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The Blame Game

The second in a series of workplace culture blogs written by Stacey Blease on behalf of VetLed

A Just Culture?

The vet and the three practices

In the previous article I mentioned how I had been in a car accident but I didn’t tell you that I skidded on black ice, the car slid into a ditch and rolled onto its roof. Did the environment play a role in my accident?

Mistakes can happen for many reasons. Should the blame rest on the shoulders of one individual? Deliberately reckless incidents are thankfully rare. What about genuine mistakes? Fortunately, many industries are moving away from a blame culture to a just culture which examines incidents holistically by assessing the working environment and systems in place rather than simply putting the people involved under the microscope.

Imagine that you were invited (unlike Goldilocks) to three different practices for interviews because you were considering a new job. In the first practice there were several heated conversations taking place where the flow of patients between the prep area and theatres was clunky due to miscommunication. You notice that they were using techniques considered suboptimal according to data published in several evidence-based articles. During your visit to the second practice, there was a frosty reception, some anxious smiles and lots of people rushing around. The Clinical Director was dictating the order of the day and looking over peoples’ shoulders throughout your visit to the practice. The atmosphere in the third practice had a more genuinely supportive feel to it which started with one of the partners stating that there’s no such thing as a stupid question. There were several vets and nurses helping to decide the plan for the day based on their knowledge of the patients. The team was working in an environment where systems were in place with all staff members contributing and communicating effectively to ensure the day could run as smoothly as possible. Based on your initial impression, which practice would be your first choice?

Just culture recipe

Teams with a just culture will experience setbacks and errors but it is how these are dealt with that is crucial. I have come across several different descriptions of what a just culture is within different industries. Here is my interpretation of the themes commonly discussed when organisations are aiming to develop a just culture.

· Lifelong learning

A commitment from both the individuals and the organisation to strive for improvements and an openness to learn is key. There is a willingness to modify existing or adopt new practice policies in response to new information.

· A team approach

The organisational hierarchy is minimised and team members with the relevant expertise have chairs pulled out for them at the table. Support is provided at all levels because we can all make mistakes.

· Responsibility

Individuals are accountable for their decisions and deliberately reckless behaviour will be sanctioned but events arising from inadvertent human error are used as learning opportunities for all staff and the organisation.

· Consistent approach to dealing with mistakes

Having a fair and consistent approach to dealing with situations when something goes wrong and ensuring that all team members are aware of the process which involves looking at the situation holistically.

· Psychological safety

Working in an environment where everyone is invited, encouraged and feels confident to share their thoughts and experiences without the fear of judgement (see previous blog).

The purpose of achieving a just culture is not to provide a fluffy and light cake which looks pretty but is not worth the calories. The aim is to provide a working environment which has a solid base to acknowledge that mistakes will happen and the assurance that genuine mistakes will be used as learning opportunities for the individual, their colleagues and the practice in order to change the way we work and ultimately improve patient safety. This solid base would also include being informed on standardised procedures for reporting incidents and near misses which would reduce ambiguity and therefore, anxiety. Implementing a just culture needs to be deep-rooted in the way all team members approach all aspects within the workplace.

The police statement for my car accident was very straight forward and was a part of the routine procedure. I wish I’d known that earlier! The just culture recipe isn’t one you can whip up and shove in the oven, it requires teamwork, education, a framework and the desire to improve patient safety and your colleagues’ wellbeing.

After graduating from the University of Liverpool Vet School with an intercalated Master’s degree from the Royal (Dick) School of Veterinary Studies, Stacey worked in general practice. She completed her PhD at Harper Adams University on dairy herd health planning. Stacey has worked for an online CPD provider, The Webinar Vet and the British Veterinary Nursing Association (BVNA) as the Head of Learning & Development. Currently, Stacey is a trustee for the Animal Welfare Foundation (AWF). Stacey's experience is diverse and her passions include research, education, organisational culture and innovation.

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