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Domhnall MacAuley: On the rocks

25 Jan, 12 | by BMJ Group

Domhnall MacauleyThe captain made a mistake. We don’t know why; misjudgement, show boating, foolishness. After hitting the rocks, he seemed to ignore the consequences, delaying action, almost pretending it didn’t happen, and leaving people fend for themselves. Master of a recently built vessel of such scale, he was clearly at the top of his profession having risen through the ranks. But, no one is immune to weakness; the frailty of human behaviour, self preservation, or failure to do the right thing. Only, this time the ship was the size of a small hospital and he had absolute responsibility for the well being of his passengers and crew. The effect was catastrophic. 


Could this ever happen in healthcare? While it is unlikely that mismanagement would lead to such an immediately dramatic and public disaster, errors could equally harm the well being of many and cost lives. Medicine is not good at admitting mistakes and trying to sort out problems early and fairly. Those stories that make the headlines are just the tip of the iceberg.

Mistakes happen. Often its because procedures are ignored, shortcuts taken, guidelines not followed, or someone thinks they know better. Human error, systems failure, poor communication, misunderstanding. The aircraft industry, after a series of serious mishaps, looked closely at their systems and communication. Relationships were redesigned to allow co pilots and other staff to question decisions without pre-judgement. There are hazards in hierarchies. People can be cowed or bullied; those who quietly point out problems may be ignored, and others remain silent because of a previous uncomfortable experience.

When the review of this Italian shipping disaster is finally released many months hence, the core message will probably include the following—the importance of effective leadership, creating an open culture that allows authority to be questioned, the need to admit errors early and honestly, and do something about it. All pretty straightforward—and its not just about major disasters. We are all human.

Shortly after writing this piece I came across an article by Theodore Dalrymple in the Daily Telegraph who explored this area in much more depth and with great sensitivity.

Domhnall MacAuley
is primary care editor,
BMJ

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