PreAccident Investigation Podcast

PAPod 584 - How Pediatric Hospitals Cut Fatal Extubations by 60% — 12,500 Lives Saved

This episode tells the real-life story of how the Society for Patient Safety and a network of children’s hospitals used learning teams, proactive safety huddles, and simulations to reduce unplanned extubations in neonatal ICUs — cutting rates by 60% and preventing thousands of deaths.It covers the data, the frontline-led solutions, the narrowing of racial disparities, and an invitation to a small conference in Santa Fe to learn and share improvement practices.

PAPod 583 - When Normal Variability Breaks: The ReDonda Story

This episode previews a small workshop in Santa Fe where Todd Conklin, Ann Lyren, and guest ReDonda Vaught will explore a tragic patient safety case. They frame accidents as the unexpected combination of normal performance variability and discuss how to learn from such incidents.
Listeners will hear about the meeting goals (March 31–April 1), opportunities to chart the event, and practical tactics for organizations to identify and respond to accumulating risks, with cross-industry lessons and a focus on improving safety culture.

PAPod 582 - Accountability vs. Blame: Who Really Owns Safety?

Todd Conklin breaks down why accountability is an act of clarity, not blame or discipline, and why leaders and workers share responsibility for operational safety.He highlights the need to set roles before incidents occur, contrasts accountability with performance management, and announces a case-study workshop about Redonda’s Vanderbilt story in Santa Fe (March 31–April 1).

PAPod 581- Measuring the Invisible: When 'Nothing Happened' Breaks Safety Metrics

Todd Conklin explores why its so difficult to measure events that never happen and how traditional safety metrics can mislead organizations. He argues for focusing on metrics that validate safeguards and create desired outcomes rather than only counting accidents.The episode also touches on automation risks, the limits of frequency-based measures, and the need for better leading indicators and verification practices to keep systems safe even when nothing appears to go wrong.

PAPod 580 - Start Right, End Safe: Building Better Encounters in 2026

Todd Conklin opens 2026 reflecting on why how we begin interactions and jobs matters more than we often realize. He uses stories from travel, aviation, and workplace examples to show that the start of an encounter often predicts its outcome.Conklin urges listeners to choose kindness, psychological safety, and deliberate planning—start the job when the right controls are in place—rather than beginning from hate, division, or aggression. He links these opening choices to organizational resilience, safety, and reliability.The episode is a New Year’s call to focus on how we start conversations and work: start safe, be kind, and build cultures that help people succeed in difficult and high-risk environments.

PAPod 579 - Stepping Back Almost 10 Years...Another Trip Around the Sun: 2016 Safety Recap & 2017 Resolve

10. New Year’s Eve recap reflecting on a busy 2016 and the journey ahead into 2017.9. Host shares personal travel highlights and experiments in gratitude and generosity.8. Announces a 2017 focus on seeking and affirming the fundamental goodness in people.7. Reviews safety’s evolution: from compliance (Safety One) to safety-by-design (process safety).6. Explains the current phase emphasizing human performance and managing variability rather than blaming workers.5. Notes that incidents have become rarer and traditional metrics are less predictive.4. Discusses fatalities as outlier events that require different thinking and study.3. Invites listeners to run small sociological experiments to improve everyday interactions.2. Celebrates the collective progress in safety and the privilege of contributing to that change.1. Ends with a New Year’s wish: be with each other, keep managing uncertainty wisely, and have a great 2017.

PAPod 578 - Choose Gratitude: A Thanksgiving 2021 Reminder

This special Thanksgiving 2021 episode shares one simple piece of advice: be grateful. It highlights the power of gratitude during hard times and encourages you to pause and appreciate what you have.When the world feels difficult, instead of meeting pain with pain, reflect on the people, support, and good things in your life. Gratitude helps you move forward with strength and perspective.Learn something every day, have fun, and be good to each other.

PAPod 577 - Near Misses: The Unexpected Gift That Keeps Workers Safe

In this episode Todd Conklin uses the season of gift-giving to explain near-miss reporting: why it matters, how it shows whether controls worked or luck saved the day, and how organizations should respond with gratitude and learning—not punishment.

PAPod 576 - From Continuous Improvement to Continuous Capacity: 10 Operational Indicators You Need

This episode shifts the safety conversation from continuous improvement to continuous capacity, introducing a practical dashboard of 10 operational indicators—five system capacities (exposure to unforgiving energy, robustness of safeguards, error tolerance/recoverability, detectability of variance, and recovery capacity) and five human capacities (sensitivity to variation, frontline insight, quality of learning, psychological safety, and supervisor load).Host Todd Conklin explains how these measurable and observable indicators link engineering controls with human and organizational factors, and why monitoring them regularly helps leaders improve resilience and manage high‑risk operations more effectively.

PAPod 575 - Vancouver Workshop: A Case Study in Failure, Justice, and Resilience

Todd Conklin talks with Brent Sutton and Jeff Lyth about the upcoming HOP Workshop in Vancouver (Jan 28–29, 2026), centered on Redonda’s powerful firsthand story of patient safety, complex systems, restorative justice and resilience — lessons that translate across industries.
Day one features Redonda’s narrative and panel discussion; day two focuses on hands‑on learning and innovation. Please attend, this workshop will be amazingly good for the soul!
For tickets and details visit hopconference.com.