Added on Dec 17, 2015

Half-dozen is just a complicated way of saying six. High Reliability Organizations love simplicity – especially in guidance documents such as policy, protocol, flow-sheets, and checklists. (Reluctance to Simplify Interpretations is one of the five Weick & Sutcliffe attributes of High Reliability Organizations. This is a statement against over-simplification – not simplification.)

Say it simply. We at HPI use a collection of methods called Focus & SimplifyTM to streamline processes and rewrite policy & protocol using good human factors. We would never say half-dozen when six would do.

Complexity in the written word has a long history:

1. Winston Churchill observed “this report, by its very length, defends itself again the risk of being read.”

Healthcare Safety

2. Geologist James Hutton was such a poor writer that his revolutionary theory was not understood until rewritten by a friend, John Playfair. Hutton cloaked his work in a 2,138 page book. Playfair later remarked “the great size of the book … prevented it from being received as it deserved.”

Hutton is now recognized as the father of modern geology. His theory is that movement of the Earth’s crust has created all geological features. His theory replaced the notion that the Earth was shaped by the great flood.

Here is a sample of his work:

A rock or stone is not a subject that, of itself, may interest a philosopher to study; but, when he comes to see the necessity of those hard bodies, in the constitution of this earth, or for the permanency of the land on which we dwell, and when he finds that there are means wisely provided for the renovation of this necessary decaying part, as well as that of every other, he then, with pleasure, contemplates this manifestation of design, and thus connects the mineral system of this earth with that by which the heavenly bodies are made to move perpetually in their orbits.

And closer to our world of patient safety, quality, and reliability – a chief nursing officer asked us if the way they had written their medication policy was causing medication error. Our finding was “no, there was little evidence that anyone was using that policy.”

We could and should be applying human factors to our guidance documents, just as we apply human factors in the design of devices and the environment of care. An easy way to get started is saying it simply. Flesch-Kincaid is a reading comprehension measure built into the Tools section of Microsoft Word. To be consistent with good human factors, general guidance should range between 6 and 8. Warnings and precautions should be 4. (The measure roughly corresponds to reading grade level.) An example – from a medicine warning label – is inset right.

Questions to consider:

1. How usable are our guidance documents? Do poor human factors in these documents inhibit good use and adherence?

2. What could we – as safety and reliability leaders – do to systematically improve human factors in our guidance documents? Should we start, as some healthcare systems have done, a long-term effort to Focus & SimplfyTM all of our guidance documents?