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'Why are NHS staff afraid to ’fess up?'


Last week, the health secretary felt the need to create an open reporting culture, fearing that incidents were going unreported. 

He is definitely right – but why? Why should staff feel afraid to raise issues when they happen, or admit mistakes have occurred? What is it about healthcare that constrains people from speaking out when something is not right?

Secretary of state for health Jeremy Hunt took the opportunity at his Global Patient Safety Summit last week to talk about the need to set up a “learning from mistakes league” and a range of other measures. See our interview with Mr Hunt here.

At Nursing Times, we’ve long said that reporting and learning from incidents should be encouraged and normalised, so you won’t find any arguments here, Mr Hunt. It’s what we have been fighting for through our Speak Out Safely campaign, which aims to make all trusts and organisations providing healthcare safer by supporting their staff to raise concerns.

Humans are fallible, as Mr Hunt quite rightly pointed out, and we must ensure we respect the fact that nurses and other health professionals will get things wrong, and must learn from that.

Cultures in other sectors have set up organisations that thrive on learning from mistakes, so what makes the NHS different?

Could it be its size? Experts believe that start-ups are energetic, boundary-less and innovative but, over a certain number of employees, the culture goes awry. Perhaps it’s the punitive, target-driven culture. Or could it be that the service is incredibly hierarchical and that challenge feels a bit too much like insubordination in many settings, or the consequences are too severe. Maybe it’s because making a mistake is still ultimately never celebrated anywhere in the NHS. In all probability, it’s a combination of these factors and more.

Could Mr Hunt be right, that the NHS culture needs to emulate that of renowned hospital Virginia Mason in the US? Incident reporting there is lauded rather than hidden; perhaps, in an NHS more like that, people would feel more inclined to ’fess up.

Unless the plethora of barriers preventing staff from speaking out are dismantled, Mr Hunt’s league table won’t work. But fixing things isn’t quite as easy as simply introducing another target and more reporting responsibilities, is it? 


Readers' comments (19)

  • michael stone

    ' But fixing things isn’t quite as easy as simply introducing another target and more reporting responsibilities, is it?'

    No, it usually isn't that simple.

    But 'I always become wary' (even without any justification - I have no knowledge of 'the Virginia Mason hospital' and its approach to this issue) when a Tory uses a US example, re the NHS.

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  • The VM model in my view is not the answer it is the tool headed approach to the destruction of the NHS. Ask experts in Canada and the Minesota Nursing Association what they think of lean? VM is not perfect it has had a union strike, legal issues with clean equipment, and alleged issues with botched surgery (according to the net). Read reviews also about stressful work environments based on plateud improvement and stress caused to perpetuate lean and likely false money grabbing consultants/ QI empire building. Also read employee reviews of american frontline staff who talk of uncaring lean style management. It also potentially flies in the face of proven Health and safety. Haven't you wondered why the emphasis on person performance through VM lean is counter productive to all round Health and safety? Safety does not occur in a vaccum. Haven't you wondered why the Union Bill is important to maintain in regard to raising issues to care environment? It creates false quality improvement potentially ignoring other external factors and many variables, which care tends to possess. They now want to pay hospitals for reducing stress or is it about hiding it better? = lean care staff deletism? The NHS is in crisis and the government looks like it is bamboozling you the public and nurses with managing cost approaches,which looks like less staff.

    Love from the British Anti-Lean Care Movement.

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  • I find it odd Jenni you don't mention the mechanization automaton of nursing when you mention start ups and VM. This approach leads to greater concerns to cover up and loss of education and ability to identify it as such. If you think stop watches, Kanban, waterfalls, Kaizen, Gemba, RPIW, flow,muda, mura, muri, 5s and all the other tripe is going to work then your wrong. All evidence is antidotal on this nonsense and leads to one certainty less nurses to do their job. Open your eyes, Jeremy Hunt is listening to greedy American lean consultants possibly from VM. There are those of us coming together finding inmovative ways to overcome Jeremy Hunt. Nothing British ball dog spirit. Safety will suffer under this approach and so will nurses well being.

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  • michael stone

    It looks as if the previous 2 posters [who unlike me seem to know something about this 'WM model'], think I am right to be wary !

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  • michael stone

    'VM model' - typed my previous comment in a great hurry.

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  • Michael start looking through the lean lense of Jeremy Hunts american approach and it all comes together to why it necessary to better understand this 1970s disguised Taylorism. When you do there is a realisation to the essential counter strategy to overcome Hunts approach. When for example patients are described as airport luggage on a conveyor belt or processes to improve you start to understand the very methods as well as the people using it have arguably created many problems in our own healthcare system. What we end up with is a sanitisation of hard greater truths and diversion techniques, which eventually gives greater blame to the frontline when improvement struggles. As some would say only a bad mechanic blames the performance of his tools. Michael whilst not the same go to your local medium sized supermarket (which is accessible) that uses these approaches and look on the faces of the struggling low numbered staff. Whilst these organisations seem successful ask yourself is there another story to be told that flies in the face of well-being. But in this sorry state should it be used in hospitals the safety of staff well-being could become a pure mechanical performance issue and thus stress levels are misleadingly lowered and hospitals get more money for going lean.

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  • What on earth is fess up? Is this the quality of writing this once renowned nursing journal now stoops to?

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  • Because sometimes the system negates peoples truth in favour of business corporate lies, false or manipulated confession and political conformity in suspect design for privatisation by Simon and his insurers. I thank you (takes a theatrical bow). Simon if you're out there mate we prefered you as a porter (no disrespect to hard working porters).

    P.s I might not like what M.Stone always puts out there but it's good to know someone cares and whether fortunate or not it's called a democracy. Your better aiming at the tyranny presented in senior circles of the old boy club in the NHS and aspects of government/ American insurers involved (where proven).

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  • michael stone

    Just 'filling time' here - but ...

    I think Cameron - who I think has relevant personal experience of the NHS - might value the NHS more than many Tories.

    I think a lot of Tories, don't like the idea of an NHS funded from general taxation, and essentially free to users. But they know a majority of the public want the NHS to stay put.

    So, I tend to distrust the Tories on the NHS - I am not disagreeing with writers such as ANONYMOUS 16 MARCH, 2016 11:58 AM.

    This isn't really 'my specialist topic' - I'll leave it there.

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  • What does 'fess up mean'? for a start.
    Mr Stone is entitled to his opinion, whether he is a nurse or not.
    As nurses we should respect each other, and agree to disagree in a civil manner.

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