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Hindsight bias, outcome knowledge and adaptive learning
  1. K Henriksen1,
  2. H Kaplan2
  1. 1Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, MD 20850, USA
  2. 2Columbia University, College of Physicians & Surgeons, New York, NY 10032, USA
  1. Correspondence to:
 Dr K Henriksen
 Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, USA; khenriks{at}


The ubiquitous nature of hindsight bias is a cause for concern for those engaged in investigations and retrospective analysis of medical error. Hindsight does not equal foresight. Investigations that are anchored to outcome knowledge run the risk of not capturing the complexities and uncertainties facing sharp end personnel and why their actions made sense at the time. Important lessons go unlearned if the exercise is simply to back track someone else’s decision landmarks. Outcome knowledge can also bias our thinking on the quality of the processes that led to the outcome. This paper examines the influence of outcome knowledge in relation to reconstructive memory and legal testimony, ways for reducing the impact of outcome knowledge, and an adaptive learning framework that places hindsight bias in a broader context of rapid updating of knowledge.

  • medical error
  • hindsight bias
  • outcome knowledge

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  • No official endorsement of this article by the Agency for Healthcare Research and Quality, the Department of Health and Human Services, or Columbia University, College of Physicians & Surgeons is intended or should be inferred.