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PAPod 583 - When Normal Variability Breaks: The ReDonda Story

PreAccident Investigation Podcast

The Pre Accident Podcast is an ongoing discussion of Human Performance, Systems Safety, & Safety Culture.

Show Notes

This episode previews a small workshop in Santa Fe where Todd Conklin, Ann Lyren, and guest ReDonda Vaught will explore a tragic patient safety case. They frame accidents as the unexpected combination of normal performance variability and discuss how to learn from such incidents.


Listeners will hear about the meeting goals (March 31–April 1), opportunities to chart the event, and practical tactics for organizations to identify and respond to accumulating risks, with cross-industry lessons and a focus on improving safety culture.


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