Replacing a Culture of Fear with Trust to Reduce Medical Errors

Despite recommendations by healthcare accrediting agencies like the Joint Commission and the prestigious Institute of Medicine, to reduce medical errors, the number of adverse medical events has continue to rise over the past decade.

What has not been fully addressed in these recommendations is the role organizational culture plays in medical errors.

The culture of fear that permeates healthcare system effectively blocks open communication and collaboration that is necessary to provide safe healthcare. Rather than learning from mistakes, the healthcare managers and leaders place blame for errors squarely on doctors’ shoulders. Consequently, many medical errors go unreported by physicians, because of fear of litigation, blame and accusations of incompetence, creating unresolved conflict throughout the organization.

With unresolved conflict, mistrust persists, anxiety grows, conflict escalates and mistakes continue, creating an unsafe environment.

As pointed out in a Healthcare Finance News article by Diana Manos (“New York hospitals use aviation safety techniques to prevent medical errors”), we understand that errors are the proximate cause of the conflict. The root cause is in the system: failure in the design of processes, tasks, training, and working conditions that make errors more likely. If we want to significantly reduce the number of errors, working conditions must change; the culture of fear that permeates healthcare must be replaced with one of trust.

To erase this culture of fear that has compromised patient care and safety, healthcare managers and leaders must be willing to change their behavior and work collaboratively with all healthcare workers to minimize the effect of conflict in the workplace. Employees will then be empowered to openly communicate and collaborate to learn from mistakes, which will result in a spiral of trust and, as a consequence, better patient care and safety.

As pointed out in the article by Manos, without this change at the top of the organization, mistrust will persist no matter how many check lists are designed.

Jeffrey Kreisberg blogs regularly at takingcontrolofyourhealthcare.com