Missing the obvious

In an attempt to restore confidence after a flurry of blunders, the Hospital Authority is reportedly planning to establish a 'court of discipline and professional competency' for proceedings against staff involved in serious adverse events. Coupled with management exhortations for improved teamwork and the prospect of 'safety police' patrolling the wards, the public may be forgiven for assuming that delinquency is widespread among hospital staff.

From a judgmental perspective, it can be difficult to understand why ostensibly straightforward tasks are bungled with such regularity by supposedly well-trained individuals. But this view is strongly prejudiced by our societal concept of sentient autonomy, which attributes erroneous actions to poor choices and inapt risk-taking. This is fundamentally unfair to the hospital frontline workforce who are overwhelmingly dedicated and conscientious.

The psychology of cognition provides a more complete (but uncomfortable) explanation: error-proneness is itself a by-product of expertise. This paradox arises because proficiency is attained by attentional filtering and the formation of mental models. Skilled behaviour becomes increasingly automatic and less under conscious control as rules develop (based on expectations) which allow for fast and accurate predictions and correct performance most of the time.

However, these schemata are subject to subliminal biases of confirmation (selectively seeking data which support a preconceived view) and cue generalisation (using broader, rather than more detailed, characteristics for inference) which can lead to failure of the planned task in some settings. A key concept here is looking but not seeing ('inattentional blindness'), which is a seemingly inexplicable failure to apprehend what should be obvious. A classic demonstration of this phenomenon is one in which observers tasked with counting basketball passes often failed to perceive a gorilla walking across the court.