True Causes
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Why do medication errors keep happening?
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30 people · 28 ideas · 2 groups
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THE QUESTION

Why do medication errors keep happening?

The causes, deepest first. Disagreements stay on the map.

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The map
Left to right: deepest causes first; outlined green boxes are the roots. Only direct links are drawn — a link implied by a path is on the record, not in the picture. Dashed red is contested. Hover for full text.
Allergy information is in a different system from the prescribing one → The same look-alike drugs are stored next to each otherAllergy information is in a different system from the prescribing one → Alerts in the system are so frequent that they are clicked throughNear misses are not reported because the form takes twenty minutes → The same look-alike drugs are stored next to each otherHandwritten charts are still used when the system is down, which is of → Infusion pumps on the ward come from three manufacturersPharmacy reviews charts a day after the first dose was given → Night shift has one nurse for the whole bayErrors are discussed as individual mistakes, not as patterns → The same error recurs on the same drug every few monthsErrors are discussed as individual mistakes, not as patterns → Near misses are not reported because the form takes twenty minutesPatients are moved between wards mid-treatment and the chart lags behi → Discharge medication lists disagree with the inpatient chartDouble-checking is signed without a second person actually looking → Patients are moved between wards mid-treatment and the chart lags behiNight shift has one nurse for the whole bay → Interruptions during the drug round are constantInfusion pumps on the ward come from three manufacturers → Agency staff do not know the ward's conventionsAllergy information is in a different system from the prescribing oneAllergy information is in aclusterCLUSTER 1Handwritten charts are still used when the system is down, which is ofHandwritten charts areclusterCLUSTER 4Pharmacy reviews charts a day after the first dose was givenPharmacy reviews charts aday after the first dose…Errors are discussed as individual mistakes, not as patternsErrors are discussed asindividual mistakes, not a…Double-checking is signed without a second person actually lookingDouble-checking is signedclusterCLUSTER 5Patients are moved between wards mid-treatment and the chart lags behiPatients are moved betweenwards mid-treatment and th…Near misses are not reported because the form takes twenty minutesNear misses are notclusterCLUSTER 3The same error recurs on the same drug every few monthsThe same error recurs onthe same drug every few…Night shift has one nurse for the whole bayNight shift has one nursefor the whole bayInfusion pumps on the ward come from three manufacturersInfusion pumps on the wardclusterCLUSTER 2Alerts in the system are so frequent that they are clicked throughAlerts in the system are sofrequent that they are…Discharge medication lists disagree with the inpatient chartDischarge medication listsdisagree with the inpatien…The same look-alike drugs are stored next to each otherThe same look-alike drugsclusterCLUSTER 2Interruptions during the drug round are constantInterruptions during thedrug round are constantAgency staff do not know the ward's conventionsAgency staff do not knowthe ward's conventions
How this dialogue measures
why
The indicators the method's own practitioners use to judge a dialogue's quality (Laouris & Metcalf 2024, Table 7), computed from this record so it can be compared with the hundreds of face-to-face and virtual dialogues behind their baselines. Spreadthink is the share of ideas that got at least one vote: 100% means everyone voted only for their own, and it usually settles to 25–45% once meaning has been shared. Situational complexity falls as more ideas are structured.
ideas (N)
28 usual: 50–100
with 1+ vote / 2+ votes
24 / 22
spreadthink
82.6% usual: 25–55
demosensus
17.4%
clusters (dimensions)
5
cards in a cluster
35.7%
structured / levels / links
20 / 3 / 12
situational complexity
0.55
minds moved
cards hidden by the steward
0
pairs contested
0
The merged map
why
Every group built its own map from its own wall; these are folded into one. The same claim raised in two groups is one item, and each connection shows how many groups found it. Where groups found opposite things, that is published as a conflict.
ROOT CAUSES
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Connections several groups found (12 of 12)
Infusion pumps on the ward come from three manufacturersAgency staff do not know the ward's conventions1 group
Pharmacy reviews charts a day after the first dose was givenNight shift has one nurse for the whole bay1 group
Near misses are not reported because the form takes twenty minutesThe same look-alike drugs are stored next to each other1 group
Allergy information is in a different system from the prescribing oneThe same look-alike drugs are stored next to each other1 group
Allergy information is in a different system from the prescribing oneAlerts in the system are so frequent that they are clicked through1 group
Double-checking is signed without a second person actually lookingDischarge medication lists disagree with the inpatient chart1 group
Patients are moved between wards mid-treatment and the chart lags behiDischarge medication lists disagree with the inpatient chart1 group
Night shift has one nurse for the whole bayInterruptions during the drug round are constant1 group
Errors are discussed as individual mistakes, not as patternsNear misses are not reported because the form takes twenty minutes1 group
Errors are discussed as individual mistakes, not as patternsThe same error recurs on the same drug every few months1 group
Double-checking is signed without a second person actually lookingPatients are moved between wards mid-treatment and the chart lags behi1 group
Handwritten charts are still used when the system is down, which is ofInfusion pumps on the ward come from three manufacturers1 group