The culture of accountability is a firmly established approach to workplace safety. While being widely recognized and practiced in many fields, including healthcare, it has been criticized as having no effect or even disrupting the healthy workplace environment. The central point of the culture of accountability is each employee’s personal responsibility for their actions, including faulty ones. The mistakes are addressed by disciplinary measures which are often punitive in nature.
This became one of the most controversial points as some argued that punishment does not lead to improvement in safety and creates the sense of fear among employees. As an alternative, the concept of just culture was introduced in the late nineties (Dekker, 2012). Its central difference lies in its approach to mistakes. According to the just culture concept, not all mistakes are the result of reckless actions. Some of them may be triggered by faulty processes and protocols. In this case, they should be viewed as a way to learn a lesson and not as a reason for punishment. This leads to several advantages of the just culture.
First, the people do not feel treated unfairly when the mistake is not the result of their conscious poor decision making. Second, the proper discussion of mistakes may reveal the shortcomings of the system. Finally, targeting all faulty actions regardless of the actual adverse outcomes serves as a preventive measure against future incidents. However, just culture still needs disciplinary actions in case of the poor decision making, but the line between personal and organizational accountability. Thus, just culture requires time to interpret the actions. In comparison, the culture of accountability is streamlined, simple, predictable, and leaves little room for interpretation (Dohmann, 2010).
Besides, it leads to stricter discipline. This rigidity is viewed by some as a disadvantage as it contributes to the stressful workplace environment and fear of retribution but does not improve safety (Dekker, 2012).
The revealing of information to the patients and their families is a complex ethical topic. While both the healthcare providers and the general public are almost unanimous about the positive effects of fully informing the patients of the mistakes regardless of their seriousness or the actual outcome, such strategy involves several risks. First, while the mistakes that inevitably lead to adverse outcomes must be reported for obvious reasons, the minor ones which pose no threat to the patients’ well-being and are otherwise irrelevant to them are more controversial.
The revealing of such mistakes may lead to misinterpretation by the patient, unnecessary anxiety and stress, the loss of healthcare provider’s reputation, and possibly legal action by the client (Yasgur, 2012). All of these can be prevented by the additional effort which will exclude interpretation but requires slightly more resources and time. The concealment of mistakes, however, has far more risks. First, it undermines communication with the patient, who may provide information regarding the error. Second, it introduces the possibility of subjective interpretation, where the doctor misjudges the seriousness of the withheld information and conceals something that is important for the patient.
Finally, once the fact of concealment surfaces, it will likely lead to the same negative effects as the intentional disclosure (loss of reputation, distrust, legal action against the physician), but on a much bigger scale, as the concealment is an active practice that naturally implies malpractice (Drane & Reich, 2002). Finally, concealment of minor and negligible mistakes requires a viable framework for determining the level of consequences instead of the current intuitive approach. As such, the unintentional misjudgment by the clinician of the error’s seriousness creates the health risk for the patient. Thus, revealing the mistakes is currently more straightforward and involves fewer risks both for the patient and for the healthcare personnel.
References
Dekker, S. (2012). Just culture: Balancing safety and accountability. Burlington, VT: Ashgate Publishing.
Dohmann, E. (2010). Clinical accountability in homecare: Six strategies to build and maintain a culture of commitment. Danvers, MA: HCPro Incorporated.
Drane, J. F., & Reich, G. H. (2002). Honesty in medicine: Should doctors tell the truth. American Journal of Bioethics, 2, 14-17.
Yasgur, B. S. (2012). Should you reveal nonharmful mistakes to patients? Web.