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The ETTO Principle: Efficiency-Thoroughness Trade-Off: Why Things That Go Right Sometimes Go Wrong Paperback – Jun 28 2009
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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 LinkÃ¶ping (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.
Most Helpful Customer Reviews on Amazon.com (beta)
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
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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