I wonder if any of you have seen the tv series ‘The Rehearsal‘? It is a very unusual, and often difficult to watch, programme directed by Nathan Fielder. Hard to summarise, it is mainly about taking people and placing them in a simulation almost so real that they cannot tell the difference between the simulation and real life. He then tries out multiple scenarios to see how they play out. The second series focused predominantly on aviation safety.
I kept thinking about patient safety and the many questions that those of us who work in safety are grappling with such as:
- how do we anticipate failure?
- how do we prepare people for any eventuality?
- how do we assess and mitigate the risks before something has happened?
I think there are 10 key areas that I took away from watching.
- A key part of safety is about trying to understand what happens before things go wrong in order to prevent a failure or unintended consequence. Rather than wait for failure he asks what could happen, what decisions might someone make, what information would they need, what pressures might influence their choices?
- Context shapes everything. Nathan repeatedly creates environments where people can practice their choices and you can see that even the tiniest of change in the conditions can have a big impact.
- The programme questions the illusion of control. Nathan’s extraordinary effort to anticipate every possibility is unsettling because the desire to create certainty in an uncertain world is impossible. We cannot control everything but that is what he tries to do, time and time again.
- Risk is about building in safeguards, barriers and the ability for people to adapt because ultimately you cannot test out every possible scenario. The world is too complex. Despite the desire for certainty, in the end what the programme suggests is that you can help people work with that uncertainty; recognise patterns, explore different options, build confidence and practice responses. This is exactly what those who work in simulation or emergency exercises are trying to do.
- Expertise alone does not make us safe. We have to have reliable systems, communication, teamwork, safe staffing, cross checking, and dependability of resources and people around us.
- Safety is emergent. Small decisions, small choices, assumptions, misunderstandings, missed opportunities all create a gradual change in outcomes.
- Having time for conversations matters. Creating the space to talk things through before something is done is vital. We see this in briefings or the time out step of the WHO surgical checklist.
- Using two words ‘what if’ is really powerful. What if this happens next, what if this person reacts in this way, what if….
- That we need to seek better ways in which we can explore the difference between what should happen and then what actually happens when real people face real situations.
- There are unintended consequences to everything. What if our attempts to make things safer create new problems? When does preparation become too much control? When does reducing risk reduce creativity or stifle performance?
Reference: Fielder, N. (Creator, Writer and Director). (2025). The Rehearsal: Season 2. HBO.
Season 2 explores aviation safety, particularly the challenges of communication, decision-making and human behaviour in complex systems. Through elaborate simulations and rehearsals, the series examines how people prepare for uncertain situations and how small interpersonal dynamics can influence safety outcomes.
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