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This document summarizes key discussions from the ACHSE Victoria Branch Conference held on April 3-4, 2003, facilitated by Associate Professor Jeffrey Braithwaite. The conference focused on critical issues in clinical governance, including the culture of blame and reluctance to admit errors among clinicians. It emphasized the importance of effective management in healthcare delivery and the need for a shift towards a culture that fosters accountability and constructive incident reporting. Additionally, it introduced the iceberg model of workplace culture, highlighting observable behaviors and underlying beliefs.
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Residential Conference 2003 3 and 4 April Facilitator: Associate Professor Jeffrey Braithwaite Centre for Clinical Governance Research in Health, University of NSW www.achse.org.au/frameset.html ACHSE Victoria Branch
KEH: key barriers to change • Reluctance to admit errors and flaws. • Reluctance to adopt a ‘beyond blame’ culture. • Reluctance to acknowledge that clinicians are accountable.
1. Reluctance to admit errors and flaws • review of 372 high risk obstetric cases • 47% - one or more clinical errors
2. Reluctance to adopt a‘beyond blame’ culture Perinatal Mortality Committee meetings • ‘witch hunts’ • ‘finger pointing exercises’ • ‘blame culture’ • ‘intimidating’ • ‘denigrating’ • ‘vindictive’
3. Reluctance to acknowledge that clinicians are accountable ‘Peering in from outside’ Poor incident reporting andmanagement • ‘Doctor’s Alert’ • No patient information to ‘management’ without written authority from the patient • No answers to management questions without prior written notice of question.
Management Significance of management: • management is crucial to delivery of health care • management affects all aspects of the quality of health care. Who should manage? • the best doctors are not necessarily the bestmanagers • the best managers are not necessarily doctors • doctors can’t be in two places and do twojobs at the same time.
Above the waterline lie the observable workplace behaviours, practices and discourse: this is ‘the way we do things round here’. Figure 1: the iceberg model of culture Below the waterline lie the underlying beliefs, attitudes, values, philosophies and taken-for-granted aspects of workplace life: ‘why we do the things we do round here’. Day 2: Friday 4 April 2003
