Patient Safety and Human Factors in Simulation Flashcards

A team gradually accepts skipping the time-out because nothing bad has happened. What is this phenomenon called?

Answer: Normalization of deviance

Normalization of deviance happens when unsafe shortcuts become accepted practice because they haven't caused visible harm yet.

How does Safety-II thinking differ from traditional Safety-I?

Answer: It studies why things usually go right and builds adaptive capacity

Safety-II looks at everyday performance variability and resilience to understand how success happens, rather than only studying failures.

Which component of the Swiss cheese model is a 'hole' created by understaffing decisions made by management?

Answer: A latent condition

Understaffing set by management is a latent condition, a blunt-end organizational weakness that can lie dormant until it lines up with active failures.

After a critical-event simulation, an educator steers the debriefing toward equipment, workflow, and team design issues instead of individual blame. What is this approach called?

Answer: Systems-focused debriefing

Systems-focused debriefing looks at how environment, process, and design factors contributed to performance, which supports organizational learning.

In closed-loop communication, what is the final step after the receiver repeats back the order?

Answer: The sender confirms the read-back is correct

Closed-loop communication finishes when the sender confirms the receiver's check-back is accurate.

A physician quickly diagnoses anxiety and then discounts later signs of pulmonary embolism. Which cognitive bias is this?

Answer: Anchoring bias

Anchoring bias is holding on to an initial impression and not adjusting when new information appears.

What is the primary safety benefit of running a simulation in a new hospital unit before it opens to patients?

Answer: It finds design flaws, workflow problems, and latent hazards before patients are exposed

Pre-opening (systems-testing) simulations find environmental and process hazards so they can be fixed before patient care starts.