Talk Health and Care

Culture of blame that is reinforced everywhere

Currently the understanding of what causes errors in healthcare is very immature - as such staff as seen as the weakness in the system and errors are presumed to be human ones and hence focus is still on blaming individuals -thi seems is reinforced by attitudes at multiple levels in NHS provider organizations and regulators and arms length bodies. We fail to globally recognise the cause of errors in healthcare and the new fail to fix it. 

The RCA process is reactive the need is to understand and prevent errors through task analysis and designed of systems that understand how humans work is stressful situations

Error and harm is completely a blame process that staff resent as they feel they are being blamed - more understanding of how these subconscious errors are predictable and programmed into our blames engages with staff and allows the frontline staff to describe and develop safety in conjunction with non healthcare experts who understand how humans work

Think of a safety incident with a patient or service user where you or a colleague have felt supported and treated in a fair way in your workplace. Explain why you felt this.

Now think of a time where you have not felt supported or treated fairly in the workplace. Explain why you felt this.

What could have been done differently to make you feel better supported and treated fairly?

What would be useful in helping develop a just culture?

Having a culture which sees patient harm as a symptom of poor design and encourages user centered design with engagement of front line staff, patients and non healthcare experts ( ie behavioural psychologists, ergonomists etc) 

Michelle McDonald 3 months ago

As a social worker on a newly integrated care team with NHS staff, one thing that stands out for me is the blame culture amongst health professionals rather than looking at models of reflexive practice. Scrutinising decision-making doesn’t have to become a defensive exercise about who hasn’t done what wrong. Instead we should be focusing on what could we do differently in the future to deliver a more effective service. It makes for a much better working environment and helps people to grow rather than dwell on mistakes, which only breeds stress and resentment. Human error is unavoidable but learning opportunities are everywhere.

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Michael NHS I 3 months ago

This is very important feedback, and we hope that our proposals to implement a national curriculum for patient safety can help us to change this. We also hope our work on the future patient safety investigations will help. (

We also recognise Michelle’s feedback – many people have reported that reflective pieces can be used at times as a form of punishment. Part of the principle behind our just culture guide is to encourage managers to assess whether there’s actually any meaningful issue with an individual that needs addressing before taking action aimed at individuals, even comparatively minor ones such as reflective pieces, that tend to take on a punitive undertone.

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