The topic of criminalization of healthcare negligence in a just culture is an interesting and important point of discussion as healthcare professionals are often tasked with providing “perfect” patient care in all cases and scenarios, particularly in a litigation-heavy environment. There are many challenges that arise from this pursuit of perfection and “justice” within the current healthcare culture, and healthcare providers are often left to feel as though they are the problem, as opposed to feeling like the situation is the problem. This is unfortunate because there are foreseeably many instances in which a practitioner does the best he or she can at a moment, but there may be patient factors that lead to poor patient outcomes. For instance, a surgeon performing a risky and complex surgery on a high-risk patient and a surgeon performing a routine and simple procedure on a healthy patient are very different in terms of potential confounding factors. In this scenario, some individuals may fault the former surgeon for deciding to pursue a risky and complex surgery on a high-risk patient, but what if this surgery is potentially life-extending? As can be seen from this example, the notion of holding healthcare providers at fault for their decision-making and their attempts to help “imperfect” patients are a problematic concept because healthcare is a human-based field, and unlike areas such as engineering, there are too many unpredictable factors, and too many challenges to performing without any error. As such, a “just” approach where clinicians are accountable for following rules and regulations, yet where they are not personally at fault for mistakes, would lead to a safer system where individuals do not attempt to hide their mistakes. Dekker (2010) recently conducted a systematic review of criminalization of human error in healthcare settings. Interestingly, this researcher comments that the practice of criminalizing human error actually leads to more mistakes by means of provider’s reports of self-blame, guilt, and depression. In terms of possible solutions, Ankowicz (2010) recommends limiting overtime, implementing a second-victim supportive program for those involved in critical incidents and errors, and focusing on the processes and behaviors, not on the outcomes. In other words, this researcher is advocating for a “just” approach.
- Ankowicz, D. (2010). Criminalization of healthcare negligence. In B.J. Youngburg (Ed.). Principles of risk management and patient safety. (pp.265-277). Sundbury, MA: Jones & Bartlett Learning.
- Dekker, S. (2010). The criminalization of human error in aviation and healthcare: A review. Safety Science, 49(2), 121-127.
