Telling cultures: ‘cultural’ issues for staff reporting concerns about colleagues in the UK National Health Service

• Published in: Sociology of health & illness 2006-11, Vol.28 (7), p.903-926
• Main Author: Ehrich, Kathryn
• Format: Article
• Language: English
• Subjects: blame; Cultural studies; Culture; errors; Ethics and moral life; Health care; Health care policy; Health Care Services; Health Care Services Policy; Health Policy; Health services; Hospitals; Humans; inquiries; Interprofessional Relations; Medical errors; Medical Errors - prevention & control; Medical personnel; Organizational Culture; Patient safety; Patients; Power (Psychology); Safety; Safety Management; Sociology; Sociology of health and medicine; Sociology of knowledge and ethics; Sociology of knowledge and sociology of culture; Staff; State Medicine - organization & administration; United Kingdom; Whistleblowing
• ISSN: 0141-9889; 1467-9566
• DOI: 10.1111/j.1467-9566.2006.00512.x

Recent UK health policy initiatives promote a ‘no blame culture’ and learning from adverse events to enhance patient safety in the NHS. Similar initiatives exist in the USA and Australia. Changing the ‘blame culture’ in the NHS has been advocated in policy documents and inquiry reports for over a decade. Some key concepts that are used in the policy discourse –‘blame’; mistakes, errors and misdemeanours; and ‘culture’– are examined and considered in the light of pertinent social science literature to question some of the assumptions concerning these terms in the policy discourse, and to suggest some alternative questions and perspectives. The Three Inquiries, a recent series of statutory inquiries held in the UK, are used as a case study to explore some of the intra‐ and inter‐professional difficulties of reporting errors and misconduct by medical practitioners. The paper offers an interpretive social science perspective as an alternative to more policy oriented and managerial approaches to patient safety issues, focusing on deeper structural aspects of organisational phenomena implicated in the ability or otherwise of medical and other healthcare staff to report mistakes and misconduct as one aspect of patient safety.