to do that. 00:22:44.564 --> 00:22:47.704 And I don't like giving advice to people about what they should do. 00:22:48.304 --> 00:22:55.764 But to me, that advice of a musashi to perceive the things that cannot be seen is really important. 00:22:56.124 --> 00:23:01.624 And sort of looking at the things that often stare you in the eye and are so 00:23:01.624 --> 00:23:02.844 obvious that you miss them.

00:23:03.164 --> 00:23:06.424 And you have to sort of question yourself all the time and say, 00:23:06.424 --> 00:23:09.364 what am I really doing here? What am I looking at? 00:23:10.184 --> 00:23:12.324 That's phenomenal. What's your next book going to be about?

00:23:13.275 --> 00:23:16.675 I don't have any firm plans for our next book. 00:23:16.835 --> 00:23:19.795 It may happen, may not happen. 00:23:19.935 --> 00:23:25.155 Well, I mean, yeah, there is a series of books we've been doing on resilient 00:23:25.155 --> 00:23:28.215 healthcare, and that seems to be going on. 00:23:28.355 --> 00:23:34.215 I just completed editing the fourth book, and we are in the process of working on the fifth book.

00:23:34.335 --> 00:23:39.555 But that's sort of a collective effort. 00:23:39.555 --> 00:23:43.875 And perhaps you're asking whether I would do a monograph myself, 00:23:44.115 --> 00:23:53.835 and if time permits and if I can find a way of doing it, maybe what we talked about in the beginning, 00:23:54.175 --> 00:23:57.275 the development of Safety 2, 00:23:57.555 --> 00:24:05.075 sort of getting towards an understanding of how an organization works which 00:24:05.075 --> 00:24:08.815 is not tied up to specific issues or criteria, 00:24:08.975 --> 00:24:14.715 sort of safety and quality and efficiency, but it looks at the whole in another way. 00:24:14.895 --> 00:24:20.735 That's why I like the term that I use safety synthesis because I think I don't 00:24:20.735 --> 00:24:25.315 like safety so much now, but I like synthesis because I think it's the synthesis 00:24:25.315 --> 00:24:29.435 that we need to achieve and we need to understand, we need to work at. 00:24:29.815 --> 00:24:33.695 So maybe something along those lines.

Who knows? 00:24:34.255 --> 00:24:39.455 I think you're right. I think safety as a term is probably carried about as 00:24:39.455 --> 00:24:44.495 much water as it can carry and is no longer really no longer aligns with the 00:24:44.495 --> 00:24:48.235 way that we currently think about sort of reliable operations or reliable systems. 00:24:48.735 --> 00:24:52.735 Why do you think healthcare is so slow to come around to the new view?

00:24:55.512 --> 00:25:01.312 Well, I don't know why. I mean, are they slowing coming around to this issue? 00:25:01.752 --> 00:25:07.952 I think healthcare has always been about being careful and making sure that 00:25:07.952 --> 00:25:09.552 nothing happens to patients. 00:25:09.872 --> 00:25:11.812 That's a part of the Hippocratic Oath.

00:25:12.272 --> 00:25:15.272 First of all, do no harm. That's what it says. 00:25:15.612 --> 00:25:20.932 So that's 2,000 years old, so you can't really say that's slow. Okay, fair enough.

00:25:22.352 --> 00:25:25.792 But then I think healthcare has 00:25:25.792 --> 00:25:31.432 been a system that worked under its own conditions for a long, long time. 00:25:31.712 --> 00:25:39.592 And then only maybe about 50, 60 years ago, it started to be more tightly coupled 00:25:39.592 --> 00:25:41.192 to other aspects of society. 00:25:41.352 --> 00:25:49.172 And it started to get the focus of society and authorities also because it started 00:25:49.172 --> 00:25:52.112 to become more and more expensive. and then people are more and more concerned.

00:25:52.392 --> 00:25:57.612 And then the pressure came on the Institute of Medicine report to errors human 00:25:57.612 --> 00:25:59.632 and stuff like that. And then the pressure was there. 00:25:59.752 --> 00:26:04.612 And then as in every other industry, when the pressure suddenly comes on, 00:26:04.752 --> 00:26:09.092 like nuclear after TMI, like aviation and a number of cases, 00:26:09.812 --> 00:26:14.332 they sort of rush around like crazy and look for solutions wherever they can 00:26:14.332 --> 00:26:18.592 and they borrow solutions from others and apply them. 00:26:18.592 --> 00:26:22.832 And usually they don't work because they're not designed for that specific purpose.

00:26:23.052 --> 00:26:29.372 So healthcare is in that situation now, but I think it's partly because of the 00:26:29.372 --> 00:26:32.652 external pressure that came for any number of reasons. 00:26:33.404 --> 00:26:36.724 I find that really interesting, this idea that they borrow solutions from other 00:26:36.724 --> 00:26:40.064 industries and they don't work because they're not designed to work in that industry. 00:26:40.504 --> 00:26:43.684 That's actually a really good example, at least in the United States, 00:26:44.404 --> 00:26:46.764 of kind of where h