Clinical governance can become oppressive

doi:10.1136/bmj.39150.389919.BE

BMJ 2007;334:549 (17 March), doi:10.1136/bmj.39150.389919.BE

Letters

Regulation

Clinical governance can become oppressive

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Bruce mentions the climate of fear and the culture of defensivepractice created by increasing regulation of doctors.¹ The governmentwhite paper on which his editorial is based recognises thatthere has been managerial over-reaction in NHS trusts.² It alsoconcedes that more should be done to ensure clinical governancestructures can facilitate fair and effective action locally.

Clinical governance must be implemented in a facilitative andnon-oppressive way. James Reason recently noted that the beliefthat medical errors are necessarily due to incompetence, carelessness,or recklessness for which naming, blaming, and shaming are appropriateresponses is perhaps the greatest obstacle to improving patientsafety.³ Other authors think that NHS organisations can be idiosyncratic,self serving, and autocractic, so they react to problems inarbitrary and sometimes capricious ways.⁴ These authors alsosuggest that "such organisations are not necessarily easy toidentify, because they may contain persuasive individuals whoare . . . [Full text of this article]