I think Bob Wachter has it completely right in his blog post. He also makes the same point in his book Understanding Patient Safety.
While Dr. Deming taught (and patient safety experts like Wachter have emphasized) that most problems are due to the system, that doesn't mean it's ALWAYS the system.
There's a difference between a nurse or physician being part of a systemic multiple-failure medication error and someone intentionally choosing to not follow a process. Now, if someone chose to not follow a process because they didn't have time, management has a responsibility to help improve the system so that people DO have time. But “no blame” can't be taken to an extreme where personal accountability isn't part of the picture.
Wachter's piece starts:
In this week's New England Journal, Peter Pronovost and I make the case for striking a new balance between “no blame” and accountability. Come on folks, it's time.
At most hospitals, hand hygiene rates hover between 30-70%, and it's a near-miracle when they top 80%. When I ask people how they're working to improve their rates, the invariable answer is “we're trying to fix the system.”
Now, don't get me wrong. I believe that our focus on dysfunctional systems is responsible for much of our progress in safety and quality over the past decade. We now understand that most errors are committed by good, well-intentioned caregivers, and that shaming, suing, or shooting them can't fix the fallibility of the human condition.
But not washing hands? When I hear, “It's a systems problem,” my BS detector goes a little bit haywire, particularly after I walk around the hospital and see alcohol gel dispensers every 2 feet and glossy photos of smiling clinical leaders cleaning their hands at every turn. I think all of us realize that in 2009, failure to clean hands is no longer primarily a systems problem. It's an accountability problem.
Click on the link up top to read the rest. What do you think? Where do you strike the balance between “no blame” (systems view) and personal accountability?
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