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The ETTO Principle: Efficiency-Thoroughness Trade-Off: Why Things That Go Right Sometimes Go Wrong [Paperback]

Erik Hollnagel

Price: CDN$ 33.89 & FREE Shipping. Details
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Book Description

June 2009 0754676781 978-0754676782
Accident investigation and risk assessment have for decades focused on the human factor, most notably in the form of 'human error'. Countless books and papers have been written about how to identify, classify, eliminate, prevent and compensate for 'human error'. This preoccupation with failure is near universal and can be found in all fields of application. One consequence of this has been a bias towards the study of performance failures, leading to a neglect of normal or 'error-free' performance. The common, unspoken assumption is that failures and successes have different origins and that there therefore is little to be gained from studying the latter. Erik Hollnagel argues strongly that this assumption is incorrect and that it is impossible to attain safety by eliminating risks and failures. Instead it is better to study why things go right, and to find ways to support and amplify that. The aim of this book is to present a single, simple but powerful principle for human performance that can be used to understand both positive and negative outcomes. The ETTO Principle reflects the common trait that people in their work naturally adjust what they do to match the conditions - to what has happened, to what happens, and to what may happen. It proposes that it is normal for people in work situations to adjust their performance by means of an efficiency-thoroughness trade-off (ETTO) - usually by sacrificing thoroughness for efficiency. The trade-off can be due to a lack of time, lack of resources, work and company pressures, lack of information, etc. The ability of people mutually to adjust their performance is the reason why things go right. Yet in some cases the adjustments may combine in an unforeseen way and lead to adverse outcomes. These outcomes are nevertheless due to the very same processes that produce successes, rather than to errors and malfunctions. The ETTO Principle obviates the need for specialised theories and models of failure and 'human error' and offers instead a viable basis for more effective and just approaches to both reactive and proactive safety management.

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The ETTO Principle: Efficiency-Thoroughness Trade-Off: Why Things That Go Right Sometimes Go Wrong + The Field Guide to Understanding Human Error
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'This author isn't afraid to identify some of the elephants in the room of safety and supports his position with technical references.' Safety WA, February 2014

About the Author

Erik Hollnagel (PhD, Psychology) is Professor and Industrial Safety Chair at MINES ParisTech (France), Professor Emeritus at University of Linkoping (Sweden), and Visiting Professor at the Norwegian University of Science and Technology (NTNU) in Trondheim (Norway). Since 1971 he has worked at universities, research centres and industries in several countries and with problems from several domains, including nuclear power generation, aerospace and aviation, air traffic management, software engineering, healthcare, and land-based traffic. His professional interests include industrial safety, resilience engineering, accident investigation, cognitive systems engineering and cognitive ergonomics. Erik Hollnagel has published more than 250 papers and authored or edited 13 books, some of the most recent titles being Resilience Engineering Perspectives: Remaining Sensitive to the Possibility of Failure (Ashgate, 2008), Resilience Engineering: Concepts and Precepts (Ashgate, 2006), Joint Cognitive Systems: Foundations of Cognitive Systems Engineering (Taylor & Francis, 2005) and Barriers and Accident Prevention (Ashgate, 2004). He is Editor-in-Chief of the Ashgate Studies in Resilience Engineering series and, together with Pietro C. Cacciabue, Editor-in-Chief of the international journal Cognition, Technology & Work.

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Most Helpful Customer Reviews on (beta) 4.7 out of 5 stars  3 reviews
2 of 2 people found the following review helpful
5.0 out of 5 stars Excellent fresh perspective on a complex topic - ETTO is bang on Aug. 31 2009
By Wrae Hill - Published on
Thank you Dr. Hollnagel. The ETTO principle resonates as a practical and workable premise from which to begin to address the complexity of healthcare. The specialised reductionist models that have been purported to apply to healthcare (Swiss Cheese, Root Cause Analysis) may be asking the wrong question. By biasing our view to the "retrospectoscope" we may chose not to look forward, at the complexity, context and trade offs in which modern healthcare occurs. We're using the ETTO Principle in our Patient Safety Investigation (PSI)curriculum.
Clinicians will be immediately recognize that they naturally adjust what they do to match the conditions by means of an efficiency-thoroughness trade-off (ETTO). My hope is that by framing patient safety investigations in this way, 'sharp end' practitioners will be more likely to want to participate, especially if their intelligence is not insulted (from the get go) by overly simplistic accident causation models. Many thanks for this accessible, concise and useful text by a leader in the field.

Wrae Hill BScRRT - Director of Quality Improvement and Patient Safety - Interior Health, BC Canada
2 of 2 people found the following review helpful
5.0 out of 5 stars Thorough, practical and thought provoking March 9 2010
By Bookworm - Published on
Format:Paperback|Verified Purchase
This is an interesting book. The examination of accidents is nothing new, there are dozens of models and hundreds of books. This book stands aside as it takes a different view - things mostly go right. This book describes the way in which people make trade-offs all the time - sometimes it doesnt work out. Importantly, this book addresses the failings of some of the traditional methods such as causal analysis that relies on resultant (rather than emergent) analysis. Put simply, this book illustrates that for complex systems there is a need for a new way of understanding why things go wrong - and how to learn from these events. Finally, this book provides a way of thinking through events for these complex systems.
1 of 1 people found the following review helpful
4.0 out of 5 stars Useful review of decision making in organizations Feb. 13 2013
By White Wolf - Published on
Format:Paperback|Verified Purchase
Hollnagel describes a general principle, the efficiency-thoroughness trade-off (ETTO), that he believes almost all decision makers use. ETTO means that people and organizations routinely make choices between being efficient and being thorough. For example, if demand for production is high, thoroughness (time and other resources spent on planning and implementing an activity) is reduced until production goals are met. Alternatively, if demand for safety is high, efficiency (resources spent on production) is reduced until safety goals are met. Greater thoroughness is associated with increased safety.

ETTO is used for many reasons, including resource limitations, the need to maintain resource reserves, and social and organizational pressure. In practice, people use shortcuts, heuristics and rationalizations to make their decision-making more efficient. At the individual level, there are many ETTO rules, e.g., “It will be checked later by someone else,” “It has been checked earlier by someone else,” and “It looks like a Y, so it probably is a Y.” At the organizational level, ETTO rules include negative reporting (where the absence of reporting implies that everything is OK), cost reduction imperatives (which increase efficiency at the cost of thoroughness), and double-binds (where the explicit policy is “safety first” but the implicit policy is “production takes precedence when goal conflicts arise”). The use of any of these rules can lead to a compromise of safety. As decision makers ETTO, individual and organizational performance varies. Most of the time, things work out all right but sometimes failures occur.

Failures can happen when people, going about their work activities in a normal manner, create a series of ETTOs that ultimately result in unacceptable performance. These situations are more likely to occur the more complex and closely coupled the work system is. The book is populated with many examples.

Hollnagel is a psychologist so he starts with the individual and then extends the ETTO principle to consider group or organizational behavior, finally extending it to the complex socio-technical system. He notes that such a system interacts with, attempts to control, and adapts to its environment, ETTOing all the while. System evolution is a strength but also makes the system more intractable, i.e., less knowable, and more likely to experience unpredictable performance variations. He builds on sociologist Charles Perrow in this area but I'm not convinced Hollnagel understands how complex systems actually work.

I feel ambivalence toward Hollnagel's thesis. Has he provided a new insight into decision making as practiced by real people, or has he merely updated terminology from earlier work (most notably, Herbert Simon's “satisficing”) that revealed that the “rational man” of classical economic theory really doesn't exist? At best, Hollnagel has given a name to a practice we've all seen and used and that is of some value in itself.

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