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Time to stop the blame game
  1. Kathryn Clark

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EVERYONE makes mistakes – as the saying goes, ‘We're only human’. While for most people, their mistakes do not come to the public's attention, for those working in professions such as medicine and veterinary medicine, the consequences of an error can be severe, even fatal.

Speaking at the BSAVA congress earlier this month, Catherine Oxtoby, who has studied the causes and types of error in veterinary practice and their effects on organisational culture and patient safety, explained that vets seem to be particularly good at blaming themselves and internalising their feelings following mistakes.

While there may be support available for an individual who has been on the receiving end of a clinical error, the ‘second victim’ of that error – the person who made it – is often forgotten. As a result, they can experience loss of clinical confidence, anxiety and depression; they may ultimately decide to leave their job.

Such issues are key for the veterinary profession, with its recognised challenges with mental health and wellbeing, as well as with retaining vets in practice. Research, Dr Oxtoby said, had shown that women felt the effects of an error more strongly and for longer than men. In a profession where most of its members are female, this has clear implications for individual veterinary surgeons and the profession as a whole.

The fear of making a mistake can also have wider consequences: if no one is prepared to try anything new because they are so afraid of what might happen to them if something goes wrong, how is a discipline to advance?

Mistakes are not usually simply due to individual failings, but rather they are a result of the limitations of the individual involved combined with the systems within which that individual works. There will be layers of defence within the systems, but each layer will be fallible and, sometimes, every defence will fail at the same time.

It is natural, in the aftermath of a mistake being made, to assume that the person on the receiving end will be looking for someone to blame. However, as Dr Oxtoby explained, in many cases, those affected by an error do not want to punish the individual who made it; rather they want an explanation to help them understand what went wrong.

While there will be situations where someone has to be accountable for an error, in many cases, mistakes provide opportunities for learning. Looking in detail at what occurred and why, can help identify weaknesses in systems, areas where defences can be strengthened and, most importantly, how mistakes can be prevented in future.

But, an instinctive response of the person making an error is to become defensive and it is often this reaction that compounds the situation. Attempts to cover up mistakes, rather than being open and honest, can lead to professional conduct issues.

The RCVS is keen to stress that it does not expect vets to be perfect. It is keen to do its part to create a culture that encourages learning from mistakes.

In its strategic plan for 2017 to 2019, the College pledged to explore the extent of the blame culture in the veterinary profession and how it, as the profession's regulator, might contribute to this culture. Ultimately, it would like to see the profession moving towards a culture that places greater emphasis on learning and personal development.

Work is just getting underway – in March, the RCVS carried out a survey aiming to establish the extent of the blame culture in the veterinary professions. This attracted almost 7350 responses from veterinary surgeons and veterinary nurses. Analysis of the information gathered is ongoing and, while it will no doubt make for uncomfortable reading, the College will use it to establish a baseline against which any changes in the years ahead can be measured.

As a ‘Royal College that regulates’ the RCVS has a complex role. As a College, it has a duty to set professional standards but, when a complaint is made against a veterinary surgeon, as a regulator, it is legally obliged to investigate and to uphold those standards.

Moving towards a ‘no blame’ culture is going to be challenging. Working cultures will not change overnight and, while the profession can look elsewhere for examples of how culture change can be achieved – for example, to the aviation industry, which has worked hard to ‘flatten the hierarchy’ to give all members of the flight team the confidence to speak up if they feel something is wrong – ultimately it will have to develop its own approach.

Despite the challenges, moving towards a culture where mistakes are viewed as sources of learning and where those who make mistakes feel supported to discuss them openly without fear of being blamed, will surely bring benefits to individual vets, to practices and to the profession as a whole. If it can pave the way to improving practice and practice standards, then the ultimate prize will be beneficial for animal health and welfare too.

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