Efforts to improve safety in the NHS requires a major cultural change which recognises the fallibility of staff working under immense and escalating pressure.
This was the message from doctors and human factors specialist Trevor Dale at an event to launch an ambitious new BMA project on the future of the service.
BMA representative body chair Anthea Mowat said she had heard stories of doctors bullied for raising concerns about pressures in the system and working beyond their capacities.
‘The case of Dr Bawa-Garba has caused significant concerns among doctors,’ she added. ‘It has fuelled the fear of being blamed for errors when you are trying to do your best for patients in a broken system.’
Dr Mowat pointed to the Don Berwick review into patient safety which, in 2013, stated that ‘culture will trump rules, standards, and control strategies, every single time’ and that ‘a vastly safer NHS will depend far more on major cultural change than on a new regulatory regime’.
‘We need to create a safer NHS,’ Dr Mowat said, ‘but it will require major cultural change.’
Former British Airways captain Mr Dale said the culture of the NHS should match that of the airline industry in which pilots are told to accept their fallibility and so felt safer to report mistakes.
‘Healthcare is far more complex and challenging than flying a jumbo and one has to understand where human fallibility and human factors come in,’ he added.
‘Why don’t people report mistakes in healthcare? They don’t report if it’s cumbersome and they’re absolutely exhausted at the end of the day. They don’t do it if they don’t feel safe. In the wake of Bawa-Garba, who the hell feels safe?’
The airline industry’s focus on ‘human factors’ in accident prevention was based on evidence from the ‘famed black box’ which records pilots’ actions and speech throughout a flight.
‘A lot of people can’t accept their own fallibility, or won’t,’ he added. ‘That’s something we’ve had to get rid of in aviation. In my time in BA, we fired senior captains because despite trying to retrain them to be nice to people, they couldn’t hold on to their tempers and their behaviour when the stress came on.’
Dr Mowat said the BMA’s work for its bullying and harassment project had highlighted the need to understand human factors in healthcare.
‘We need to consider the impact of our behaviour on our colleagues and our patients,’ she added. ‘But also that our behaviours are a reaction to other factors in this system, like work pressures, job design, organisational structures and leadership styles.’
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