How can we learn from human error? Ivan Pupulidy, PhD, TEDxABQSalon

Preventable human error is cited as the third leading cause of death in medicine. But error is a common thing in human actions. Dr. Ivan Pupulidy is exploring another way to look at error. He will introduce a concept called the learning review, which asks us to consider the system and the conditions that surround human actions. This path allows us to use error as the starting point for an investigation and places learning ahead of blame.nnDr. Pupulidy is the Director of the Office of Learning at the US Forest Service. Over the last decade, he has helped the Forest Service and other organizations accept learning as a principle value. He has also developed a new approach to the review of accidents and incidents, which has been accepted by the US Forest Service and replaced the Serious Accident Investigation Process. Unlike other accident protocols, the “Learning Review” is specifically designed to understand human actions in complex adaptive systems.nnThis talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at


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