Letters Staff treatment when things go wrong

Focus on what went wrong, not who might be blamed

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i5859 (Published 08 November 2016) Cite this as: BMJ 2016;355:i5859
  1. Bill Kirkup, former chair
  1. Morecambe Bay Investigation, Gateshead, UK
  1. bkirkup{at}blueyonder.co.uk

Oliver makes excellent points about NHS complaint handling.1 We are caught in a lock that is hard to break.

On one hand, in investigations that I have done, those who had suffered harm understood that healthcare is complex, risky, and demanding and that things go wrong sometimes. They didn’t blame clinicians for that. They lost sympathy, however, when they saw denial and concealment.

On the other hand, clinicians obviously do fear blame, and with good reason based on their experiences of trusts, regulators, and the media. We underestimate the capacity of clinicians to blame themselves for mistakes, and self blame and guilt in trainees can be reinforced by how their role models react. This can lead to lack of openness, ranging from reluctance to disclose or apologise to denial and cover-up. The resulting loss of trust may be disastrous for clinicians and those harmed.

This will continue until we do things differently. We could shift the emphasis of professional regulation from pursuing clinicians who have made mistakes to see if they might be negligent to finding those who falsify and conceal, thus failing to learn. We could investigate incidents to find out what went wrong and why, rather than who might be blamed. We could include education in responding to errors by trainees to counter unhelpful behaviour learnt by observation.

These changes are now being discussed and planned,2 3 but we have a long way to go. Until then, the failing complaints system will remain just one visible sign of deeper malaise.



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