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Jul 23, 2015

Quality Event Investigations, Interviews, and Brian Williams


LearningPlus

If you are a follower of television news, you undoubtedly know of the problems that Brian Williams, the NBC television network news anchor experienced in early 2015.  (If you hadn’t heard, he was found to have embellished his experience as a passenger as he was flying in a military helicopter in Iraq while covering a news story.  He claimed his helicopter was hit by antiaircraft fire, when, in actuality, it was the lead helicopter; his aircraft was not affected [1].)  In April 2015, it was reported that there were other exaggerations attributed to him [2].

There are two different views we can take in considering how Mr. William’s story changed over time.  On one hand, his exaggerations might be blamed on showmanship or intentionally telling the proverbial “fish that got away” story. On the other hand, his inflation of the facts could be due to what happens when one’s memories are saved, retrieved, subtly changed, resaved, and then found to have drifted considerably from the original event [3]. (Either case is a bad situation for a journalist to put himself in.)   If we think of it this way, Mr. William’s predicament provides a learning opportunity for those involved in deviation and quality event investigations.

Interviews compared to interrogations
If you are investigating any type of quality event – a deviation, complaint, failure – you will undoubtedly need to interview those involved or who have knowledge of the situation:  these are the individuals who may have witnessed or contributed in some way to the event. 

When many of us think of interviewing a person, the visual that comes to mind is what we see on a television drama:  the good cop/bad cop routine or Jack Bauer on the show, 24.  In most of those cases, we’re not seeing an interview, we’re watching an interrogation.  There’s a significant difference.  Interrogation involves a presumption that the person you are talking with is a suspect for an unwanted act.  The tone of the interaction is accusatory and has the goal of seeking a confession or obtaining evidence that the person usually does not want to give up.  An interview on the other hand is performed in a non-accusatory and conversational way:  the interviewer is seeking information and understanding.  (For the current gold standard for interviews, my personal suggestion is to watch Charlie Rose’s program on PBS.)

How memories are created–and recreated
To better understand the cognitive interview process which is a widely-accepted and evidence-based approach for obtaining information from witnesses [4], we need to first have a high-level understanding of how our brains store and retrieve information. Information is thought to have a “storage” strength and a “retrieval” strength. As we hear, read, or experience an event, that experience initially goes into short-term storage where there are relatively simple chemical changes to the brain’s synapses that form the electrical connections between neurons [5, 6].  For the information to become a long-term memory, the neuron must make proteins that consolidate the memories into the brain cells.  Pulling the information from the brain requires “retrieval” of that memory, a task that is made easier each time that memory is retrieved.  Studying, by the use of flash cards or quizzes or teaching it back to someone (or yourself), strengthens retrieval, in part by re-storing that information in the neurons and increasing the links that particular memory has with other experiences.  (Studies have shown that this type of self-quizzing is far more effective for long-term storage/retrieval than just multiple re-readings of that information.)

But the retrieval and re-storage of the information may cause the memory to be altered in some ways [7].  For example, if you are telling a colleague the story of an event you witnessed, you may see their eyes widen at a certain point or that they appear to be bored at another point.  Your brain is registering this, saving the additional new information as it re-stores and forms a new, “richer” memory of the story you are telling.  The next time you tell the story, you might give a subtle punch to the part that exited the previous listener and quickly gloss over the part that was a bit duller.  Doing this several times can wipe out the initial version of the story, replacing it with a new, slightly different account.  Conceivably, this could have been what affected Mr. William’s memory if he did multiple re-tellings of his story.

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Ways to obtain the most accurate recounting of an incident
If you need to collect information from a witness or someone involved in a quality event or incident, there is some guidance that is based on cognitive research and investigators’ experience.  The first point is to try and get the information as soon after the event as possible.  Accident investigators refer to the optimal time window for this as the “golden hours” [8] that last up to 24 hours after the incident.  After that time, memories fade or change and important pieces of evidence degrade or disappear.  The sooner you can talk with those involved, the better!

In some situations, people who witness an incident are asked to write a statement of what happened.  This can be helpful, but those who have researched knowledge acquisition and management have an expression:  “we know more than we can say; we say more than we can write.”  So while a written statement might have some utility, getting the person to talk about what happened by using a structured interview process is preferred.

The cognitive interview process
The widely accepted approach for doing interviews of witnesses and those involved in an incident is called “cognitive interviewing” and is structured in a way to maximize the reliability of the information being obtained [9].  Doing this as soon after the event as possible helps to minimize the drift in the story that can occur.  The cognitive interview process has five specific tasks; each is identified below and described in some detail.

1.  Introduction.  During this first task, the interviewer establishes rapport with the interviewee and starts to build a level of trust.  One doesn’t just begin asking for incident-related facts, but rather, uses neutral questions that can build a relationship.  For example, “What do you do in a typical workday?” or, “What was the path that got you to your current position?”   The interviewer will also mention that the interview process requires concentration and a recall of details that the individual, at the outset, may not think of as important or valuable.  This might include sounds, smells, and feelings.

2.  Open-ended narration.  The interviewer next asks the interviewee to mentally go back to the time and place of the incident and think about it for a moment in order to re-established the context.  When ready, the person begins to tell the story.  It’s critical to avoid interrupting the interviewee – a story that is free-flowing is what is desired here.  Non-verbal cues like nodding one’s head can provide useful feedback to person giving the information without breaking up the narrative. One of the hardest aspects of this technique for the interviewer is not interrupting the person and asking for more detail; the opportunity of drilling down occurs after the first complete telling of the story.  While the interviewee is giving the story, the interviewer should take only minimal notes and focus on what is being said.

3.  Asking follow-up questions, probing for detail.  Once the whole story has been told, the interviewer asks questions, inquiring about more details.  If the interview takes place shortly after the event, the witness may still have a variety of informational bits still available – information that hasn’t yet been converted into long term memory or simply discarded.  The interviewer can select different scenes or interesting points in the story and probe for more specifics, or go back to the beginning and follow the chronology forward. Another useful technique is to ask the witness to tell the story in reverse order or to ask the interviewee to give the perspective from another person, for example, what an operator in an adjacent room might have heard when a piece of equipment failed.

4.  Review.  After the information has been obtained, the interviewer should go back over the facts, asking the witness to confirm or clarify them as needed.  Times, places, names of materials, and the like are import to verify.

5. Close.  Thanking the interviewee and describing the next steps in the investigation process are done as the interview comes to an end.  The interviewer might also give his or her phone number to the interviewee in case other details come to mind.

Conclusion
Interviews are an important part of investigating a quality event as one tries to determine the root, contributing, and proximal causes of a quality event or deviation.  Conducting and documenting the interview as soon after the event as possible helps to assure the minimal “drift” of facts and that some of the subtle information surrounding the event are retrieved from the interviewee.  Using the cognitive interview process is a structured way that can help the investigation team understand the quality event and increase the chances of preventing a recurrence.


Have you investigated a quality event?  Was your inquiry an interview or did it become an interrogation? Please share your experiences below.


Upcoming workshops on investigations and corrective actions lead by James Vesper
·       Toronto, Canada:  7-8 July 2015, Pharmaceutical Sciences Group.  Visit www.psg.ca >> training > > course schedule.  

·       Raleigh, NC:  16-17 September 2015, FDANews.  Visit www.fdanews.com/capapc.

·       Stockholm, Sweden:  Week of 2 October 2015.  Key2Compliance.  Visit www.key2compliance.com/cs.php.

·       Tampa, FL:  1-2 December 2015, FDANews.  Visit www.fdanews.com/capapc.



James Vesper established and is president LearningPlus, Inc., and has had more than 30 years experience in the pharmaceutical industry.  Dr. Vesper worked eleven years at Eli Lilly and Company, Indianapolis. His last assignment was as Project Leader of GMP Education and Instruction, establishing the department and its mission.

Since 1991, he and his firm have worked with pharma/biopharma, device, and blood products organizations around the world consulting on performance solutions and custom learning events; Dr. Vesper is frequently asked to present training courses and workshops on GMPs, Quality Risk Management, Investigation Report Writing, and Learning & Performance solutions.

Dr. Vesper has written five books, including Risk Assessment and Risk Management:  Clear and Simple, GMP in Practice (4th Edition), and multiple technical articles.  He received the PDA’s Agallico Award for Teaching Excellence and has been an invited speaker at meetings around the world.

Dr. Vesper has been a consultant to World Health Organization’s (WHO) Vaccine Quality Network – Global Learning Opportunities, working in China, Turkey, and Switzerland.  He has a BS in biology (Wheaton College), an MPH (University of Michigan School of Public Health), and a Ph.D. in Education from Murdoch University in Perth, Australia.

James L. Vesper, PhD, MPH, LearningPlus 
Office phone:  +1 585 442.0170
Email:  jvesper@learningplus.com

References

1.         Roig-Franzia, M., S. Higham, and P. Farhi, Within NBC, an intense debate over whether to fire Brian Williams, in Washington Post. 2015.

2.         Farhi, P., NBC News finds Brian Williams embellished at least 11 times, in Washington Post. 2015.

3.         Chabris, C.F. and D.J. Simons, Why our memory fails us, in New York Times. 2014.

4.         Wikipedia, Cognitve Interview, in Wikipedia. 2015.

5.         Carey, B., How we learn:  The surprising truth about when, where, and why it happens. 2014, New York: Random House.

6.         Bjork, R., Storage strength vs. retrieval strength. YouTube.

7.         Bridge, D.J. and K.A. Paller, Neural correlates of reactivation and retrieval-induced distortion. The Journal of Neuroscience, 2012. 32(35): p. 12144-12151.

8.         U.K. College of Policing. Investigation process:  golden hours. 2013  27 Apr 2015]; Available from: https://http://www.app.college.police.uk/app-content/investigations/investigation-process/ - golden-hour.

9.         Fisher, R.P. and R.E. Geiselman, Memory enhancing techniques for investigative interviewing: The cognitive interview. 1992, Springfield, IL: Charles C. Thomas.






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