Accident investigation and risk assessment have for decades focused on the human factor, particularly 'human error'. Countless books and papers have been written about how to identify, classify, eliminate, prevent and compensate for it. This bias towards the study of performance failures, leads to a neglect of normal or 'error-free' performance and the assumption that as failures and successes have different origins there is little to be gained from studying them together. Erik Hollnagel believes this assumption is false and that safety cannot be attained only by eliminating risks and failures. The ETTO Principle looks at the common trait of people at work to adjust what they do to match the conditions - to what has happened, to what happens, and to what may happen. It proposes that this efficiency-thoroughness trade-off (ETTO) - usually sacrificing thoroughness for efficiency - is normal. While in some cases the adjustments may lead to adverse outcomes, these are due to the very same processes that produce successes, rather than to errors and malfunctions. The ETTO Principle removes the need for specialised theories and models of failure and 'human error' and offers a viable basis for effective and just approaches to both reactive and proactive safety management.
'Hollnagel combines an accessible style with rigorous logic as he invites us to examine in new ways the socio-technical systems that have become so essential to our world. His observations of the ETTO Principle lead to insights about human and social performance variability and expose the limits of traditional bimodal analytical methods. Healthcare practitioners will find inspiration and greater understanding of the challenges of providing safe care in an underspecified and frequently intractable system. Bravo!' Rob Robson, Chief Patient Safety Officer, Winnipeg Regional Health Authority, Canada 'This is an impressive book, simultaneously bold and reasonable. Hollnagel, in his highly readable style, lays out a simple but profound principle - the tradeoff between thoroughness and efficiency - and uses it to cut through all kinds of sterile debates in order to provide valuable insights about human behavior.' Gary Klein, author of Sources of Power: How People Make Decisions 'With characteristic flair, Erik Hollnagel has cleverly captured in The ETTO Principle the pervasive problem of how we balance efficiency with thoroughness in our working life. Deftly blending material from decision science, accident analyses and risk management, he leads the reader through a fascinating series of adverse events, identifying the ETTO components to produce new insights into causal influences. Provocative reading for those interested in business efficiency and organisational safety.' Rhona Flin, University of Aberdeen, UK 'The ETTO principle resonates as a practical and workable premise from which to begin to address the complexity of healthcare. The specialized reductionist models that have been purported to apply to healthcare (Swiss Cheese, Root Cause Analysis) may be asking the wrong question. By biasing our view to the "retrospectoscope" we may chose not to look forward, at the complexity, context and trade offs in which modern healthcare occurs. We're using the ETTO Princ
Contents: Prologue; The need to understand why things go wrong; From rationality to ETTOing; Explaining human irrationality; Efficiency-thoroughness trade-off in practice; The usefulness of performance variability; ETTOs of the past; ETTOs of the future; Epilogue; Index.