Automaticity and safety II

Automaticity is the ability for us to do things without thinking – going on to automatic pilot if you will. It allows us to automatically do things that are habits, rituals and norms. In my view this has a clear link to how we want to look at safety through the safety II lens or framing.

Automaticity is usually the result of repetition and practice. The obvious analogy is driving. Once we have learnt to drive and we repeatedly continue to drive, this increases our skill and our ‘muscle memory’ that then lends itself to a degree of automaticity. Other common examples would be walking, speaking, any aspect of a production line way of working. Once we gain this skill and are sufficiently practiced we can then focus our mind on other activities or thoughts. How many times at work do you think you are experiencing this automaticity, that you are doing one thing but are thinking of something else. Given the complex adaptive nature of healthcare I would suggest this is extremely frequent.

What are the links with safety II?

This ability to be on automatic pilot or to be thinking of other things while doing something else and to be distracted has consequences for safety. For example, it has consequences for our checking of prescriptions, checking of infusion pumps, ensuring we have the right information or the right patient and so on.

So when we try to study what we do everyday, the mundane and the ordinary, part of this is to study the things we do automatically. Because, by doing so we may reach some interesting conclusions and not only find your how we maintain safety but also what the near misses might be, or the clues that we might see that show us the fine line between safe and unsafe care. What is that study telling us about how we generally succeed to complete our task but also what are the conditions or factors that could lead it to fail.

In the same way as when we are driving, every now and then we notice what we are doing, we notice when we came close to another car, or didn’t break as quickly as we could or we thought we could move out of a junction in time but nearly didn’t. It is the same way that we might think we can drift into an unsafe space and move from the speed limit to something faster and faster. This could also be an unsafe space at work. We drift into taking more and more risks.

It is clearly linked to the four stages of competence:

Unconscious Incompetence – you don’t know what you don’t know – we may not may not recognise our own incompetence

Conscious Incompetence – you know what you don’t know – we recognise that we don’t know how to do something and value addressing this

Conscious Competence – you know that you can do it now – we know how to do something but the skill or knowledge still requires our concentration

Unconscious Competence – you can do it without thinking about it – we have so much practice that it has become second nature (automaticity) and can be performed easily – as a result the skill can be performed while doing something else

What can we do about this?

Automaticity can be disrupted by paying explicit attention to what you are doing.

Asking yourself to slow down, press the pause button because you are concerned that you are drifting into that unsafe space.

Bring the subconscious into your conscious.

Activily tell yourself to be alert when you know you could be anything but.

Study how safe we are and how safe our systems are by thinking about the times where we are on automatic pilot or where we are exhibiting unconscious competence.