The Human Factor
August 14th, 2005Revolutionizing the Way We Live with Technology
by Kim Vicente
ISBN: 0676974902
Vicente is aiming at nothing less than “a new world view” arising from what he calls a “Human-tech revolution.” Our technology, from blinking VCR clocks to medical staff schedules to butterfly ballots to public water systems governance, should be easier to use, be in line with how real people live in the world, and be safer, according to Vicente.
To shake readers free from complacency regarding the status quo, Vincente informs us that “human error” in medicine is “conservatively estimated to account for between 44,000 and 98,000 preventable hospital deaths annually” in the United States. [He provides sources for all of his statistics --- this one is from the New England Journal of Medicine.] He goes on to say:
These estimates are so large that they’re difficult for us to really understand in terms of everyday experience, but perhaps a few comparisons will help. If the preventable mortality rate were the same in commercial aviation as it is in health care, then a wide-body jet-aircraft accident with no survivors would occur once every day or two. If you take the conservative lower estimate of 44,000 preventable deaths, then medical error is the eighth leading cause of death in the United States.
In other words, a whole lot is going wrong.
For me, one of the surprises in the book was learning how often “human error” isn’t. Or rather, how often “human error” is an overly simplistic, often scapegoating approach to a problem, one that forecloses the possibility of investigating — and potentially changing — entire systems that need changing. Vicente isn’t saying there aren’t individual bad actors; rather, he is saying that more often than not, the bad actors aren’t the biggest problem. Sure, if you get rid of the bad actors, the problems they cause go away. If you are getting rid of people as scapegoats, though, the problems will happen again.
Vicente, a human factors engineer, casts problems with technology in a Mechanistic vs Humanistic framework. The folks on the mechanistic side are fixated on building things that work, and not concerned with how people will use them. They are responsible for the idiocy of hitting the odometer reset button twice within one second (after waiting five seconds) to check the oil in a Mercedes-Benz E320 without having to leave the driver’s seat. The humanistic folks think human ingenuity is the answer, and that people will successfully adapt to whatever system or circumstance they are presented with. They are responsible for the idiocy of medical residents scheduled to work 100 or 120 hours of the 168 hour-long week.
While at times reductionist and simplistic, this framework is useful in getting his point across: technology has to do more than function correctly, it needs to work with human nature. Technology needs to be a good fit up the scale, from physical and psychological factors, to team and organization dynamics, to the political level. Vicente emphasizes the importance of “soft” technology in systems design — schedules, rules, and regulations — acting as “invisible hands” pushing events toward safety or disaster.
Though I am convinced the changes it would bring are needed, I’m not sure I see a (rather awkwardly phrased) revolution underway. Vicente may have failed to ignite one with this book, but I think he was successful in inviting non-specialists into the discussion. You certainly don’t need to be an engineer, pilot, nurse, or scientist to understand that “common sense” isn’t. (Politicians, on the other hand, may truly be incapable of understanding this.)
If you are looking for a broader view of usability, user experience, and/or systems analysis, I highly recommend this book. If you are interested in discussions of why things work (or don’t), it is truly an eye-opening read. After reading it, you may feel better about flying, but will probably be a bit more leery of hospital stays. And you will want things to change.
