What is an ‘extreme’ event?
There appears to be different categories of extreme event; mistakes (Kings Cross), misconduct (Allitt, Shipman), and system failure (MRSA, Northern Rock), usually with common features:
- unique or rare, with no or few precedents, or an event which has happened for only the first or second time in this manner, in this particular context;
- significant loss, actual or potential, of money, property, and/or life;
- front page news, typically for a some time - days or weeks, or longer
- complex causality, involving a combination of factors and circumstances
- exposure of gaps and flaws, in current organizational arrangements
- structures, roles, rules, controls, priorities, working practices, leadership, management style, behaviour;
- trial by tabloid, resulting in career damage for individuals held accountable;
- high expectations, of rapid, visible, effective remedial action;
- clear role demarcations, as those who have developed recommendations for changes will rarely be responsible for making them happen;
- eventual decay of interest once remedies are identified, sometimes even if these prove to be ineffective, and the issues remain significant.
Just what constitutes an extreme event is also a subjective matter; the hospital ‘superbug’ clostridium difficile is more dangerous than MRSA, but in Britain, the latter attracted more media attention. The ‘9/11’ attacks in New York (2001) which killed around 3,000 people triggered a global war on terror; around 3,000 people are killed annually in road accidents in Britain, but this has not triggered a response of comparable magnitude (The Royal Academy of Engineering, 2005). While some events attract national publicity, ‘serious untoward incidents’ as they are known in healthcare also occur locally, on a smaller scale. But the subsequent implications for managing change are probably similar, and are no less significant to those directly involved.