Letter: Sweden’s no-blame culture curbs healthcare accidents

Darina McAlpine and numerous public inquiries identify that a cover-up seems to be the default NHS response to medical accidents (“How the NHS handles scandal is the real problem”, Letters, April 14). But she and many others are fundamentally wrong to see “rotten apples” as the problem to be addressed.

As a 2016 report from the UK Department of Health healthcare safety investigation branch explains, “the vast majority of safety incidents are associated with inadvertent or unintentional errors on the part of caring and committed staff. These errors are typically provoked by poorly designed systems, equipment or work contexts. ”

This mindset that bad people make bad mistakes and a cultural and legal assumption that blame, 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 adversarial process that assigns blame to individuals alone, not systems, not cultures, not working conditions.

This is considered the most appropriate way to stimulate future improved conduct. It actually prevents it. The medical director of the Swedish patient compensation scheme goes as far as to say that looking for scapegoats through a fault-based litigation system is “a very efficient way of killing more people”.

A change in the way that such problems are dealt with in a “no-blame administrative compensation scheme” would put accountability where it is deserved, deliver appropriate compensation but shift the focus from actions by a potential injurer to the condition of the injured, circumstances of the injury and contributing factors.

Such schemes in place in Nordic countries and elsewhere are proven to result in fewer mistakes and harms to patients, lower legal costs for everyone and much quicker access to justice for patients.

Professor Chris Hodges, a collaborative governance expert, identifies that this approach promotes “a particular style of society that identifies problems and solves them quickly and through co-operative engagement, rather than waiting for the litigation system to be invoked and to operate in a mode of conflict and adversarial legalism ”.

That’s the sort of society I want to live in and the basis for a legal system that could be fairer and more effective in many fields.

Hilary Sutcliffe
Director, SocietyInside
London SE21, UK

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