Former Surgeon says ‘name, blame, shame, retrain’ culture across health service is not the solution
Surgical specialist turned pilot says aviation safety models should be adopted within the Irish health service to significantly benefit patient care and outcomes
- ‘Name, blame, shame, retrain’ culture is placing extra strain on staff already under immense pressure in challenging working conditions.
- Staff shortages and a lack of capacity means Consultants and other medical professionals cannot work to the best of their ability, increasing the potential for error.
- Over 900 permanent Consultant posts nationally remain either vacant or filled on a temporary or agency basis which is compounding the issue of safety.
- Captain Niall Downey “In aviation we assume we are going to get it wrong, and all our systems are designed around that. We expect error, we don’t blame the individual for that”.
Airline Captain Niall Downey, a former Cardiothoracic Surgeon, has said the Government should implement an aviation style safety model when it comes to healthcare.
Speaking in a New Video as part of the Irish Hospital Consultant Association’s Care Can’t Wait campaign, Captain Downey says a ‘name, blame, shame, retrain’ culture within our health service is placing extra strain on healthcare workers who are already facing immense pressure.
The IHCA has previously highlighted that stress levels among Consultants in recent years has been amplified by deteriorating working conditions and increased recruitment challenges. Consultant and medical staff shortages and a lack of hospital capacity means that Consultants cannot work to the best of their ability, increasing the potential for error. This in turn can lead to reduced healthcare outcomes and care for patients and an even more stressful working environment for staff.
Figures at the end of last year showed that 8 in every 10 Consultants screened positive for burnout, which is exacerbating concerns in our hospitals for both medical professionals and their patients.
Captain Downey says Consultants and other healthcare workers should feel safe in identifying risks and where mistakes have been made, in order to develop a system where health service management can assess “what went wrong, not who went wrong”.
“In aviation we assume we are going to get it wrong, and all our systems are designed around that. We expect error, we don’t blame the individual for that. We have reporting systems where we can speak up without the fear of disciplinary action or dismissal. It’s called a Just Culture”.
Speaking on the staffing deficit across the health service and its implications for safety, Captain Downey said it is inevitable that “mistakes will be made” when our hospitals and mental health services are being run without the necessary levels of staff, as those in the service are consistently overworked.
Over 900 permanent Consultant posts nationally remain either vacant or filled on a temporary or agency basis. This is due to decades of underinvestment, staff and bed shortages, and unsustainable working conditions that are driving our highly trained medical specialists abroad.
Not only does the extent of vacancies and hospital capacity deficits seriously undermine the provision of care to patients and the development of acute hospital and mental health services, but it is also a false economy. The cost to the HSE of managing and settling claims via the State Claims Agency has increased from €96m in 2015 to €435m in 2022 – more than a four-fold increase over the past 8 years (+€339m or +350%).1
Captain Downey believes the implementation of adequate safety models with appropriate staffing and hospital capacity levels would inevitably lead to better outcomes for patients and change the culture found within the health service, so that medical professionals are no longer “pilloried” for highlighting an error or issue.
He said it is now imperative that a system is put in place to allow health staff to “put their hand up” and highlight a problem when it arises in order to implement the changes needed to deliver safer models of care.
“In aviation we use a system called avoid, trap, mitigate.
“For example, at 800 feet the plane will tell us if the landing gear isn’t down. It is now too late to correct it, but we can put on full power and climb away. So we haven’t resolved the problem, but we’ve mitigated it in that we haven’t crashed the plane and we can come back and have another go. We could get that sort of mentality within the health service and reduce the blame game.
“In aviation it’s taken for granted that I’ll put my hand up and not worry about losing my job or being sued. Errors will happen, we have to legislate for them not blame people for them.”
With the crisis in our health service growing, latest figures show more than 885,000 people remain on some form of NTPF hospital waiting list2, a further 250,000 are awaiting urgent CTs, MRIs or ultrasounds3, while almost 11,300 admitted patients were treated on trolleys in January alone this year and a record 121,000 patients in 2022.
1. HSE National Services Plans 2015 and 2022: https://www.hse.ie/eng/services/publications/serviceplans/
2. Latest NTFP data as at end February 2023: https://www.ntpf.ie/home/nwld.htm
3. Dáil PQ response from Minister Stephen Donnelly to Deputy Neasa Hourigan, 25 January 2023:
Captain Niall Downey is a former surgeon who previously worked in the National Cardiac Surgery Unit. He subsequently retrained as an airline pilot with Aer Lingus and combined aviation with medicine by working as an Accident & Emergency doctor for six years, before focusing fully on aviation.
Captain Downey’s comments were made in a new video released on social media today by the IHCA as part of its #CareCantWait campaign. The video is available here: https://vimeo.com/797391448