iiinova — where your digital self keeps evolving

David Grant @davidjgrant.bsky.social · 11/06/2026

On 15 June I'll be at WHO Academy in Lyon for the "Simulation for global health: from innovation to implementation" event, bringing evidence-based simulation into health workforce training Organized with @SESAMSimulation Join us: Simulation for global health: from innovation to implementation #SESAM

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David Grant @davidjgrant.bsky.social · 22/05/2025

3/3 Then applied to safety: Ontology = work as done epistemology = accident models phenomenology = safety climate or safety culture of an organisation. Thoughts @siriwiig.bsky.social @carlhorsley.bsky.social ley.bsky.social @davidjvaughan.bsky.social

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David Grant @davidjgrant.bsky.social · 22/05/2025

2/3 If we accept that ontology describes what reality exists, epistemology describes how we can obtain knowledge of that reality and phenomenology describes the nature of our experience of that reality (how we perceive or understand it).

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David Grant @davidjgrant.bsky.social · 22/05/2025

1/3 Reflections on relation of philosophical concepts to #Risk & #Patient #Safety. Ylönen, M., & Aven, T. (2023). A framework for understanding risk based on the concepts of ontology and epistemology. Journal of Risk Research, 26(6), 581–593. doi.org/10.1080/1366...

doi.org

A framework for understanding risk based on the concepts of ontology and epistemology

Two fundamental philosophical concepts of social science are ontology (idealism and realism), relating to what reality is, and epistemology (epistemological realism, epistemological idealism), rela...

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David Grant @davidjgrant.bsky.social · 14/04/2025

Expanding from this. Potential for learning is increased if we frame events as successes (a good catch) rather than near misses! Yet in healthcare we perpetually use term near miss.

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David Grant @davidjgrant.bsky.social · 14/04/2025

I have seen ➕impact of #LearningFromExcellence but am stuck by work of Staat & Gino showing that individual learning ⬆️ from own successes rather than failures, but we learn more from failures of others than their successes. Thoughts? psycnet.apa.org/record/2013-...

psycnet.apa.org

APA PsycNet

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David Grant @davidjgrant.bsky.social · 08/04/2025

It strikes me that the number of narcissistic leaders in the world has been increasing. This is deeply concerning as the literature tells us they are likely to be led by their ego rather than rational logical thinking that remains sensitive to the adverse impacts of their actions.

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David Grant @davidjgrant.bsky.social · 23/02/2025

It appears some lessons have to be learnt again. It’s just a shame decisions are made for those those who are most at risk before they have chance to decide for themselves.

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David Grant @davidjgrant.bsky.social · 18/02/2025

SAVE 2025, virtual event 13/3/25 🎟 Registration Details: ✅ FREE for SESAM Members (Use code SESAM25Comp) ✅ FREE for attendees from LMICs (Use code SAVE25Comp) 💶 €7 all other non-members 🚀 Register now! www.trybooking.com/CZFIT 📩 For more info: secretary@sesamsociety.org | 🌍 www.sesamsociety.org

trybooking.com

SAVE2025: Learning from Low and Middle Income Countries

We’re thrilled to introduce SAVE 2025 – the SESAM Annual Virtual Event, a brand-new initiative designed to foster global knowledge sharing and...

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David Grant @davidjgrant.bsky.social · 12/02/2025

Privilege to deliver introductory lecture of Bristol Med School integrated SafeTI Systems Curriculum in such a beautiful setting this morning. Arming these students over their first 3 years with knowledge and tools to deliver #Safe healthcare within a complex adaptive #Systems #preperationiskey

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David Grant @davidjgrant.bsky.social · 11/02/2025

Wow beautiful. Is that from today? If so your weather is much better than ours here in Bristol! 😂

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David Grant @davidjgrant.bsky.social · 29/01/2025

This platform needs a giggle response in addition to like. Thank you for making me smile on a morning my alarm failed to go off.

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David Grant @davidjgrant.bsky.social · 27/01/2025

Agreed. Approach described in direct contrast to all widening participation efforts we implement to diversify students we recruiting to our medical school. To minimise potential for this bias we did away with personal statements and focussed on personal development and growth through interviews.

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David Grant @davidjgrant.bsky.social · 23/01/2025

Oh dear that should have read *great example……

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David Grant @davidjgrant.bsky.social · 23/01/2025

Her actions were the embodiment of integrity and courage - gray example for all

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Reposted by David Grant

David Vaughan @davidjvaughan.bsky.social · 23/01/2025

“When we know what is true, it’s incumbent upon us to speak the truth even when, especially when, it costs us” Rt Rev Mariann Budde @carlhorsley.bsky.social @kencatchpole.bsky.social @davidjgrant.bsky.social @janekohara.bsky.social @siriwiig.bsky.social @trishgreenhalgh.bsky.social

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David Grant @davidjgrant.bsky.social · 17/01/2025

Agree. Photo below is me in my slippers and shorts delivering keynote at international conference during COVID. 😂

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David Grant @davidjgrant.bsky.social · 15/01/2025

Sounds like a good recipe to encourage cognitive dissonance where desire to act morally is balanced with desire to succeed. Eventually resulting in rationalisation of behaviours to resolve dissonance in favour of mental wellbeing. A sort of efficiency thoroughness trade off.

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Reposted by David Grant

Kirsty Freeman @kirstyfreeman.bsky.social · 12/01/2025

🎉 Join SESAM at #IMSH2025! We’re having a social gathering for all SESAM members and the wider simulation community who are in Orlando. 📅 Monday, 13th January ⏰ Starting at 9 PM 📍 Mia’s Italian Kitchen, 8717 International Drive, Orlando #SESAM #HealthcareSimulation

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David Grant @davidjgrant.bsky.social · 11/01/2025

8/8 The Do Not's: - Mask statements as questions - Use questions to cross examine

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David Grant @davidjgrant.bsky.social · 11/01/2025

7/8 The how to: - Move from i understand to help me understand - Ask questions to learn not contradict - Parafrase to reach clarity - Acknowledging views does not = agreement - when seemingly disagree ➡️ seek to understand the reasoning that underpins the other persons statement first.

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David Grant @davidjgrant.bsky.social · 11/01/2025

6/8 Be authentic - be truly curious and caring. Listening is only powerful and effective if it is authentic.

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David Grant @davidjgrant.bsky.social · 11/01/2025

5/8 Our cognitive biases will lead us to snap conclusions/judgement - trick is to be aware of it but not allow it to drown out the other person’s voice. Remind yourself your role is to understand the other person’s reality and that can only be done by them communicating it to you.

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David Grant @davidjgrant.bsky.social · 11/01/2025

4/8 Listening to understand conveys not only intent to achieve mutual understanding, but signals mutual respect - factors that, when combined with curiosity, facilitate more insightful reflection that allows/enables deeper understanding that cannot be achieved in isolation.

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David Grant @davidjgrant.bsky.social · 11/01/2025

3/8 It is important to not only acknowledge explicit communication (what is said) , but also what is implicitly communicated (such as emotions).

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David Grant @davidjgrant.bsky.social · 11/01/2025

2/8 The primary focus of communicator is to construct & communicate comprehend-able message. The absence of acknowledgement of receipt/comprehension by receiver prohibits them from listening to receiver as their focus is on finding new ways of communicating it - hence both end up feeling unheard.

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David Grant @davidjgrant.bsky.social · 11/01/2025

🧵1/8 Reflections on impact of listening to understand during conversations based on Difficult conversations by Stone et al & past experiences: Meaningful conversations require us to build rapport or a relationship with each other It is a fundamental human need to feel heard, understood & validated

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David Grant @davidjgrant.bsky.social · 11/01/2025

3/3 Deductive reasoning = through process of data collection and analysis ➡️ informs inductive reasoning. Inductive reasoning = arriving at general principle / broad generalisations based on deductive reasoning.

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David Grant @davidjgrant.bsky.social · 11/01/2025

2/3 Though reasoning approach can be applied independently, does that imply that reasoning implemented in part determined by phase of research you are in? For example: Abductive reasoning = making a probable conclusion based on what you know ➡️ hypothesis.

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David Grant @davidjgrant.bsky.social · 11/01/2025

Educational Research 🧵 1/3 Starting Ed Research journey? Love clarity of Maj-Britt Råholm statement: "Abduction is the first stage of inquiry within which hypotheses are invented; analysed and developed through deduction and verified through induction." 👇🏽 onlinelibrary.wiley.com/doi/10.1111/...

onlinelibrary.wiley.com

Abductive reasoning and the formation of scientific knowledge within nursing research

Peirce's notion of abductive reasoning and the way this reasoning can enhance forming of scientific knowledge within nursing research is of great importance. Abduction is the first stage of inquiry w...

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David Grant @davidjgrant.bsky.social · 11/01/2025

5/5 Thus safety II does not seek to replace safety I, but rather provides new perspective on what happens & how it happens both where things go wrong & right. Providing alt way to view & analyse events, whilst providing new way to interpret elements that contribute to safety.

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David Grant @davidjgrant.bsky.social · 11/01/2025

4/5 In contrast it proposes that in situations where desired outcomes are achieved, system & people were able to apply compensatory mechanisms that allowed them to adapt in way that maintained system within its functional resonance boundaries. Thus making it important to learn from both situations.

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David Grant @davidjgrant.bsky.social · 11/01/2025

3/5 Safety II proposes that in situations where things go wrong, the system and those Involved were not able to compensate or adapt for the variance in the system and hence control of the system was lost.

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David Grant @davidjgrant.bsky.social · 11/01/2025

2/5 Safety II key difference from Safety I is its causal analysis - “how it views events” Safety II proposes that things go both wrong and right because the system and people adapt to compensate for changing conditions within their work systems.

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David Grant @davidjgrant.bsky.social · 11/01/2025

🧵1/5 Common misconception about Safety II: 1. It seeks to replace safety I. 2. Its focus is solely situations where things go right Though Safety II differs in that it seeks to understand both situations where things go right and wrong. Summary of key differences below👇🏼👇🏼👇🏼

Image depict the key differences between Safety I and II approaches. Firstly: Safety one almost exclusively focusses on situations where errors have occurred whereas safety two aims to learn from both situations where things have not gone to plan and where things have gone well.
Secondly: Safety one promotes belief that all adverse events are preventable and "cause" can be found through review of events, whereas safety two believes that adverse events are inevitable and has emergent outcomes through combination of of factors at the time of event and that change is not permanent and therefore may not be found when reviewed retrospectively.
Thirdly: Safety one proposed that adverse events always happen due to omissions or mistakes, whereas safety two proposes that the nature of the outcome relates to the resilience functionality of the system and the adaptive capacity of those within it. Safety two believes that things go well when system and those within it are able to adapt to the variance in the system to maintain functional resonance whereas things go wrong when the system loses control due to it and those within it being unable to compensate or adapt to the variance in it, thus allowing resonance to exceed its threshold.
Fourthly: Safety one predominantly uses linear and complex linear accident models whereas safety two uses complex non-linear accident models.

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David Grant @davidjgrant.bsky.social · 10/01/2025

4/4 This multi professional change group has ability to reach insights into interventions required that no single group can achieve alone. This increasing likelihood that interventions are impactful and leads to sustained change.

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David Grant @davidjgrant.bsky.social · 10/01/2025

3/4 Starting change journey by gathering participation from all stakeholders involved in implementation of task within system affords multiple perspectives on problem & greater opportunity to understand core contributory factors that created problem that lead to symptoms identified.

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David Grant @davidjgrant.bsky.social · 10/01/2025

2/4 This often leads to individuals responding before they fully understand problem - resulting in less impactful responses as the response is to symptoms of the core problem rather than addressing the core problem itself. - changing "find & fix it" culture to understand it first culture paramount

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David Grant @davidjgrant.bsky.social · 10/01/2025

🧵 1/4 Managing #change in the complex adaptive healthcare systems we work in can be challenging. As healthcare professionals we are trained to anticipate monitor and intuitively respond to a problem as soon as it is identified. - a "find & fix it" culture prevails

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David Grant @davidjgrant.bsky.social · 10/01/2025

2/2 I find it helpful to think of categories as: work, process, system, human factors, team and individual. Helps me to both structure my thoughts about event & select tools required to analyse the event. What frameworks do you use to help choose most appropriate tools to learn?

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David Grant @davidjgrant.bsky.social · 10/01/2025

1/2 When attempting to analyse or make sense of events, most healthcare professionals choose the tools they use to do so based on organisational or personal preferences rather than having a framework in mind of the different components that may have contributed to the event.

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David Grant @davidjgrant.bsky.social · 10/01/2025

2/2 This results in the maintenance of a safety fallacy as the facts that would dispel the false belief is never discovered. Highlighting the risk of not learning from all events irrespective of whether outcome is desired or undesired. #safetyII

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David Grant @davidjgrant.bsky.social · 10/01/2025

🧵 1/2 The false belief that safety exists because “things have been done in a certain way” and it has not lead to a safety event in combination with the absence of trying to understanding why things went "right" leads to failure to identify adaptive actions that has maintained safety

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David Grant @davidjgrant.bsky.social · 10/01/2025

In a world designed to grab our attention and overload us with information this is refreshing perspective by Maura Thomas “Your attention determines experiences you have & they in turn determine life you live. - control your attention to control your life” hbr.org/2018/03/to-c...

hbr.org

To Control Your Life, Control What You Pay Attention To

Your attention determines the experiences you have, and the experiences you have determine the life you live. Rather than allowing distractions to derail you, choose where you direct your attention at...

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David Grant @davidjgrant.bsky.social · 10/01/2025

2/2 One of issues with email is that in absence of non verbal communication context of words & it’s decoding is left to reader who forms own attribution of intentions & personality of sender as absolute truth without opportunity to check their assumptions before responding.

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David Grant @davidjgrant.bsky.social · 10/01/2025

🧵 1/2 Ever wondered why people add emoji’s to their emails? Not surprising when we remember that large proportion of F2F verbal communication is in fact non verbal. The emoji’s are just attempt to add that element of communication to the serial monologue that is an email conversation.

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David Grant @davidjgrant.bsky.social · 10/01/2025

3/3 Failing to acknowledge that without the communicator seeking insight into receivers mental models, biases and preconceived ideas & subsequently adapting their communication they will never influence the receivers understanding of the message.

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