Involuntary automaticity: a work-system induced risk to safe health care

Abstract

Automaticity is the term given by psychologists to the skilled action that people develop through repeatedly practising the same activity, for example driving a car. Usually, automaticity is discussed in terms of the benefits it brings to people, such as the reduction in the degree of conscious attention a person needs to pay to such skilled activities. However, there is evidence to suggest that substantial costs may also be associated with such learned behaviour. Managing patient safety is a difficult task and one of the ways in which health-care professionals seek to accomplish it is through the use of verbal challenge-response protocols. However, it is argued in this paper that it is possible for the negative effects of automaticity to involuntarily capture those using such verbal checklist techniques and cause them to erroneously believe that the treatment that they are about to administer to a patient is safe when it is not. This phenomenon does not, however, seem to have been recognized by the health-care community nationally or internationally. We conclude that patient safety could be significantly improved worldwide if the organizational arrangements which appear to induce involuntary automaticity were to be robustly addressed by the management of all health-care organizations.

Primary Care Physicians’ Use of an Electronic Medical Record System: A Cognitive Task Analysis

“…27 However, when actions that require attention become habitual, automaticity can lead to errors. [28][29][30] Expertise The Dreyfus Model of Skill Acquisition 31 suggests that people pass through five stages in the process of developing expertise. These stages are: novice, advanced beginner, competent, proficient, and expert.…”

Understanding vs. competency: the case of accuracy checking dispensed medicines in pharmacy

“…This may be problematic in the practice setting where pharmacists may check dispensed medicines in a ritualised manner without conscious control or attention to the task (James 2009). This phenomenon of involuntary automaticity is more likely to occur when workload is high, interruptions frequent, staff are stressed, fatigued, well acquainted and trust each others professional judgement (Toft and Mascie-Taylor 2005;James 2009). Furthermore, interruptions and distractions in the workplace may impair a pharmacist's prospective memory, resulting in the undetection of dispensing errors due to failure of the pharmacist to recall and execute each stage of their checking process (Dieckmann et al 2006;James 2009).…”

The dangers of heparin flushes

“…Toft and Mascie-Taylor14 argue that the phenomenon of “involuntary automaticity”, a mindset induced in healthcare professionals by their working conditions, can defeat even the most dedicated and meticulous checkers. The problem appears to arise because although the task that is the subject of the verbal double-checking safety protocol actually requires close attention, once it is captured by involuntary automaticity only a superficial amount of attentiveness is paid to the variables being checked.…”