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'Stop the blame game to raise standards of care'


Too many times in healthcare, managers and staff use what went wrong to inspire them to find a model for safe and better practice.

Several organisations have reacted to events at Mid Staffs, Maidstone and Tunbridge Wells, Care Quality Commission and other reports to try and find a way to ensure such events don’t happen where they work.

While this reactive approach is understandable and can be a useful starting point, such methods shouldn’t create a “blame game” culture, where nurses are used as scapegoats. Instead, they should also study what excellent practice, customer service and outcomes look like and model those for imitation.

In private business, people in retail or the service industry or those working in environments where safety is key (aeronautics, for example) will look at what circumstances and behaviours create a successful day, and then look at creating a checklist system to emulate them.

Exceptional businesses are confident of what is needed to create excellence, and are relentless in a drive to ensure they achieve it.

This is the approach taken at the Heart of England Foundation Trust by chief nurse Mandie Sunderland and her nursing team. The trust has launched VITAL4Care, an online platform that assesses nurses’ skills in 14 fundamental areas of care and highlights the latest thinking and learning around these areas. Only by knowing all of these areas inside out can nurses be confident that they are safe to look after patients, says Ms Sunderland. True, what led to the launch of VITAL was a series of high-profile problems at the trust. But the result is not a knee-jerk piece of faddism or a tick-box designed to placate the board. Neither did HEFT hide behind its nurses and sacrifice their professional reputations to silence the critics – and the press – for a few weeks.

Instead, it took a long hard look at what was needed to ensure that its nurses were good enough to do the jobs they were hired to do. It set about creating a system that was easy to access and provided all the knowledge the workforce needed to deliver safe care, and could verify that nurses knew and understood it all. VITAL supports staff as well as ensuring patients will be safely treated, and has had a phenomenal impact on the care being delivered.

This is proof that when things go wrong, it’s best not to retreat, but tackle the challenge head on. It’s time to stop blaming nurses and start supporting them to ensure that things go right.


Readers' comments (21)

  • Pirate and Parrot

    'Too many times in healthcare, managers and staff use what went wrong to inspire them to find a model for safe and better practice.'

    Unless you didn't mean to type that, you are wrong - every time something goes wrong, you should try to learn from it !

    But if you mean that 'honest mistakes which did not really invovle incompetence' should be learnt from without 'blame being doled out, then I am 100% with you: it is the apportioning and avoidance of blame, that prevents proper learning from mistakes.

    But it is very hard, to work out to solve that conundrum !

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  • It is easy to throw blame around.
    Would it be better to start with 'what went well?', then 'what can be improved?' and 'how can we make these improvements together?'

    One would have thought that more senior staff could tap into their greater experiences and knowledge to come up with constructive suggestions and offer to help make improvements to benefit everyone concerned.

    The senior team should provide front-line staff with enough resources to meet whatever challenges that face them to have more successful outcomes. Rather than reducing resources and expecting more in return.

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  • Tiger Girl

    andy | 14-Jun-2012 11:42 pm

    The point is, that you tend to learn more by working out why things went wrong. You start by using your existing experience and skills to try and design a system which will work, but then you need to look at when it fails to see what you may have missed, or not properly understood.

    Nobody has ever investigated a perfect landing !

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  • The trained nurse gets the blame for everything that goes wrong more so now than previous years. I strongly believe that all the extra paperwork/policys/procedures etc that have appeared taking nurses off the shop floor and caring for their patients especially in the busy areas have not helped.
    Nurses these days don't know which way to turn and you can guarantee the one thing you couldn't fit in or missed is the bit that gets picked up by someone who hasn't a clue what happened on that shift, wasn't aware of all that you did do just picked up on what wasn't done and this can feel like a kick in the teeth after all your hard work.
    And yes I am getting to the point of leaving a career I used to enjoy.

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  • King Vulture

    Anonymous | 16-Jun-2012 11:26 am

    Your point is very valid - but I think it is a different one from Tiger Girl's. If there are too few staff to do the job, the problem is (and would, presumably, be found to be by investigation) the shortage of staff. If there are enough staff, and something procedural is 'wrong', then that is a different type of problem. Etc.

    But 'the mistake happened, because we had too much to do' is a perfectly acceptable conclusion - and it would probably be a very common finding.

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  • "But 'the mistake happened, because we had too much to do' is a perfectly acceptable conclusion - and it would probably be a very common finding."

    not in the eyes of some managers who respond it is up to you to organise your work better, now matter how well we felt we had planned and even though much of it consisted of emergencies, unforeseen circumstances, unplanned admissions from A&E or transfers from other wards including ICU arriving on the ward without any warning and needing immediate attention and clerking or patients returning from investigations such as cardiac catheterisation needing immediate transfer from trolley to bed and regular obs. sometimes these patients arrived out of hours and it was a rush to do bloods, order any urgent examination, carry out preps. or order drugs or meals, etc. sometimes on our own with 20 beds, usually all filled, for up to four hours or with one aide and very occasionally two.

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  • Mandie Sunderlands' VITAL 4 CARE does sound like a great way of ensuring Nurses are up to date and have the relevant skills, knowledge and support. However when things do wrong we have to look at the whole picture. My heart sinks when we recieve serious complaints in our area. Thankfully and truthfully this only happens 2 or 3 times a year where I work. Its still 2 or 3 times too many in my opinion though. The majority of our complaints are NOT about the nursing care. It is usually about the medical care or lack of it!!
    I think it is important to analyze what does work and what has been sucessful as well as looking at what has gone wrong when investigating a complaint.
    It is very easy to feel threatened, angry and defensive when we recieve complaints. However these need to be seen as an oppertunity for improvement.
    And yes we have to stop playing the '' Blame game''... As the circumstances leading to a complaint are usually multifactorial and by assessing each element of the problem we can identify what has gone wrong.
    Onlly then we can start to look at what does work well and put it into practice.

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  • Anonymous | 17-Jun-2012 5:22 am

    'And yes we have to stop playing the '' Blame game'''

    Yep, that is the confounding factor - that is why it is so hard to 'look objectively' at why mistakes happened.

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  • Screwing up is the only way we can truly reflect on something, so nurses should make at least one mistake a day as part of the learning atmosphere of a hospital ( unless you are a student or a band 5 then it's the high-jump!). I try to make at least one catastrophic mistake a week, one so bad that the hospital management are forced to cover it up for fear of losing THEIR jobs for letting something so heinous occur under their supervision. Keeps 'em on their toes.

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  • tinkerbell

    when i was younger and a lot more naive i actually thought that managers would want to know if something 'bad' was going on. I'm not talking trivial stuff but 'bad'. Won't eleaborate as don't want to keep revisiting the crime scene years later.

    I learned the hard way that they would rather 'cover up' anything that was going wrong and sweep it all under the carpet if there was the slightest whiff that they knew about it and hadn't acted.

    In the process i became the perceived threat and when the proverbial hit the fan every concern i had ever raised to management was denied. How could they admit that i was telling the truth all along as their jobs would be on the line. I understood from then on their motivation and it was a real eye opener to me.

    In a spy thriller i would probably have been 'bumped off' as every manager at every level was involved. They just ended up stuck with me.I found the whole episode sickening and eventually left. If i ever found myself in a similar situation, which thankfully i never have, i would employ a completely different strategy so that i don't end up the meat in the sandwich.

    I imagine that in every hospital there is a carpeted room 101 behind a heavily locked door where everything has been swept under a very lumpy carpet.

    Until this culture changes and sadly most managers have been brought up in it, very little else will change.

    Until the upper echelon step up and accept responsibility for their failings too then we will continue on this merry go round which is a conspiracy of silence and collusion.

    This corruption goes on at every level in every institution and it is usually only a journalist who reveals it.

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