The difference between blame and accountability Denise Chaffer Director of Safety and Learning NHSLA

Is It Blame or Is It Accountability? by Rick Brenner Brenner Blame is to be accountable in a way deserving of censure, discipline, or other penalty, either explicit or tacit. Accountable does not mean "blame-able” Accountability means to be responsible for and answerable for an activity. If something goes wrong, those accountable are expected to answer for their part in the goings-on, because there is a need for their knowledge to perfect our ‘flawed’ systems

Accountability and blame differ in at least four dimensions : Learning vs. punishment - If blame is the goal, instead of real organizational learning, activity usually stops after the culprit or culprits have been found Incidence of fear - Fear of accountability is a strong indicator of blaming Organisational chart altitude distribution - Where those accountable are at many levels of the org chart, we're more likely to be assigning accountability; when we find those accountable concentrated at the bottom of the org chart, chances are that we're assigning blame. Acknowledging interdependence - finding those accountable will probably result in a long list ie system failure

Decision tree simplified The USA have modified it to apply the following questions : 1.Did the employee intend to cause harm 2.Did the employee come to work drunk or impaired 3.Did the employee knowingly and unreasonable increase risk 4.Would another similar trained and skilled employee in the same situation act in a similar manner (Reason substitution test) If the answers to the first three questions are no and to the question 4 is yes, this points to the error being a system problem. The error would require a full root cause analysis to understand and then seek to rectify the system error.

Safety culture Human error coupled with harm to a patient usually results in social condemnation and disciplinary action Disciplining employees in response to honest mistakes does little to improve the overall safety system Few people are willing to come forward and admit an error when they face the full force of the current punitive system

Things you can do in your own organisations Number One: Review your current disciplinary policy Ensure it accounts for when incidents are investigated that there is an understanding of human factors and the just culture Your key issue is to ensure that learning from the events outweigh the deterrent effect of punishment and your staff feel able to speak out, raise concerns and report incidents

Number Two: Conduct a survey of your staff (may need to have an anonymous route) Ask them if mistakes are made that they feel safe to come forward so that the organisation can learn from the event Feedback the information on a unit by unit basis not for the whole organisation

problems with processes and equipment – you have a low reporting culture – these are easy to do without backlash on individuals individuals reporting on other individuals – you have a low reporting culture – it is easy to point the finger at others individuals reporting their own mistakes – you have a good reporting culture – the individual will act against their own self interest and report so that others can learn individuals reporting their own violations – you have an outstanding reporting culture – they understand that you understand that violations are not disciplinary actions and are to be learned from Number Three: Review your incident reporting system – if your incident reports are mainly about: