On this morning’s Today programme on BBC Radio 4, the UK’s National Health Service (NHS) featured strongly, including an interview with its newly-appointed Chief Executive, Simon Stevens.
Earlier in the programme, Sarah Montague interviewed Professor
Malcolm Green, a former physician at Royal Brompton who argued for replacing the
current “culture of blame and shame”. In outline, Professor Green said:
When things go wrong in the NHS, someone has to
be blamed; someone has to be fired;
There is little learning from errors;
It is uncommon for processes to be improved;
The NHS needs to learn from airline and
construction industries, which means:
Working in teams to make sure there is
progressive and consistent improvements in processes
Incidents and mistakes should be understood and
worked through how to stop them happening
The interview went no further, for lack of time. However, had it done so, it would have been
interesting to hear more about how the current culture inhibits learning in the
The discussion reminded me of Sidney Dekker’s book, “Just
Culture” – a review of which is available on this blog here.
In that book, Dekker argues that a balance must be struck
between safety and accountability. When
things go wrong, if all that happens is for people to be ‘blamed’ then true
learning can never take place. This is
because we all make honest mistakes and always will – “to err is human”.
However, if honest mistakes are treated as crimes and ‘justice’ sought, all
that will happen is that mistakes will be covered up and we will never learn from
This is far from easy and requires strong, bold and compassionate leadership and for people in senior positions to be honest about their own failings as well as others'.
For a conversation about lessons, leadership and how to
develop a learning culture, please get in touch directly or via the Knoco website.