Intellectual humility

Bob Latino blatino at RELIABILITY.COM
Tue Apr 18 14:43:40 UTC 2017


Thank you Robert.

Recently on this forum someone posted a Cognitive Bias Codex that was reprinted in Business Insider magazine.  I tracked the source of that back to Wikipedia which lists over 175 different types of biases and their definitions.  That astounded me given that while many had different names, a considerable number of them overlapped to varying degrees.

In the case of 'intellectual humility', that reminded me of 'Confirmation Bias, defined as:

‘If new information is consistent with our beliefs, we think it is well-founded  and  useful “Just like I always said!”  But if the new information is dissonant  then we consider it biased and foolish “What a dumb argument!”  So powerful is the  need for consonance, that when people are forced to look at  disconfirming evidence they will find a way to criticize, distort, or dismiss it, so that they can maintain or even strengthen their existing belief.’

Tavris, Carol., Aronson, Elliot, Mistakes Were Made (But Not By Me), Why We Justify Foolish Beliefs, Bad Decisions, and Hurtful Acts, Orlando, 2007, p.13, [Chap. 1].

When considering if a bias existed in a decision made, that resulted in an adverse event, the facilitator/investigator conducting the interviews would have to be well versed in understanding all of these biases.  In my experience, it would be rare to find such a lead investigator which such deep domain knowledge about the scope of these biases.  I say this because I believe this lack of domain knowledge would be a big detriment to conducting an effective, comprehensive and accurate investigation.  Such an investigation would require a leader who knew the right questions to ask.  "An expert is not someone that gives you the right answers, but rather someone that asks you the right questions." - Eli Goldratt - The Goal

One of the primary problems I see with the application of 'RCA' in HC is that most RCA efforts are compliant, they meet the minimal requirements of TJC and everyone is happy because they get their Federal funding.  However, while most of the 6000 hospitals in the U.S. are accredited, the reported death rate due to medical error has risen from 44,000 - 98,000 (IOM, 1999) to 440,000 (NPSF, 2014).  If most hospitals are accredited (compliant), shouldn't we expect the medical error death rate to decline?  I believe much of this is due to the lack of effective investigations that do not delve deep enough into the understanding of human reasoning.

I also wrote about this if anyone is interested,  'Effective Root Cause Analysis Means Accepting We Could Be Part of the Problem'

https://www.linkedin.com/pulse/mistakes-were-madebut-mefacing-mirror-bob-latino

We all share unity in purpose, but the challenge I see is defining the scope of the problem and breaking it down into its manageable elements.

Thanks for your time everyone.


Robert J. Latino, CEO
Reliability Center, Inc.
1.800.457.0645
blatino at reliability.com
www.reliability.com
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From: Centor, Robert [mailto:rcentor at UABMC.EDU]
Sent: Tuesday, April 18, 2017 9:48 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: [IMPROVEDX] Intellectual humility

I just wrote a blog post based on a fascinating article about intellectual humility.  In it I suggest that this trait could help us minimize some diagnostic errors.  I would love the group’s comments:

A personality trait that may help us minimize diagnostic errors
http://medrants.com/archives/8695

======================
Robert M Centor, MD, MACP

Chair-Emeritus, ACP Board of Regents

Professor, General Internal Medicine
UAB
FOT 720
1530 3rd Ave S
Birmingham, AL 35294-3407

Phone: 205-934-7997
Fax    : 205-975-7797
--


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