I wonder how many saw the Horizon programme on BBC1 this week. An anaesthetist was discussing the issues around Doctors mistakes. He looked at 1) Becoming so focused on the task that situational awareness is lost and looked at some fire service training to deal with such issues. 2) The use of checklists to avoid the problem of overlooking key task actions before moving forward 3) The way F1 pit teams are organised to undertake complex high risk tasks by the use of defined individually allocated smaller tasks and the use of an overall control to decide when things can move forward. Fascinating stuff and well worth reflecting on for all H&S situations Bob

Didn't stop Lewis Hamiliton drawing up at the wrong pit crew the other day!!! Oops!

My first thoughts went around the problem of overtraining so as to create total focus on the task. In construction the situational awareness is key however. Why else do people climb on handrails to get a job finished or run up an insecured ladder or even fill in a pothole on a main road without signage and guarding. Checklists too must surely replace much of the verbiage of so many risk assessments but they need time to construct properly but be broad enough not to require continuing update. There is a major training course here but it needs some thinking about Bob

This is a timely news story on the heels of what happened to me very recently...... I had a medical intervention about 3 weeks ago which involved the application of a pain killing drug (lidocaine) into my neck. At an early stage in the procedure, I was on a theatre bed with my face covered with a clean dressing when a huge row broke out between the surgeon and anesthetist. It appears that the anesthetist had put the lidocaine and a saline solution on the same table - something this surgeon does not do. The surgeon shouted NO YOU FOOL! DO YOU KNOW WHY I WANT IT KEPT SEPARATELY?? . The anesthetist argued the toss saying it didnt matter as they didn't do it for the previous procedure. The surgeon the went of to shout at him explaining if he injected the lidocaine into my cerebral spinal fluid (instead of the saline??), he (ie me!) would immediately stop breathing. "DO YOU WANT THAT?... WELL DO YOU?". The theatre went silent and hardly a word was said until the end when the surgeon finally acknowledged my presence and said the op was complete. God knows what my blood pressure was by then. This is a routine procedure but with a huge needle being passed between vertebrae and close to the hundreds of nerves in my spine, you would like to think the team would be on the same wavelength and certainly not fight as they did it!!

The book "The Checklist Manifesto" by Atul Gawande, the featured surgeon in the programme who developed the WHO checklist, is well worth a read for much more detail and background. Also for the clarity of types of checklist, and the 'science' behind said checklist development. James Reason is referenced I believe from memory.

Bob Your thread started with medical risks. Assessment of risks is the responsibility of every doctor with every patient at all times. And the nature of risks differ not only between patients but between fields of specialisation in medicine. In the UK, legal management control of clinical risks is a matter both for the individual clinician and his/her senior consultant (who is cross-examined by a coroner in the event of a fatality, including suicide). As indicated by the relatively rare occasions when an issue surfaces in the media, responsibilities in medical affairs are unavoidably distributed amongst many individuals and groups.

tabs, your comment "A checklist for groups of people unwilling to acknowledge real risk is unlikely to succeed" rings true with things I've witnessed. Examples are vehicle pre-use checks for road-working where drivers seen ticking all the yes boxes without checking tyres, lights etc, and even some permits to work checklists I've looked at were not done properly e.g. tower scaffold users who had ticked the boxes but had missing toe-boards or mid-rails or no traffic barriers. Both cases they are solely focussed on getting the job started quickly (so they can finish early, I expect). No comparison with the commitment required of F1 teams or hospital theatre staff.

Bob, I'm (as a consultant) dealing with some small companies who only employ me because a bigger client insists, and although the employees have inductions etc they will often get on with job instead of doing the safety first things. I catch them out because they don't know what day/hour I will turn up to audit. I do my best to explain/remind what they are not doing, and what the consequences will be of an accident and they haven't taken the proper precautions/checks - not just the company is at risk but the employee/supervisor/manager can be liable. Toolbox talks with illustrated leaflets and such are employed when I persuade managers that there's been too many recent findings, e.g. to remind/explain why we have specific risk assessments (yes, they sometimes have checklists...) why we insist on PPE, vehicle checks etc. Within the same construction company I will audit some seasoned gangs who do everything by the book, great, but next day there's a gang of recent recruits just a week after their induction and it's hard work with them. "despair" as you say comes to mind, and as tabs said "I think this is where we come in and we must try harder".

Kieran, as well as the statements I agreed with, referred to in msg #15, I also have to agree with Bob when he said "we are bad at getting the message across" which is why the 'try harder' comes in. I do wonder, though, how trainers/consultants' effectiveness can ever be satisfactorily achieved. We could liken it to the 'flaw of democracy' often quoted: giving everyone the vote when half the population have below average intelligence (they may not make the right decision) We give everyone 'responsibility' in safety but maybe half the population don't want that responsibility and do the unintelligent thing - ignore it.

Jeff You seem to be describing many Safety persons I have met also. Maybe many who have been diploma trained or equivalent will have heard of these people and events BUT most seem very poor at applying the information to their professional practice. The evidence is in the continual stream of the "same" accidents where lessons learned from elsewhere are still not applied. Bob

Messy, surely this is a Near Miss/Close Call which should be reported!?

My daughter was in theatre the other day and shadowing a trained nurse who was so intent on getting through the patient pre-op checklist that he seemed to forget he had a traumatised and very frightened patient in front of him. Checklists are good, they have a place, but they have to be used in conjunction with a personal, hands on approach. We need to do everything properly but we need to rememberd that people do not all fit into the same mould and then structure our approach to the person we are dealing with at the time.

Messy - I understand where you are coming from but three observations worth considering. 1. It should have been reported by the surgeon as a near miss. 2. I thought following the Staffordshire debacle the NHS is now encouraging whistleblowing. 3. I would have thought of all people a safety practitioner should be less worried about any repercussions.

Messy, it was not intended to be a criticism old chum - just an observation. God knows how many times I have turned a 'blind eye' in my professional career for whatever reason.