The bad apple theory won't work: Response to 'challenging the systems approach: why adverse event rates are not improving' by Dr Levitt

摘要

There is no doubt about Dr Levitt's genuine concern for patient safety.1 His experience, like that of others, must indeed have led him to hospital staff he'd rather do without. One can understand the seduction of sanctioning non-compliant doctors or getting rid of the deficient practitioners-the system's bad apples-altogether, as also proposed by Levitt. In 1925, German and British psychologists were convinced they had cracked the safety problem in exactly this way. Their statistical analysis of five decades had led them to accident-prone workers; misfits whose personal characteristics predisposed them to making errors and having accidents. Their data told the same stories flagged by Levitt: if only a small percentage of people is responsible for a large percentage of accidents, then removing those bad apples will make the system drastically safer.