“I feel it's time we recalibrate our approach,” argued Wachter, who said the nature of the problem is accountability. If there's no penalty for not following a rule, there is also no real incentive to adhere to it, he said. “I think we have all become enablers of allowing people to break certain safety rules, and the message it sends to the entire organization is quite profound.”
Wachter also argued that in an increasingly more transparent world, the concept of “no blame” may be perceived by patients as an effort to protect healthcare workers who have done wrong. Not having consequences could potentially lead to more oversight and regulation, especially from outside sources, like government, he said.
An audience poll found that 79% agreed with imposing fines and considering certain safety practices inviolable. But in his counterarguments, Meyer said it's much easier to punish individuals than it is to put forth the necessary resources to educate, build better systems and remove barriers.
“Punishment is not the route to improving safety,” Meyer argued. “We don't want to get dragged down by keeping track of checked boxes.”
Putting too much emphasis on process in the short term could potentially set safety efforts back, he argued, and it ignores the element of humanity, is counter to what has been learned by safety science, is impractical, drives the wrong behaviors and is a distraction for healthcare workers. When someone is fearful that they are being watched, they are more likely to experience performance anxiety and make more mistakes.
“Other than that,” he joked, “Bob's proposition is terrific.”
For the sake of this debate, Wachter and Meyer may have represented positions that they did not necessarily support. However, the concerns they raise are reflections of the real concerns about accountability in the move toward a culture of safety.
In the end, Meyer did not successfully sway the audience, with another poll of the audience showing that more than 80% still felt penalties such as fines, suspensions and firing would help, not hinder, efforts to ensure patients are free from harm in the healthcare setting.
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