It's Not Just Safe - It's 40% Safe

Added on May 29, 2015

Patient Safety

Futurama is an animated sitcom on Comedy Central. Bender is the robot character (see inset right). In another one of Bender’s wild schemes, he has his team attached to headsets and electric current. The team responds “Are you sure this is safe?” And Bender replies “It’s not just safe – it’s 40% safe.”

I learned of this scene from my fourteen-year-old son, Jack. Here is a link to view the scene:

We laugh because 40% safe is not safe at all. And in this comedy – there is a serious safety lesson. Safety margins are not well known or sometimes even knowable in patient safety. The difference between 99.9% safe and 99.0% safe – or even 95% safe - is not well understood. That is why we have an unfortunate tendency to sometimes borrow from safety to make time or cost or satisfaction work in the moment.

James Reason – in his book, Managing the Risks of Organizational Accidents – concluded that we are not very good odds-makers. We don’t know the difference between a harm probability of one in 1,000 and a harm probability of one in 10,000. Reason states “Accidents do not occur because people gamble and lose, they occur because people do not believe that the accident that is about to occur is at all possible.”

We are not Las Vegas odds-makers. We do not think it is possible. It will not happen to us. It cannot happen here.

Questions to Consider:

  • 1. Not all harm comes from short-cuts, but short-cuts can cause harm. In our work, what short-cuts are sometimes taken without us knowing the change in harm probability? What makes us think that these short-cuts are safe?
  • 2. What makes the difference in our safety thinking when we realize that a short-cut is unsafe? Is the difference realizing that the probability of harm is too high? More likely – it is the experience of an actual harm event near to us, where somebody important to us was harmed. That harm event may be recent or long ago and etched into memory.
  • 3. How can we learn from each other? Instead of everyone learning the hard way, how can we learn from each other’s actual harm events? This learning would need to be more than intellectual – it would need to change our belief that it really can happen here.  
    If we could learn this way, there would be fewer patients harmed, fewer of us injured, and less Bender-like thinking.