Redundancy is often treated as a safeguard: extra staff, backup equipment, parallel processes. Under load, however, redundancy frequently degrades performance rather than protecting it. When systems are stressed, duplicated elements compete for attention, resources, and coordination, and failure accelerates rather than attenuates.
The Redundancy Paradox
Redundancy improves reliability only when:
- Load is low to moderate
- Roles are clearly partitioned
- Failure modes are independent
In high-acuity, time-compressed environments, these assumptions break down.
Failure Mechanisms
1. Cognitive Saturation
Multiple “backups” increase decision density:
- Parallel alarms, monitors, and inputs
- Competing mental models among team members
- Diffusion of responsibility (“someone else has it”)
The brain becomes the bottleneck.
2. Coordination Overhead
Redundant actors require synchronization:
- Verbal updates
- Handoffs
- Confirmation loops
As load increases, coordination cost rises faster than benefit. Latency replaces resilience.
3. Mode Confusion
Redundant systems often behave differently under stress:
- Backup ventilators with unfamiliar interfaces
- Secondary infusion pumps with different defaults
- Alternative workflows activated only in crisis
Switching systems mid-event introduces error at the worst possible moment.
4. Hidden Coupling
Redundant components frequently share upstream dependencies:
- Power, oxygen, staffing, bandwidth
- Single decision-maker or team lead
- Shared cognitive workspace
Failures are not independent; they cascade.
Clinical Examples
- Two vasopressors started simultaneously without a unified MAP target
- Multiple airway plans without a declared primary strategy
- Parallel documentation streams degrading situational awareness
- “Extra help” arriving without role clarity, increasing noise
In each case, redundancy exists, but performance worsens.
Redundancy vs Robustness
Redundancy is not robustness.
Robust systems favor:
- Simplicity over duplication
- Clear primary pathways with explicit failover
- Minimal mode switching under stress
- Fewer interfaces, not more
A single well-designed pathway outperforms multiple poorly coordinated ones.
Design Implications
Redundancy Must Be:
- Explicit: roles, triggers, authority defined in advance
- Asymmetric: primary vs backup clearly differentiated
- Practiced: failure modes rehearsed under realistic load
Unpracticed redundancy is latent fragility.
Operational Takeaway
In high-load resuscitation systems, more is not safer by default.
Safety emerges from clarity, not quantity.
Redundancy without coordination becomes interference.
Bottom Line
Redundancy protects systems at rest.
Under load, it often accelerates failure.
Design for simplicity.
Declare primacy.
Practice failure deliberately.
CableCrit 