Ms bk

“Memory, it turns out, is not as reliable as we think. We do not encode high-definition movies of our experiences and then access them at will. Rather, memory is a system dispersed throughout the brain and is subject to all sorts of biases. Memories are suggestible. We often assemble fragments of entirely different experiences and weave them together into what seems like a coherent whole. With each recollection, we engage in editing”

“Think back to the divide between aviation and health care. In aviation there is a profound respect for complexity. Pilots and system experts are deeply aware that they are dealing with a world they do not fully understand, and never will. They regard failures as an inevitable consequence of the mismatch between the complexity of the system and their capacity to understand it.

This reduces the dissonance of mistakes, increases the motivation to test assumptions in simulators and elsewhere, and makes it “safe” for people to speak up when they spot issues of concern. The entire system is about preventing failure, about doing everything possible to stop mistakes happening, but this runs alongside the sense that failures are, in a sense, “normal.”

In health care, the assumptions are very different. Failures are seen not as an inevitable consequence of complexity, but as indictments of those who make them, particularly among senior doctors whose self-esteem is bound up with the notion of their infallibility. It is difficult to speak up about concerns, because powerful egos come into play. The consequence is simple: the system doesn’t evolve.”

“Cycling is very different from international development, but the success of its most pioneering coach is based on the same conceptual insight. As Brailsford puts it: “I realized early on that having a grand strategy was futile on its own. You also have to look at a smaller level, figure out what is working and what isn’t. Each step may be small, but the aggregation can be huge.”