STILL LEARNING HOW TO LEARN

The emergence of safety in health care as a legitimate systemic public issue has turned on its head a good deal of our traditional thinking. One area where this has been particularly acute is what we could call “medical epistemology”—how we know we know something in health care. When health professionals first encounter the study of safety in health systems, they frequently feel a tension between the familiar world of epidemiology and bioscience and this strange new world, with its roots in psychology and engineering and its methods seemingly subjective and anecdotal. Cook¹ pictures them caught between these two worlds, trying to learn new ways of learning about safety but holding on to the security blanket of more familiar evidentiary methods. Their problem goes beyond simple intellectual assent; to some extent there seems to be an emotional and aesthetic—one might even say visceral—discomfort with these new methods, a fear that letting go of the evidence-based life ring will inevitably lead to superstition, myth, and chaos. This tension has led to debates about proper methods,² with both sides largely preaching to the already converted.³

The classic paper by March et al⁴ republished here should help redirect this conversation into more productive areas. By describing in detail …