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Why we need a plan to shift individual blame culture

Will rethinking the concept of accountability shift the individual blame culture in the NHS?

Will rethinking the concept of accountability shift the individual blame culture in the NHS?


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Every year across the world an estimated one million patients die in hospitals because of avoidable clinical mistakes. There is no doubt that much progress has been made in improving the NHS safety culture since the Francis report into the care of patients at the Mid Staffordshire NHS Foundation Trust.

Culture of blame

For instance, according to the Health Foundation, the proportion of patients being harmed in the NHS has dropped by more than one third in the past three years. One of the reasons for this is the drive for openness and candour when things go wrong.

The problem is far too often an individual is blamed and opportunities for learning missed. Blame cultures need to become learning cultures now but the problem is, in my experience, change in the NHS moves at the speed of mist.

'Blaming good people for bad mistakes misses the point; it is rarely about individuals and is much more likely to be about systems and the prevailing culture of "how things are done around here"'

Nobody comes to work to do a poor job and everyone hopes for change, but hope is not a plan, and more than anything we need a plan. For me the answer is to rethink our concept of accountability. Blaming good people for bad mistakes misses the point; it is rarely about individuals and is much more likely to be about systems and the prevailing culture of ‘how things are done around here’. If the culture is one of transparency, and the workforce can raise concerns without fear of blame or recrimination, we will create environments of openness and shared accountability.

We need to embrace the concept of learning and spread the message, create leaders who influence behaviours of choice, and collectively have the desire to improve care and reduce harm.

Ignorance

It has been said that true ignorance is not the absence of knowledge, but the refusal to acquire it. So now is the time to choose to make sure that we really do turn our healthcare systems into learning organisations – and give our patients the safest possible care experience.


About the author

Wendy Johnson is head of safeguarding adults at risk and nursing lead for learning disabilities at Great Western Hospitals NHS Foundation Trust, Swindon and writes about life with her daughter Rachael who has autism.

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