I sat down to write this editorial on the topic of moving from a blame culture towards a learning culture and the first headline I saw when I opened my web browser was: ‘Canada's ER crisis: Doctors urge governments to stop finger-pointing and find solutions’.
What is it about us that we naturally want to point fingers at someone when something goes wrong? I see this in my children all the time—the need to show that whatever happened was not only not their fault, but that it was in fact their sibling's fault! I am always reassuring them that it doesn't matter how it happened but that we should now focus on sorting it out together.
Interestingly, it turns out that we may be somewhat hardwired to deny intentionality when something goes wrong and to ascribe it to someone else (Ngo et al, 2015). According to this study, we are also more likely to feel that negative behaviours are intentional and positive behaviours are not.
In the realm of healthcare, this concept applies in multiple areas. In chronic disease, there is a tendency to blame individuals who are ill for their lifestyle choices, when the causes of disease are much more complex than this. This is also different from encouraging lifestyle improvement to prevent or even help to heal illness.
Another really obvious area where this becomes relevant is in terms of ‘whistleblowing’ or reporting incidents. We may have a natural tendency to blame others which may imply that a health professional would be more likely to whistleblow on someone else. However, in healthcare, if a blame culture exists within an organisation, the blame may fall back on the person who reported the event, whether in the form of bullying from the colleague who was reported, or even the managers who may not want to draw negative attention towards the organisation or the possibility of their own management having played a part.
While this is all understandable in terms of human nature and the dynamics between people at work, there is something more important that must always be at the centre—patient care. It is simply not possible to collectively learn from mistakes and improve patient care without an open, transparent culture where employees feel safe to report events and incidents that should be improved upon without the fear of blame. Sometimes the person who made the error is the one best placed to report it but if there is fear of being blamed, mistreated, losing their employment or, even worse, any or all of these things in addition to the complaint being ignored and no improvements being made in practice, they are not going to want to report the event.
This month, Advanced Practice Week takes place from 13–19 November. In the current issue of the Journal of Paramedic Practice, board member and clinical practice development manager of advanced paramedic practitioners in urgent care at the London Ambulance Service, Georgette Eaton, discusses advanced practice in paramedicine on p. 446. She points out the importance however of advancing practice not primarily with the goal of advancing the profession—but with a focus on meeting patients’ needs with the awareness that the profession will develop and advance as a result.
At the moment, the NHS and other healthcare systems around the world are stretched to the detriment of staff and patients. Meetings the needs of both patients and those who care for them going forward is paramount—as, while the cost of resources is high, the cost of a lack of resources is even higher.