Chapter 13 Enlightenment

William Schutlz argued in 1979 that understanding progresses through three stages;

  • superficial simplicity
  • confused complexity
  • profound simplicity

Profound simplicity is achieved when people doubt the completeness of their assumptions, and through experimenting with a wider variety of possibilities may realise that out of that confusion may come a fuller understanding of what they face (Weick 2009).

The superficial simplicity in risk and patient safety included the notion that all we needed to do was imitate aviation and other high-risk industries and we too would be safe.

Confusing complexity arrived when the care provided didn’t seem to get any safer – so we threw a load of interventions at people – shouting ‘why are you not any safer’, ‘do as you are told’ ‘stop making mistakes.

Weick (2009) suggests that we have to progress through these stages and that time and experience helps us see that our initial simplifications are superficial, but also that some of those initial simplifications still hold true, although for different reasons than first thought.  These new simplifications help us make sense of the earlier confusion and are become profound simplicities or wisdom. Profound simplicity arises from a deeper knowledge and understanding of what is happening.

So profound simplicity is only achieved by working through the confused complexity and this needs to be lived.  For this to work experiential learning is vital. Without that people have no idea why the simplifications are profound, why they work, or what lessons there are.  Without this lived experience the borrowing is superficial and typically fails when implemented (Weick 2009).

So in patient safety it feels like we are moving into an era of profound simplicity, where we are starting to realise that there are some fundamental and seemingly simple aspects related to how we work in patient safety that we considered in the beginning that could make a profound difference to the safety of patient care.

Our profoundly simply ‘approach’ is our focus on helping people talk to each other.

This is our throughline; the strong thread throughout all the elements of our work.  A way of connecting everything together.

Our solution for change is conversations; allowing people the time to speak, listening with intent and asking the right questions.  This chapter and the following chapters describes our work to build on this approach in more detail.


Weick KE (2009) Making Sense of the Organisation; the impermanent organisation Chichester: Wiley (John Wiley and Sons Ltd)