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Don’t blame me

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What’s the connection between medicine and the aeronautics industry? Sadly, there isn’t one— and medicine is definitely poorer for it.

Around 2.6 million people die every year because of a mistake or oversight across the world’s healthcare systems, making medicine more deadly even than malaria. Although every death is an unnecessary tragedy, nothing much seems to improve; medicine keeps on posting similar numbers of accidental deaths every year, and things don’t get better because, at its heart, medicine is a “blame culture.”

As a result, medicine is a closed system from which no light emits. It is loath to improve procedures, use safer drugs or double down on prescribing—because there would need to be an acknowledgment that there was a problem in the first place.

Instead, the fear of litigation, a loss of face and the end to a hard-earned career inspire a culture of cover-up, rebuttal and obfuscation, denying grieving families any resolution or even credible answers.

The aeronautics industry also used to be a blame culture, although hiding an airplane crash was always going to be more difficult than hiding an isolated death in a hospital ward. That all changed after a United Airlines plane crashed in Portland, Oregon, in 1978. The landing gear got stuck as the plane came in to land, and the pilot, Malburn McBroom, circled the city as he radioed for help—but he hadn’t noticed the plane’s fuel levels were dangerously low.

He was forced to crash-land the plane, and because of his expertise, just 10 people died. The remaining 179 passengers all walked away safely.

But that daring landing wasn’t enough to save his career. Pilots are supposed to notice when the plane is running low on fuel, and McBroom lost his license and left the industry in disgrace. He died a broken man just a few years later, as writer Matthew Syed explains in his book Black Box Thinking (Hodder & Stoughton, 2016).

But McBroom’s treatment was also the beginning of the end of the airline industry’s blame culture. If the end result of an accident or near-miss was to blame the pilot, there would always be a culture of cover-up. Today, a pilot has four routes they can follow if they want to report an error, and none points back to them.

Most pilots—and doctors and nurses, come to that—usually display “normal” human behavior, as the American academic David Marx has described, in which mistakes can happen because we’re all human. This is the exact opposite of “reckless” behavior, in which someone deliberately and willfully makes a mistake. But an admission of even normal behavior requires a change of culture, a focus shift from blame to learning from mistakes.

The UK’s former health secretary Jeremy Hunt has been ruminating on these issues in his new book Zero (Swift, 2022), which sets out ways to reduce the number of avoidable deaths in the country’s National Health Service (NHS) from 150 every week to zero.

When he took charge of the NHS in 2012, Hunt quickly realized the extent of medical error—and the tragic individual stories behind each death—was being kept from him by a battalion of civil servants. It was all down to the blame game, as he was to discover, and because the NHS is funded by British taxpayers, politicians will also get in on the act.

Two other elements contribute to avoidable deaths, according to Hunt: staffing levels and money. Even before the Covid-19 pandemic, there was a shortfall of 60,000 nurses in UK hospitals, and the problem has worsened since then. Without proper staff coverage, shortcuts will be made and accidents will happen, as he correctly argues.

But, as a politician, he also argues that the UK needs to throw even more money at the NHS. At the last reckoning, the UK’s “national treasure,” as Britons like to characterize the health service, was swallowing up more than £140 billion ($177 billion) of taxpayers’ money every year. 

But you don’t throw more money at a broken system. Hunt himself admits that medicine is a blame culture, and it’s also a system of middle management inflation, something Hunt doesn’t discuss.

This mainly otiose tier soaks up cash, and the money doesn’t get to frontline care, where it is needed. But for anything to change, the NHS doesn’t just need to rid itself of its blame culture; it also has to be seen as a broken system and not a sacred cow.

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Article Topics: Behavior, Human behavior
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