Why I think culture is so fundamental for high quality healthcare

I have recently finished reading a book entitled 'When Healthcare Hurts – Doctors share their darkest hours'. Perhaps not a book to read before admission to hospital it is, nevertheless, a book that every healthcare professional should take the time to read. After reading the book, I felt that I had been on a journey punctuated by a challenging range of conflicting emotions provoked by stories of tragedy, embarrassment, humility and reconciliation. It is both scary and re-assuring. It is certainly a departure from the norm, in that it is a full and honest self exposure of failures to deliver safe and effective healthcare in a sector that itself struggles with highlighting failure but remains one in which so many people have unquestionable trust.

The book raises many many questions for all of the healthcare community. Beyond the outcomes for the people involved, uppermost in my thoughts was how can we deal more effectively with error and lapses in healthcare? How can we move away from the common knee jerk reaction of blaming individuals and develop a culture of learning from incidents so as to modify our existing healthcare systems and models of delivery? I often read of healthcare organizations proudly announcing that they have a 'no-blame or blame-free culture'. I even came across one that stated it had a 'low-blame' approach. I suggest that such names do little to reassure those delivering or receiving healthcare; after all, the 'B' word is in the title!

So in the search for something better, I think that healthcare can learn a lot from the aviation industry. Both aviation and healthcare share a common feature; error can be catastrophic! But it is the aviation sector that has gone much further than healthcare in developing a culture that balances safety and accountability. The culture is known as the 'Just Culture'. It is a culture that aircrew are introduced to from their first day of training and one that persists throughout their careers. In an organization that has a Just Culture, error in the form of mistakes, slips, trips or lapses is seen as an opportunity to learn and there is an expectation that any lessons will be implemented. It facilitates a safe place for individuals to report when things have gone wrong or there is a near miss and an expectation that immediate action to stop unsafe practice will be effected without fear of retribution.

Everyone in the healthcare sector, whether we operate clinically or non-clinically has a duty to provide and support the delivery of healthcare that is effective, safe as possible and ensures the experiences of our patients along the care pathway are as good as they can be. I suggest these three key expectations can be met every single time if the healthcare sector, as the aviation sector has done so successfully, steps up to the mark and brings a 'Just Culture' into the very core of everything it does.