William B. Runciman, MBBCh, FANZCA, FRCA, PhD; Alan F. Merry, MBChB, FANZCA, FFPMANZCA; Fiona Tito, BA(Hons), LLB
Acknowledgment: The authors thank Dr. Klee Benveniste for conducting the literature search on open disclosure, mediation, and tort law reform in various countries.
Potential Financial Conflicts of Interest: None disclosed.
Corresponding Author: William B. Runciman, MBBCh, FANZCA, FRCA, PhD, Department of Anaesthesia and Intensive Care, Royal Adelaide Hospital, North Terrace, Adelaide SA 5000, Australia.
Current Author Addresses: Dr. Runciman: Department of Anaesthesia and Intensive Care, Royal Adelaide Hospital, North Terrace, Adelaide SA 5000, Australia.
Dr. Merry: Department of Anaesthesiology, University of Auckland, Mercy Hospital, 98 Mountain Road, Epsom, Auckland, New Zealand.
Ms. Tito: Enduring Solutions Pty Ltd, 11 Masters Place, Kambah, ACT 2902, Australia.
Patients are frequently harmed by problems arising from the health care process itself. Addressing these problems requires understanding the role of errors, violations, and system failures in their genesis. Problem-solving is inhibited by a tendency to blame those involved, often inappropriately. This has been aggravated by the need to attribute blame before compensation can be obtained through tort and the human failing of attributing blame simply because there has been a serious outcome.
Blaming and punishing for errors that are made by well-intentioned people working in the health care system drives the problem of iatrogenic harm underground and alienates people who are best placed to prevent such problems from recurring. On the other hand, failure to assign blame when it is due is also undesirable and erodes trust in the medical profession. Understanding the distinction between blameworthy behavior and inevitable human errors and appreciating the systemic factors that underlie most failures in complex systems are essential for the response to a harmed patient to be informed, fair, and effective in improving safety.
It is important to meet society's needs to blame and exact retribution when appropriate. However, this should not be a prerequisite for compensation, which should be appropriately structured, fair, timely, and, ideally, properly funded as an intrinsic part of health care and social security systems.
* Steven Small, MD, participated in the early stages of the series on Patient Safety and the Reliability of Health Care Systems.
William B. Runciman, Alan F. Merry, Fiona Tito. Error, Blame, and the Law in Health Care—An Antipodean Perspective. Ann Intern Med. 2003;138:974–979. doi: 10.7326/0003-4819-138-12-200306170-00009
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Published: Ann Intern Med. 2003;138(12):974-979.
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