Criminalisation of human error in health care: How and why legal accountability can crowd out professional accountability and undermine patient safety

Abstract

This research is about accountability in health care. Theoretically it aims to shed light on two types of public accountability, how these types interact and relate to the aim of learning to improve patient safety. The study addresses the theoretical questions how and why legal accountability can crowd out professional accountability. It seeks to answer the empirical question what is the impact of criminal charges against health professionals by presenting two sets of data: First, a case study of an event, first of its kind in Iceland, in which a nurse in an intensive care unit was charged for manslaughter by negligence in May 2014. The court case material is examined and specialised in-depth and semistructured interviews conducted to describe the experience at the level of the individual and to account for organisational responses. Second, explorative focus groups were carried out in preparation of an internet survey conducted among all practising nurses in Iceland measuring the impact of the prosecution. The narrative highlights the complexities and risks of error involved in health care. Survey results show that the prosecution has increased the level of insecurity among nurses and raised awareness of the risk involved to themselves in their job. This court case established a precedent and constitutes a defining moment in the health care system. While accountability mechanisms were in their infancies in the system, health professionals in Iceland lost their immunity with a possible setback for the fostering of effective professional accountability mechanisms and devastating consequences for patient safety.