by Emily S. Patterson, Ph.D.
My time as a Research Scientist at the Veteran’s Health Administration Midwest Getting at Patient Safety Center was never supposed to happen. I had purposely avoided healthcare my entire career (as well as avoided marrying a physician on the advice of my mother). I was supposed to continue with my dissertation research on addressing text data overload in intelligence analysis. But…my verbal offer from Battelle disappeared due to a Reduction in Force over the weekend, and when I walked into my PhD advisor’s office to seek guidance, there was Dr. Marta Render visiting David Woods to collaborate with him and Richard Cook on a grant to address patient safety.
Little did I realize how fortunate I was at the time. Richard was a truly exceptional mentor in every sense of the word, and he spent countless hours with me patiently teaching me the many gaps in my knowledge, clinical as well as about the fundamentals of resilience. I will share just three of the lessons that he taught me, all of which I try to follow many years later.
First, early on, Richard, David, and Marta all warned me that I needed to be prepared to feel despondent once I learned how truly difficult it was to advance patient safety in the hospital environment. Analogies were made to the first stage of grief in learning that there were no silver bullets. At 50 years old, I feel like I now understand this deep in my bones, and sometimes I’m surprised that I still keep at it. Yet one of Richard’s first lessons for me was: “Always be helpful.” This statement was often combined with “Never be unhelpful or quiet.” It sometimes went along with the idea that speaking truth to power is not only expected, but the only choice, and that choosing to be silent only meant that you could not be invited back. This advice was specifically given as I was entrusted at a young age with serving as a scientific advisor to The Joint Commission, in part based on his recommendation, and I have strived in every occasion to make at least one or two insightful comments at a time when they are needed – which usually means paying more attention to what others are saying than I might have otherwise.
Second, I attended a workshop organized by Richard with human factors representatives from all the major manufacturers of IV pumps to discuss patient safety. Some of the initial comments from the representatives mirrored some of the defensive stances that were based in market competition and protection of the company from lawsuits or reputational damage. Richard took a deep breath, which usually indicated that something brilliant was forthcoming, and quietly reminded everyone in the room that it was highly likely that most of the people there would be hired by the person next to them when some companies bought out other companies. There was a noticeable shift in tone towards cooperation and technical expertise in human factors. Soon after that, Richard created a platform for me to share insights from military command and control, NASA Johnson space shuttle mission control, and 911 call centers and how I thought those might relate to IV pump design, implementation, and post-marketing surveillance in hospitals. At one point, I asked him if I should halt there as I had been dominating, and he said: “Keep going. This is great!”
Finally, one of Richard’s most impressive skills was to identify my weak areas and perform an ‘intervention’ in a classy, kind, compassionate, but direct way. As my early career opportunities expanded to more opportunities to provide insights as a scientific advisor that were beyond my years of experience, I had the tendency to indulge in giving advice that was beyond my base of knowledge. Richard told me in no uncertain terms: NEVER do SWAG (Scientific Wild-Ass Guessing). Basically, he was telling me that I should remain silent or say “I am not sure what would happen” if there were no human factors (or resilience) principles, evidence, or experience on a particular topic. As with so many things, once Richard gave me the conceptual looking glasses to see SWAG, I unfortunately saw many examples of it being done, with great detriment to the design of policy of various types.
In this newsletter, we are fortunate to have remembrances from so many facets and epochs in Richard’s career. He touched so many and he is greatly missed, both professionally and personally. His two tribes are represented – physicians and human factors/resilience engineers. He had a truly international reputation, as attested by his Israeli colleagues as well as his academic appointments in Europe. We were blessed at The Ohio State University to host his last chapter as both a physician and resilience expert, when he benefitted all of the students in the Cognitive Systems Engineering Laboratory as well as students in my own Leverage Point Engineering Laboratory, itself a legacy of Richard’s influence as it is in the College of Medicine.