Qual Saf Health Care 13:163-164 doi:10.1136/qshc.2004.010959
  • Editorial
  • “No blame” culture

Creating a “no blame” culture: have we got the balance right?

  1. M Walton
  1. Correspondence to:
 Associate Professor M Walton
 Faculty of Medicine, University of Sydney, Sydney 2006, Australia;

    There is a need to clarify where and how professional responsibility fits into the “no blame” culture

    How the media reports patient harm associated with adverse events continues to cause public concern and disturb health professionals. The need for health professionals to communicate more effectively with the public about medical errors has been identified,1,2 but to date there is little evidence of this happening. Tensions surrounding professional responsibility and accountability (as opposed to institutional accountability) and the quality and safety “no blame” approach within the health system prevent health professionals communicating clearly with the public. How can we give a clear message to the public when we do not have a clear understanding of these issues ourselves?

    The current focus on improving care by redesigning systems, tasks and workforce3 necessarily emphasises the multiple factors underpinning errors, relies on reporting systems for capturing errors, and advocates a “blame free” environment so that staff will report their mistakes or near misses. This approach examines system factors as causes of errors rather than individuals. Evidence from other industries and disciplines supports this approach.

    The safety agenda requires us to switch from an individual focus to a system focus but, in making this switch, professional accountability has been cast as the “black sheep” of safety improvement. Undeveloped systems of professional accountability, inadequate support from professional bodies for professional regulation, inadequate understanding of public interest, and …

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