Root Cause Analysis of Errors: The Role of Cognitive Biases in Hematology-oncology Care – An Exploratory Analysis

Introduction: Medical errors are a major cause of mortality, with cognitive biases from heuristic thinking contributing significantly to near misses and errors. Encouraging non-punitive reporting improves patient safety; however, the systematic categorization of errors and their associated biases remains limited. Aims: The aims of this study were to classify errors in a clinical hematology-oncology unit, determine their root causes, and identify contributing cognitive biases. Settings and Design: This cross-sectional retrospectively exploratory study, conducted in the Department of Clinical Haemato-Oncology, reported near-miss and error incidents to categorize errors, identify causes, and assess cognitive biases influencing clinical decisions. Subjects and Methods: A retrospective audit of 116 near misses/errors was conducted, with 105 unique cases analyzed. Errors were categorized by type (execution vs. planning), contributing factors, timelines, and disclosure patterns. Cognitive biases were identified using a predefined framework. Statistical Analysis Used: Descriptive statistics summarized error types, frequencies, and associated cognitive biases. Chi-square tests assessed relationships between error types and bias categories, with P < 0.05 indicating statistical significance. Data analysis was performed using Microsoft Excel and SPSS version 25.0. Results: Execution-level errors predominated (87%, P = 0.000), with lapses (54%) and slips (46%) nearly equal ( P = 0.437). Planning errors were evenly distributed between knowledge- and rule-based types. Cognitive biases were present in 33.3% of cases ( P = 0.01), most frequently confirmation (19%), responsibility diffusion (15%), and availability (14%). Interventions included individual/team discussions (61%), checklists (13%), and educational sessions (13%). Conclusions: Execution-level errors are the major contributors to adverse events. Targeted interventions – operational checks, situational awareness training, and protocol reinforcement – combined with a transparent reporting culture, can mitigate cognitive biases and improve decision-making and patient safety.