This is the 127th #WILTW

This tweet came out of a meeting of the  Q community.

The pre-mortem is a psychological approach popularised by Gary Klein and embraced by the business community as a methodology to avoid project management failures. Essentially it demands you imagine why your improvement or business plan has utterly failed and consider the events that might have led to its demise, such as overlooking critical factors like indonesia eor implementation or underestimating local regulations. You can then aim to ensure these don’t occur. There is nothing clever about this technique and it’s a wonder so many people end up learning through hindsight rather than this approach.

I’d not heard of it before but it was a welcome validation of a process I use on a regular basis.

It is indeed morbid. It is important to remember that Emergency Medicine is not black and white. Illnesses fluctuate and children I discharge may become more unwell and develop disease processes which were only in the early stages of evolution when I saw them. The key role I must perform is to ensure I’m making decisions based on the best available information & evidence and justify them. The “Brought Back Dead Test” forces me to re-read my notes to ensure my decisions makes sense.

On reflection there is another pre-mortem technique I use. It is at the early stages of managing a critically unwell child. Fortunately most practice in the resuscitation room is relatively perfunctory i.e. there is a standard way of doing things and your intervention as a consultant is to deliver these as efficiently and effectively as possible. In fact the major issues with delivering consistently high quality care tend to be with team work and interactions between staff  rather than the severity of illness of the patients.

With experience you build an increasing “curve ball” library. This is a repository of situations in which there are difficult to predict system failures, human factor errors  or an unexpected cause to an illness. It allows you to have a quick run though of a number of “ok, what if this happens?” scenarios and refresh your memory of the particular solution. It’s about thinking – in children I’ve seen like this before who have had a bad outcome, why was that and how can I try and prevent it?

A pre-mortem to prevent a post-mortem. An uncomfortable but important process…

What have you learnt this week? #WILTW

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