Abstract
Healthcare systems need to consider not only how to prevent error, but how to respond to errors when they occur. In the United Kingdom’s National Health Service, one strand of this latter response is the ‘No Blame Culture’, which draws attention from individuals and towards systems in the process of understanding an error. Defences of the No Blame Culture typically fail to distinguish between blaming someone and holding them responsible. This article argues for a ‘responsibility culture’, where healthcare professionals are held responsible in cases of foreseeable and avoidable errors. We demonstrate how healthcare professionals can justifiably be held responsible for their errors even though they work in challenging circumstances. We then review the idea of ‘responsibility without blame’, applying this to cases of error in healthcare. Sensitive to the undesirable effects of blaming healthcare professionals and to the moral significance of holding individuals accountable, we argue that a responsibility culture has significant advantages over a No Blame Culture due to its capacity to enhance patient safety and support medical professionals in learning from their mistakes, while also recognising and validating the legitimate sense of responsibility that many medical professionals feel following avoidable error, and motivating medical professionals to report errors.
Highlights
Health care sometimes makes patients worse off
Sensitive to the undesirable effects of blaming healthcare professionals and to the moral significance of holding individuals accountable, we argue that a responsibility culture has significant advantages over a No Blame Culture due to its capacity to enhance patient safety and support medical professionals in learning from their mistakes, while recognising and validating the legitimate sense of responsibility that many medical professionals feel following avoidable error, and motivating medical professionals to report errors
Sensitive to the undesirable effects of blaming healthcare professionals and to the moral significance of holding individuals accountable, we argue that a responsibility culture has significant advantages over a No Blame Culture in its capacity to both enhance patient safety and support medical professionals in learning from their mistakes, while recognising the role that individuals play in error and the fact that this often demands that individuals take responsibility for their errors
Summary
Health care sometimes makes patients worse off. There is a robust body of evidence showing that errors and ‘adverse events’ within health care can harm patients. ‘Blame is Unsafe’: Even if individuals are blameworthy, blame and the fear of blame is a bulwark to the openness and transparency that is required to improve patient safety.[9] Each of these claims is sufficient but not necessary to justify a No Blame Culture. A critique of the NBC must tackle both claims This raises the possibility that a culture that focuses on systemic issues may strike the wrong balance between the potential benefits of holding people accountable and the negative consequences of blame and fear of blame. What’s more, the typical suggestion that we focus on problems with systems – except in a small proportion of cases where healthcare professionals intentionally harm patients or repeatedly cut corners – suggests that many defences of the NBC conflate blame with responsibility. The link between our positive argument for a responsibility culture and criticism of the NBC seems clear
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