Why We Make Mistakes by Joseph T Hallinan

Why We Make Mistakes by Joseph T. Hallinan examines may ways in which we make mistakes.  We often fail to correct an error because we do not look at the root cause.  Dennis Quaid's children nearly died because they were given the incorrect concentration of blood thinner.  The bags with different concentrations were of similar color and his children were given the incorrect dose twice by two different people.  The manufacturer had even made changes to the bags with different coloring and a new warning label.  Unfortunately some of the older similar colored bags were still in service at the time of the mistake. 

We also think we will do better than we actually will do unless we are depressed or know that we are very poor at the task.  Under these two circumstances, predictions about outcomes are usually very accurate. 

Failure of senior experts to respond to feedback from individuals with less experience also creates mistakes.  Deaths and errors in surgery can occur because of the strict authoritarian structure in the operating room.  This authoritarian structure created problems with airplane crashes in the past but modern flight training has put members of the flight crews on equal footing.  Thus airplane crashes and fatalities have been severely reduced.  The author reports that medical error rates have been relatively stable for over fifty years with 10s of thousands of people dying annually due to medical errors in hospitals.  The author estimates that medical errors are the 8th leading cause of death in the US.

I am not an expert on hanging outdoor lights although I acted like one. This past weekend, I refused to listen to suggestions about how to put up the hangers insisting that I had it right.  It turns out I was wrong and the light hanging took twice as long as it needed to on a cold day.

Joseph Hallinan: Design things the way people actually use them.

The book, Why We Make Mistakes: How We Look Without Seeing, Forget Things in Seconds, and Are All Pretty Sure We Are Way Above Average is available from Amazon.com.