Qual Saf Health Care 18:69-73 doi:10.1136/qshc.2007.024273
  • Organisational matters

Involuntary automaticity: a potential legal defence against an allegation of clinical negligence?

  1. B Toft1,
  2. P Gooderham2
  1. 1
    Faculty of Health & Life Sciences, Coventry University, Coventry, UK
  2. 2
    Cardiff Law School, Cardiff University, Cardiff, UK
  1. Professor B Toft, 1 Gartons Road, Middleleaze, Swindon SN5 5AG, UK; brian.toft{at}
  • Accepted 2 July 2008


Background: It has been argued that the safety of patients can be put at risk because the verbal challenge—response protocols, frequently used by healthcare professionals—can be compromised by the system of work in use and the operational environment. Individuals who constantly undertake verbal double-checking safety protocols, when subjected to adverse operational conditions such as high workloads, strict time constraints and high levels of stress, can be captured by a so-called “involuntary automaticity.”

Conclusion: Evidence suggests that involuntary automaticity could be used as a potential legal defence, against an allegation of clinical negligence, where the healthcare professional concerned had warned their management that the conditions in which they worked could promote the phenomenon, and no remedial actions had been taken by them.


  • See Commentary, p 3

  • Competing interests: None.