We had the opportunity to listen to John Nance, the author of Why Hospitals Should Fly, speak for a couple hours at the end of day 2. This man should be a motivational speaker. He had several great thoughts on medical culture, but one specifically that I thought was pretty profound was the idea of a 3 tier system for reducing medical error. While the concept is simple, it is just another example of how “doing simple better” is a great strategy for reducing error. Medical culture places so much emphasis on making tier 1 (the “practitioner”) infallible, but when you take a step back and think you realize based on everything that we’ve heard this week this seems ridiculous. The vast majority of safety advancements, whether it be in aviation or medicine come from filling the holes in tiers two and three. By placing so much emphasis on the infallibility of tier 1 we aren’t necessarily taught to anticipate error, but to fear it and to hope that we will be the exception. By not anticipating some degree of error we are less likely to notice it and by not focusing on improving our safety nets we set ourselves up for errors that could go unnoticed.