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Building a Blameless Culture in an Integrated Clinic


By William Morgan, DC


One of the hindrances of doctors working together in a collegial team is the strong individual sense of competition that the educational process imbeds in physicians.   Physicians can be strongly opinionated, competitive and domineering in relationships.  So it is not uncommon for practitioners to point the finger at someone else when negative outcomes occur. In such a culture, workers tend to hide mistakes rather than bring them forward for analysis and correction.


For example, a nurse working for a doctor who yells and blames his staff for mistakes may hide the fact that she gave a patient the wrong injection to protect herself from scrutiny. This is a recipe for disaster. A health center should recognize that individuals make mistakes, and that it is good policy to encourage people to reveal their mistakes and near misses.


Here’s another example: a physical therapist mistakenly uses electrical muscle stimulation on a patient with an internal defibulator (an implant with strong contra-indications for the use of electrical stimulation) but later identifies the error, though no injury occurred. What should he do? Keep the incident a secret and make a mental note to avoid the same mistake in the future? Obviously, the right thing would be for the therapist to alert the rest of the staff and work toward a systemic solution that will prevent he and others from making the same mistake again.


Building a blameless culture in an integrated clinic will only succeed if the providers cultivate trusting, safe relationships with each other. Trust does not occur overnight, and it may take years to develop. The ultimate goal in a blameless culture is increased patient safety and better healthcare delivery. 


There is No “I” in Team


If you recognize a condition overlooked by another provider and find it necessary to tell the patient and others that you--the great diagnostician--found what others missed, you may have un-addressed issues with your own self-esteem. The correct way to address a missed diagnosis by another physician is to respectfully contact the other provider. You may send a note to the radiologist (“Beth, could you take another look at the sacrum on Mr. Grant’s MRI? Something doesn’t look right.”) or to the orthopedist (“Bob, the patient that you referred turned out to have a positive HLA-B27. With your consent, I would like to refer him to Rheumatology.”).


We are all human, and we can overlook important findings from time to time.  That’s why it is important to have people on your team who you trust to help uncover relevant findings that you may have overlooked, and who you can also trust to help preserve the patient’s confidence in you.


As an integrated group matures, the individual specialties blur and the focus turns toward supporting the team. For instance, when a surgery has a negative outcome, instead of gossiping about the orthopedist, remind yourself that you and the orthopedist are on the same team, with the same goal. Apply yourself to healing of the patient, whether you believed the surgery was appropriate or not. Likewise, if a patient has a reaction to a chiropractic adjustment, the other providers on your team can provide care to minimize the reaction’s effects … while protecting your reputation.


A blameless integrated culture maximizes honest communication between the healthcare staff.  This results in greater patient safety and more appropriate treatment plans.