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C7RKY's profile
John Clarke
John Clarke
John Clarke
@C7RKY

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John Clarke

@C7RKY

Of course views all mine. All without prejudice. Just a regular chap after all. Oh...and RT's may equally imply ridicule as endorsement.

UK
Joined December 2011

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    1. Steven Shorrock‏ @StevenShorrock Jan 3
      Replying to @C7RKY

      But the data show that: The probability of Never Events is as low as for any complex task in any industry (human reliability doesn’t get much better than 99.997%) Resources are often suboptimal/not as designed/imagined (e.g. checklist implementation, staffing, workload, pressure)

      2 replies 1 retweet 3 likes
    2. John Clarke‏ @C7RKY Jan 3
      Replying to @StevenShorrock

      I've already said I don't expect zero. And yet the aviation industry managed to avoid killing a single passenger anywhere in the world last year? Are they just better at doing what they're ALWAYS supposed to do?

      1 reply 0 retweets 0 likes
    3. Steven Shorrock‏ @StevenShorrock Jan 3
      Replying to @C7RKY

      Yes, I know. But “never” means zero. Aviation death risk is extremely low (esp. for commercial scheduled passenger), but about 100x less complex, lower demand/pressure, better resourced, and less messy generally (not starting with a sick airplane).

      1 reply 1 retweet 2 likes
    4. Steven Shorrock‏ @StevenShorrock Jan 3
      Replying to @StevenShorrock @C7RKY

      Also vastly different safeguards in aviation. There have been, e.g., landing on or taking off from taxiways, landing wheels up, running off end of runways, clipping wings when taxiing, losses of separation, but a little bit of blue sky, plane itself or pilot protects passengers.

      2 replies 1 retweet 1 like
    5. John Clarke‏ @C7RKY Jan 3
      Replying to @StevenShorrock

      To be honest, I lost an entire day yesterday to one tweet a wrote comparing healthcare to aviation. And my only focus was on the impact of relative candour levels. I'd really prefer not to lose any more time to it. I'll stay focussed on healthcare, I think. Thanks though.

      2 replies 0 retweets 2 likes
    6. Steven Shorrock‏ @StevenShorrock Jan 3
      Replying to @C7RKY

      I agree. I have worked in aviation for half my life, and sometimes (voluntarily) in healthcare safety, and am a patient and father/husband/son of patients. I see ~few similarities.

      1 reply 0 retweets 2 likes
    7. John Clarke‏ @C7RKY Jan 3
      Replying to @StevenShorrock

      I'm not trying to directly compare the two - honest! I just find it impossible to conceive that candour isn't playing a role in healthcare safety, in a way that aviation doesn't suffer from. Personal survival is a powerful drive, but can provoke v different behaviours in each.

      1 reply 0 retweets 1 like
    8. Steven Shorrock‏ @StevenShorrock Jan 3
      Replying to @C7RKY

      One big difference could be this. Candour is much easier when no-one has been harmed or died, and your future is not on the line, and ‘just culture’ is defined in EU law (e.g., EU Reg 376/2014). E.g., in ATC candour is about mostly losses of separation between aircraft.

      1 reply 0 retweets 1 like
    9. John Clarke‏ @C7RKY Jan 3
      Replying to @StevenShorrock

      John Clarke Retweeted

      Sorry for the delay. That may be true, I agree. But I think there's a little more to the dynamic surrounding candour than just that, in the world of healthcare. It's a genuine and very serious problem. https://twitter.com/DrNHS2018/status/948209781977812994 …

      John Clarke added,

      This Tweet is unavailable.
      1 reply 0 retweets 0 likes
    10. Steven Shorrock‏ @StevenShorrock Jan 3
      Replying to @C7RKY

      Fear is at the heart of it. Fear unfolds in many ways.

      1 reply 1 retweet 1 like
      John Clarke‏ @C7RKY Jan 3
      Replying to @StevenShorrock

      Indeed it is and indeed it does. Any threat to your planned career is a serious one, when you start out with a £50k+ student loan. It's not the healthiest environment for candour to thrive. Or patients, for that matter.

      5:35 PM - 3 Jan 2018
      1 reply 0 retweets 0 likes
        1. New conversation
        2. Steven Shorrock‏ @StevenShorrock Jan 4
          Replying to @C7RKY

          It seems that the problem is, the system is set up for retributive justice first, not restorative justice. Both have a role, but in most cases of unintended harm, restorative justice must at least come first, and be fully embraced.

          1 reply 0 retweets 1 like
        3. John Clarke‏ @C7RKY Jan 4
          Replying to @StevenShorrock

          I'd say you're right. There's an argument to suggest a contradiction between professional guidelines and the law, when it comes to candour in medicine. Robert Francis recognised that and recommended a fix. Sadly, the fix we actually got was perverted by gov so as to be useless.

          1 reply 0 retweets 1 like
        4. Steven Shorrock‏ @StevenShorrock Jan 4
          Replying to @C7RKY

          ‘Fixes that fail’ - very common in social systems. https://en.m.wikipedia.org/wiki/Fixes_that_fail … It sounds to me like some protected time and space is needed to apply some restorative justice.

          1 reply 2 retweets 1 like
        5. John Clarke‏ @C7RKY Jan 4
          Replying to @StevenShorrock

          We certainly need something. Not sure that Wikipedia definition is ideal for this situation? Seems to describe a fix that starts out working, but later fails? This fix never worked - as intended.

          1 reply 0 retweets 1 like
        6. Steven Shorrock‏ @StevenShorrock Jan 4
          Replying to @C7RKY

          Problem, as with checklists, is failure in implementation. Inadequate analysis of context and how a fix affects (or does not account for) the context to create secondary problems or just embed problem further.

          2 replies 1 retweet 1 like
        7. Steven Shorrock‏ @StevenShorrock Jan 4
          Replying to @StevenShorrock @C7RKY

          Like Plan-Do-Study-Act cycles...often forgotten that this is only implementation phase. Study-Plan-Do cycle would be simpler, work better, and remind everyone to study the problem situation and context deeply first, from multiple perspectives.

          0 replies 2 retweets 5 likes
        8. End of conversation

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