Blame Culture is Toxic
Tips to understanding and addressing errors in the pathology laboratory
“How could you do that? You’ve released the wrong result! What a grave mistake…” says the manager.
“But I performed all processes according to the standard operating procedure,” says the employee, trying to justify their approach.
“We will have to DATIX this as a serious incident,” continues the employer. “And put you on a performance management plan.”
“I’m not sure what went wrong…” cries the employee.
This dialogue may sound familiar to most professionals in the healthcare system. We all make mistakes from time to time. It’s what makes us human. But no good comes from blaming and shaming each other for our imperfect nature. You benefited from learning from your mistakes, so allow others to do the same. A blame culture presents a serious threat to patient safety – especially, when blame sits on one persons’ shoulders to disguise a systemic problem or when people simply stop reporting mistakes.
Similarly, a blame culture also prevents you and your team from doing your best. And it can lead to several other detrimental outcomes, including reduced job satisfaction and morale, increased employee turnover, and reduced engagement and productivity.
It’s true that errors in the lab can have serious consequences, potentially affecting patient diagnoses and treatment plans. However, it is crucial to approach the issue of errors with a focus on improvement rather than blame. Here, I’d like to shed light on the factors contributing to errors in the pathology laboratory and explore approaches to foster a blame-free culture that promotes learning, growth, and patient safety.
In a no-blame culture, employers encourage employees to report their mistakes and learn from them because they understand that errors can happen. A no-blame culture allows all employees – at all levels – to speak up and talk about mistakes without fear of being held solely responsible for the problem.
Pathology labs are complex. And they also operate within a larger healthcare infrastructure; sometimes errors can occur due to systemic issues or technological limitations. For instance, obsolete or malfunctioning equipment can contribute to incorrect results reporting. The blame for such errors should not fall solely on individuals but rather on a lack of investment in modernizing infrastructure. By providing state-of-the-art technology and promoting a culture of continuous improvement, organizations can proactively minimize errors caused by systemic factors. A no-blame culture can only have a positive impact on patient safety because it acknowledges “the ecosystem” in which people operate and creates an environment where individuals are supported in raising and resolving concerns, addressing incidents of unsafe care with empathy, respect, and firmness.
But how do we create this no-blame culture? Leaders must look to behavior modeling with self-awareness and self-efficacy. In the workplace, change starts from the top down. Leaders cannot effectively ask employees to take accountability and responsibility, if they refuse to do so themselves. We can easily change the way we address mistakes by treating them as learning opportunities rather than viewing them as setbacks. If you’re a leader, seek out ways to turn your mistakes or wider failings into lessons from which the whole team can learn.
Even more pragmatically, we need to transition away from blame statements; for example:
“Who messed this up?”
“This is your fault!”
“Why on earth did you send out the wrong result?”
And we need to move towards accountability statements; for example:
“What is the root cause of this problem?”
“What changes can we make to ensure this doesn’t happen again?”
“What can we all learn from this incident?”
One final note: empathy sits at the core of a no-blame culture. If we all start practicing and encouraging empathy, we’ll more swiftly move in the right direction for increased patient safety, continual improvement, and a happier and more productive team.
Pathology Quality Manager/Governance Lead (Chartered Scientist).