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Letters to the Editor
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The profession
“Whistleblowing” will only work if changes are made at the top
From Mr H. A. Lockie, MRPharmS
Dame Janet Smith (PJ, 1 October, p420 PDF (75K)) contrasts the “whistleblowing” culture
of the aviation industry with the “reluctance to report a colleague” in
the medical professions. She observes that much can be learned from aviation
and urges emulation.
As an active participant in both industries, I would very much agree. The
aviation industry has an outstanding record of safety improvements over some
70 years and has developed its reporting mechanisms to a high level. But,
as I am sure Dame Janet would be aware, “whistleblowing” will
only work as part of a trusted “blame-free” culture where the
rules are transparent and evidence-based.
To emulate the aviation industry it is necessary also to accept its explicitly
stated and well understood premise that “risk is inherent in life and
cannot be eliminated. It can however be controlled within acceptable limits” and
its acceptance that highly trained professionals fail when a situation overwhelms
them, rather than because they do not care.
Thus it is considered futile to blame the person at the controls. To do so
will also result in cover-ups and thus nothing will be learned. A “blame-free” culture
allows the true cause of errors to be detected and systems changed to prevent
another professional being similarly overwhelmed in future. Part of this is “whistleblowing”,
but much more is professionals “fessing up” at an early stage
for which confidence in a “blame-free” response is a necessary
precondition.
The aviation industry really does have this culture. There are usually no
repercussions (other than embarrassment) for failure openly admitted, even
when the consequences are quite serious, and the industry will defend its
members against legal attack even when they are known to be wrong. The health
professions do not currently have this culture: the “Shipman inquiry” was
far from “blame-free”, for those unfortunate professionals deceived
by Harold Shipman.
Then there is the transparency of the rules. The aviation industry requires
them to be “evidence- based” because safety does not respond to
political correctness, only to the rules of physics (and chemistry). Any aviation
proposal that sought to cancel reciprocity for Australian and New Zealand
pilots would have required a “notice of proposed rule change”,
supported by hard data showing the harm that was being caused now by these
pilots (deaths per 100 million passenger miles), the reduction in deaths that
would arise from the change and the cost of the change. Only if this data
were robust enough to repel challenges and the benefits statistically shown
to outweigh the costs by a significant margin, could the change proceed. An
opinion that the current situation might cause someone to object at some point
in the future for political reasons would fail such a test, though it seems
it was sufficient for pharmacy reciprocity to be cancelled. There is no place
in a true safety system for assertions of benefit unsupported by hard evidence,
just as there is no place in dispensing for assertions of purity of drugs.
It is most encouraging to see a person of Dame Janet’s stature proposing
such a change. She is in just the position to encourage the administrators
of pharmacy, and especially their disciplinary bodies, to undertake the profound
change necessary for the health professions to emulate the aviation industry
in its safety improvements.
Harvey Lockie
Auckland, New Zealand
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The
Pharmaceutical Journal