Letter: Sweden’s no-blame culture stops healthcare accidents
Darina McAlpine and many public inquiries identify that blackouts appear to be the NHS ‘standard response to medical accidents (“How the NHS handles the scandal is the real problem”, Letters, April 14). But she and many others are fundamentally wrong when they see “rotten apples” as the problem to be addressed.
As a 2016 report from the UK Department of Health Safety Investigation explains, “the vast majority of safety incidents are associated with unintentional or unintentional errors by caring and engaged staff. These errors are usually caused by poorly designed systems, equipment or work contexts.”
This mindset that bad people make bad mistakes and a cultural and legal assumption that guilt, shame and prosecution will deter future mistakes is the real problem. The legal system focuses on compensating victims of medical accidents through a fault and liability rule and a deliberately designed contradictory process that places the blame solely on individuals, not systems, not cultures, not working conditions.
This is considered the most appropriate way to stimulate future improved behavior. That actually prevents it. The medical director of the Swedish patient compensation system goes so far as to say that looking for scapegoats through a trial system based on errors is “a very effective way to kill more people”.
A change in the way such problems are handled in a “no-blame administrative compensation system” would place liability where it is deserved, provide appropriate compensation but shift the focus from the actions of a potential pest to the condition of the injured party, the circumstances of the damage and contributing factors.
Such systems that exist in the Nordic countries and elsewhere have been shown to lead to fewer mistakes and injuries for patients, lower legal costs for everyone and much faster access to justice for patients.
Professor Chris Hodges, a co-operation expert, identifies that this approach promotes “a special style of society that identifies problems and solves them quickly and through co-operation, rather than waiting for the litigation system to be invoked and function in a state of conflict and adversarial legalism.”
It is the kind of society I want to live in and the basis of a legal system that could be more equitable and more effective in many areas.
Hilary Sutcliffe
Director, SocietyInside
London SE21, United Kingdom