I’m Sorry, Did You Blame Me?

Hat tip to Mike S. for pointing out this HBR article “Why “I’m Sorry” Doesn’t Always Translate.”

The piece talks about the differences in cultural norms about apologies in countries ranging from Japan, China, India, and the United States. I’m reading this, partly, with the context of thinking about hospitals being more open about apologizing to patients when mistakes are made. I’m in favor of openness and honesty… and not in favor of blame. Why do apologies equal blame in the U.S.?

From the story:

Our own work found that a core issue is differing perceptions of culpability: Americans see an apology as an admission of wrongdoing, whereas Japanese see it as an expression of eagerness to repair a damaged relationship, with no culpability necessarily implied. And this difference, we discovered, affects how much traction an apology gains.

And:

The finding that Americans link apologies with blame is in keeping, we’d argue, with a psychological tendency among Westerners to attribute events to individuals’ actions. Thus it makes sense that in the U.S., an apology is taken to mean “I am the one who is responsible.” It also stands to reason that in Japan—which, like many other East Asian countries, has a more group-oriented culture—apologies are heard as “It is unfortunate that this happened.” Researchers who’ve compared apologies in America and China have found a similar pattern: U.S. apologies serve to establish personal responsibility, while Chinese ones focus on the larger consequences of the transgression.

As I wrote about on Monday in my post about Dr. Berwick’s 1989 article, there’s a tendency to look for a single “bad apple” when there’s a problem in healthcare, instead of looking at systems and processes. I’m always reminded of Dr. Deming’s writing:

“American management is quick to assign blame to an individual when the problem, is in fact, a fault in the system.”

Deming said that 94% of problems and defects are due to the system (note he didn’t say 100%). I think the typical Western thinking is to assume a person is at fault 94% of the time.

When we teach leaders to stop blaming individuals, this is easier said than done. We’re fighting our DNA (tracing back to gorillas!) and it’s a big part of our Western culture.

So, if a physician or hospital apologizes for an error (which was most likely systemic in nature), does the recipient of the apology tend to blame the individual? There are studies that show patients sue less often when they receive a sincere apology. I’d rather prevent problems than apologize for them, but it’s interesting to think about all of these dynamics…


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Mark Graban's passion is creating a better, safer, more cost effective healthcare system for patients and better workplaces for all. Mark is a consultant, author, and speaker in the "Lean healthcare" methodology. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. His most recent project is an eBook titled Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also the VP of Improvement & Innovation Services for the technology company KaiNexus.

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2 Comments on "I’m Sorry, Did You Blame Me?"

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  1. Mark wonderful article ad it definately makes us reconsider how we state apologies not only in business but personal lives also. Thank you for continuing to fuel our minds each day.

  2. Hi Mark

    It is interesting the different attitudes toward apologies, but lets not blame it on DNA after all Asian DNA is pretty much identical to ours. It has more to do with our societal focus. In most of the west and especially in the US and Canada we are all focussed on our own rights, and our own gain. Thus we also tend to blame individuals for problems as well.

    The eastern cultures have a better understanding that society exists because people stop pursuing their personal interest and work together for the common good.

    Thus the difference is a learn attitude not genetics, we can change but it will take a massive shift in attitudes, which I doubt their is much will for.

    There is one other huge difference in the attitude toward apologies, in our society it is seen as a weakness to exploit. While in the Asian culture it is seen as the first stepo toward overcominbg a weakness, and thus is actually a sign of strength. It takes knowing you are strong enough to be able to overcome a weakness to admit one.

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