Think before condemning
BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7372.0/g (Published 09 November 2002) Cite this as: BMJ 2002;325:g
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Thanks to the editor for this excellent short article. As well as offering support to our colleagues at Middlesborough General Hospital he raises several substantial points that are undermining the move towards a blame free culture in the NHS. I would like to invite the Chief Medical Officer to publicly respond to this article, particularly upon the issue of whether his department’s error, and the potential deleterious effect it may have on reporting critical incidents, will be included in the investigation of this incident.
Competing interests:
None declared
Competing interests: No competing interests
Fault and blame are bankrupt concepts. We should simply see incidents
as a means of exploring a better way. Fault and blame are just ways of
emphasising "not my fault". The best management structures ask themselves
"Why did our management systems not stop this incident before it became an
accident? Why did WE fail?" (in contrast to "why did they fail?")
The fact that "blame" was invoked prematurely in this incident speaks
volumes of a political culture that has grown up to allow the diversion of
true responsibility away from the management system.
I have a fine example in my family at the moment. We have a family
member who lives on her own with severe arthritis of (now) both hips "as
bad as it gets" (xray evidence), who can only hobble around the house with
bone grinding on bone, yet it will be at least a year to reach the top of
the waiting list.
Should we complain through political channels then I know the
response. It will be the fault of the local hospital trust for their
inefficiency in using and allocating their funds etc etc. None of it will
be a simple admission that every chancellor sees, in horror, the gross
imbalance between ordinary and healthcare inflation. Each political party
will blame the healtcare policies of the other.
Meanwhile the invidious percentage game is played. Some will die
before they reach to top of the waiting list, many will now fork out their
life savings or have it advanced from a family member (almost certainly
the course we will take) to have it done in the next few weeks, long
delays will reduce the need for that second replacement in the future and
some will become too ill to tolerate the operation (compounded by their
immobility).
The real management "blame" - should we use this bankrupt term - is
that the whole political structure is oppositional rather than
cooperative. The simple communal and cooperative admission should,
perhaps, be that "free at the point of service" is becoming increasing
more difficult to deliver. Addressing this central, political point might
be a good starting point to a change in this "blame" culture.
Competing interests:
None declared
Competing interests: No competing interests
Suitable Precautions
Whatever happened to universal precautions? Instruments reused for
neurosurgical procedures should always be treated as if they were
contaminated by prions. With diseases of long latency, whether caused by
human immunodeficiency virus or prions, only a proactive policy can
possibly prevent occasional transmission of disease from apparently
healthy persons.
Competing interests:
None declared
Competing interests: No competing interests