Twenty years ago we saw a paradigm shift in our medical culture, following the scandal emerging from the Bristol inquiry.
The case transformed medicine, as medical professionals lost some of their power and authority. No longer could doctors expect patients to accept their word unquestioningly.
However, the GMC cynically exploited the inquiry’s conclusions in a grab for power, using it to force through radical changes including revalidation and appraisal, and moving towards a civil rather than criminal level of proof in fitness to practice cases. The ethos at the GMC became more aggressive towards doctors.
And yet the Bristol inquiry had called on the regulator to recognise crucial factors that impact on patient safety, namely:
- Wider factors that can affect clinical judgment, performance, and outcome
- Barriers to openness and frankness about doctors’ personal performance.
In the aftershock at its handling of the Bawa-Garba case, it is clear to doctors that the GMC did not reflect on the Bristol inquiry and has ignored repeated warnings that, until a culture is created where honest reflective learning is undertaken following clinical errors that every clinical team and system encounters, patients will continued to be harmed and individuals scapegoated to protect the reputations of employing organisations.
It seems that the GMC expected the profession to simply accept their judgement without question and allow individuals to continue carrying the can. But a paradigm shift has occurred again, this time driven from the grassroots up; the power of social media has allowed ordinary doctors to organise, communicate and campaign. They have moved beyond online ‘echo chambers’ of futile debate into effective, direct-action organisations.
A new organisation has emerged, the Doctors’ Association UK (DAUK), which is leading a new campaign to change the culture of medicine from the bottom up. That campaign is called ‘Learn Not Blame’ and it will radically change the professional culture for the better, for both patients and doctors.
Learn Not Blame is simple but powerful: it will create an explicit cultural change where each health professional can reflect on their own performance and raise concerns about factors that impact on their performance and patient safety, and expect those in charge to deliver improvement.
It will drive a ‘just culture’ systems-based approach to learning from errors, and will expose those directors, managers and organisations that try to divert undue blame to individuals to protect themselves. Managers will no longer be immune allowing systems to operate that increase risks to patient safety, for example by allowing low levels of staffing, or creating a culture of fear of bullying if raising concerns. Those days are ending.
Cynics out there often deride the impact that grassroots campaigns such as DAUK and GP Survival have, but already we have achieved real change – organisations such as the BMA, NHS England and GMC are meeting with us, and policies are being adjusted as a result.
Learn Not Blame is now a national campaign with the support of MPs and organisations behind it: a formal launch begins today, November 20th, at the House of Commons, with attendance of MPs, patient safety campaigners, representatives from the GMC and other medical organisations. Most importantly, we have Matt Hancock, secretary of state for health and social care) attending the launch and will be pressing him to support the rollout of our campaign across the NHS.
Patient safety must come first, and the blame culture that operates in the NHS must, and will, be rooted out and destroyed. Change will be driven bottom up, not top down. Learn Not Blame will deliver that, with the support and engagement of every grassroots doctor out there.
Dr Alan Woodall is a GP in Wales and public health lead for the Doctors Association UK