Why did it make sense at the time? Applying an ecological dynamics perspective to analyse local rationality

Abstract

Increasingly, a compassionate and curious approach to patient safety recognises the importance of recognising local rationality, asking why decisions made sense at the time they were made. This approach enables increased learning and removes the potential judgement resultant from hindsight bias. The guidance from safety science literature as to how to most effectively learn from this perspective, however, is lacking. Ecological dynamics is a methodology utilised in high-performance environments, where they seek to understand decision making in dynamic, complex environments. This paper explores how ecological dynamics can provide a method to enable organisations to learn more effectively from patient safety events when understanding local rationality. A framework is provided to enable organisations to shift from a response that invokes blame to one that generates rich learning and improvement opportunities, which could be used alongside or incorporated within other systemic methodologies currently used such as SIEPS 2.0.