Hold people responsible, even when avoiding blame
Risk managers have struggled for years to reconcile the notion of a "no-blame" culture with incidents in which - systemic problems or not - one individual clearly committed a willful violation of procedure. Embracing the philosophy is easier when the evidence suggests the health care worker made a mistake, even a failure of attention or diligence, but willful and even malicious misbehavior seems to pose a dilemma. You don't want to abandon your "no blame" culture, but it seems just as wrong to let someone get away with brazen threats to patient safety.
You don't have to, says David Maxfield, vice president of research at VitalSmarts, a corporate training company in Provo, UT, and the leading researcher of "Silence Kills" - a study that exposes how communication failures can lead to medical errors. Focusing on the culture of the organization and the systemic problems that may have caused the incident or made it possible does not have to conflict with holding an individual responsible for willful violations of protocol, he says.
"We used to look at this as an either/or situation. Either we hold people accountable or we forgive them and hold the system accountable. In fact, we want to do both," he says. "The message should be that we expect employees to maintain safe practices, but at the same time, we want to make safety convenient, easy, logical, and sensible. We want to give them the easiest path to safety, but then we expect them to follow that path."
Striking the right balance is the key, Maxfield says. If the health care worker was in the wrong, you can hold that person accountable for violating policy and procedures, he says. But don't stop at blaming the last person to touch the patient. Look back further to see what may have spurred that violation and how it could be prevented in the future.
A "no-blame" culture also cannot be taken so far that people are not judged on their abilities to perform given tasks and follow procedures, Maxfield says. At some point it can be reasonable to say that the problem is not with the system but with the individual who is not capable of following procedures. Risk managers should not feel this is a betrayal of the "no blame" culture, he says.
"In those cases, you move people to jobs where they are competent enough," he says. "Nobody wants to create an organization where incompetent people are allowed to be incompetent because we're afraid to hold them accountable for what they do, or what they prove themselves incapable of doing."
Risk managers have struggled for years to reconcile the notion of a "no-blame" culture with incidents in which - systemic problems or not - one individual clearly committed a willful violation of procedure. Embracing the philosophy is easier when the evidence suggests the health care worker made a mistake, even a failure of attention or diligence, but willful and even malicious misbehavior seems to pose a dilemma.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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