No Blame No Gain? From a No Blame Culture to a Responsibility Culture in Medicine

Parker, Joshua; Davies, Ben

doi:10.1111/japp.12433

Cited by 26 publications

(21 citation statements)

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“…It is well recognized how system failures at the blunt end may trigger unsafe cascades of events that affect healthcare providers’ performance and cause active failures at the sharp end. However, a blame culture persists in many organizations and unexpected patient harm is often attributed to individual workers [ 2 , 3 ]. When adverse events occur, the negative consequences can reach far beyond the patient.…”

Section: Introductionmentioning

confidence: 99%

Promoting the Psychological Well-Being of Healthcare Providers Facing the Burden of Adverse Events: A Systematic Review of Second Victim Support Resources

Busch

Moretti

Campagna

et al. 2021

IJERPH

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Given the negative impact of adverse events on the wellbeing of healthcare providers, easy access to psychological support is crucial. We aimed to describe the types of support resources available in healthcare organizations, their benefits for second victims, peer supporters’ experiences, and implementation challenges. We also explored how these resources incorporate aspects of Safety I and Safety II. We searched six databases up to 19 December 2019 and additional literature, including weekly search alerts until 21 January 2021. Two reviewers independently performed all methodological steps (search, selection, quality assessment, data extraction, formal narrative synthesis). The 16 included studies described 12 second victim support resources, implemented between 2006 and 2017. Preliminary data indicated beneficial effects not only for the affected staff but also for the peer responders who considered their role to be challenging but gratifying. Challenges during program implementation included persistent blame culture, limited awareness of program availability, and lack of financial resources. Common goals of the support programs (e.g., fostering coping strategies, promoting individual resilience) are consistent with Safety II and may promote system resilience. Investing in second victim support structures should be a top priority for healthcare institutions adopting a systemic approach to safety and striving for just culture.

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Section: Introductionmentioning

confidence: 99%

Promoting the Psychological Well-Being of Healthcare Providers Facing the Burden of Adverse Events: A Systematic Review of Second Victim Support Resources

Busch

Moretti

Campagna

et al. 2021

IJERPH

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“…Through the prism of care ethics, therefore, a more integrative conception of connections between medicine and policing is possible – one that involves an intertwining (rather than pyramidal ranking) of rules, practice, empathy, critique and conscience. Furthermore, since medicine is also said to suffer from a ‘blame culture’ (Parker and Davies, 2020), such connections throw up the possibility that issues with EBP in both these professions have as much to do with the fear and the effects of blame as with EBP per se.…”

Section: Discussionmentioning

confidence: 99%

Evidence-based practice and the ethics of care: ‘What works’ or ‘what matters’?

Tomkins

Bristow

2021

Human Relations

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This paper considers why and how evidence-based practice (EBP) has become distorted in practice, and what to do about it. We present qualitative data from an action research project in policing to highlight tensions between the rhetoric and reality of EBP, and the ways in which EBP’s seductive catchphrase ‘what works’ is being understood and applied. Through the lens of care ethics, we integrate ‘what matters’ with ‘what works’, and ‘what matters/works here’ with ‘what matters/works everywhere’. This approach recognises relational expertise, practical reasoning and critical inquiry as vital for EBP in practices of social intervention. Drawing on key care ethics motifs, we suggest that care is the ethical scaffolding upon which social justice relies, and hence crucial to organs of security, peacekeeping and law enforcement. From this position, we argue that policing might renegotiate its difficult relationship with the particular, recasting it from something uncomfortably discretionary (the maverick cop) and shameful (an individualised blame culture) into something which underpins and enhances police professionalism. Whilst developed in a policing context, these reflections have a broader relevance for questions of professional legitimacy and credibility, especially within the ‘new professions’, and the costs of privileging any one type of understanding over others.

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“…Professionals involved in harm events commonly experience shame and regret leading to avoidance, loss of engagement, and adverse psychological phenomena 14 . On a systemic level, this approach may also compound the culture of blame, which is highly prevalent in health care and damaging to staff and patients 15 …”

Section: Theoretical Limitations Of the Deficit‐based Approach To Safetymentioning

confidence: 99%

Positive approaches to safety: Learning from what we do well

Plunkett

2022

Pediatric Anesthesia

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Historical and current methodologies in patient safety are based on a deficit‐based model, defining safety as the absence of harm. This model is aligned with the human innate negativity bias and the general philosophy of health care: to diagnose and cure illness and to relieve suffering. While this approach has underpinned measurable progress in healthcare outcomes, a common narrative in the healthcare literature indicates that this progress is stalling or slowing. It is important to learn from and improve poor outcomes, but the deficit‐based approach has some theoretical limitations. In this article, we discuss some of the theoretical limitations of the prevailing approach to patient safety and introduce emerging, complementary approaches in this field of practice. Safety‐II and resilience engineering represent a new paradigm of safety, characterized by focusing on the entirety of work, with a system‐wide lens, rather than single incidents of failure. More overtly positive approaches are available, specifically focusing on success—both outstanding success and everyday success—including exnovation, appreciative inquiry, learning from excellence and positive deviance. These approaches are not mutually exclusive. The new methods described in this article are not intended as replacements of the current methods, rather they are presented as complementary tools, designed to allow the reader to take a balanced and holistic view of patient safety.

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No Blame No Gain? From a No Blame Culture to a Responsibility Culture in Medicine

Cited by 26 publications

References 0 publications

Promoting the Psychological Well-Being of Healthcare Providers Facing the Burden of Adverse Events: A Systematic Review of Second Victim Support Resources

Promoting the Psychological Well-Being of Healthcare Providers Facing the Burden of Adverse Events: A Systematic Review of Second Victim Support Resources

Evidence-based practice and the ethics of care: ‘What works’ or ‘what matters’?

Positive approaches to safety: Learning from what we do well

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