{"id":14277,"date":"2012-01-25T11:39:42","date_gmt":"2012-01-25T10:39:42","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=14277"},"modified":"2012-01-25T11:39:42","modified_gmt":"2012-01-25T10:39:42","slug":"domhnall-macauley-on-the-rocks","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2012\/01\/25\/domhnall-macauley-on-the-rocks\/","title":{"rendered":"Domhnall MacAuley: On the rocks"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/www.bmj.com\/site\/blog\/icons\/domhnall.jpg\" alt=\"Domhnall Macauley\" width=\"162\" height=\"110\" align=\"left\" \/>The captain made a mistake. We don\u2019t know why; misjudgement, show boating, foolishness. After hitting the rocks, he seemed to ignore the consequences, delaying action, almost pretending it didn\u2019t 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.\u00a0<\/p>\n<p><!--more--><br \/>\nCould this ever happen in healthcare? While it is unlikely that mismanagement would lead to such an immediately dramatic and public disaster,\u00a0errors 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.<\/p>\n<p>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.<\/p>\n<p>When the review of this Italian shipping disaster is finally released many months hence, the core message will probably include the following\u2014the 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\u2014and its not just about major disasters. We are all human.<\/p>\n<p>Shortly after writing this piece <a href=\"http:\/\/www.telegraph.co.uk\/news\/worldnews\/9022832\/Concordia-disaster-Should-a-captain-go-down-with-his-ship.html\">I came across an article by Theodore Dalrymple<\/a> in the <em>Daily Telegraph<\/em> who explored this area in much more depth and with great sensitivity.<br \/>\n<em><strong><br \/>\nDomhnall MacAuley<\/strong> is primary care editor, <\/em>BMJ<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The captain made a mistake. We don\u2019t know why; misjudgement, show boating, foolishness. After hitting the rocks, he seemed to ignore the consequences, delaying action, almost pretending it didn\u2019t happen, [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2012\/01\/25\/domhnall-macauley-on-the-rocks\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1287],"tags":[],"class_list":["post-14277","post","type-post","status-publish","format-standard","hentry","category-domhnall-macauley"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Domhnall MacAuley: On the rocks - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2012\/01\/25\/domhnall-macauley-on-the-rocks\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Domhnall MacAuley: On the rocks - The BMJ\" \/>\n<meta property=\"og:description\" content=\"The captain made a mistake. 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