ShapeShapeauthorShapecrossShapeShapeShapeGrouphamburgerhomeGroupmagnifyShapeShapeShapeShape

Blunders and blame: the secret burden of veterinary medicine

If we reframe error as a learning event and refuse to give airspace to blame, then we can all change for the better

01 February 2021, at 8:35am

“I can’t believe she gave that dog a double dose of meloxicam; I mean, what was she thinking?” “His spay wounds are always so red at POC. It’s little wonder they take so long to heal.” “I can’t sleep for thinking about how close I was to that ureter… I’m such a rubbish surgeon”

Blame. Is this the shameful secret of our profession? Give it enough time and all of us will make mistakes and feel the weight of blame – be that from others or by blaming ourselves. Furthermore, those of us in authority will soon find ourselves managing such situations of blame in practice.

As fellow humans, why do we tend towards blame? Blame appears to resolve the issue quickly. It puts the individual blaming in a position of moral superiority which can feel good but does little to support the person who has made a mistake. In blaming, we can (probably inadvert-ently) choose to ignore our corporate responsibility or the surrounding practical factors that led to the error. It is far easier to lay blame at an individual’s door than to hold a team, or even systems, accountable for a mistake.

So how can we do things differently?

When working through such situations of error and blame we must take care to ask what happened and why, but most importantly, “How did that come to happen?”

Is to err (always) human?

In fact, usually there are one or more systemic issues that lead to error. It is far too simplistic to pin the blame on an individual. In doing so, we do that individual a great injustice. We must take care to always look at the systems that lie behind a particular individual getting a particular thing wrong on a particular day, and what barriers can be put in place to prevent the same incident happening again.

“How did she manage to double-dose that drug?”

A 5ml syringe had ended up in among the 2.5ml syringes in the drawer, then a client had called and the call was put through the back. Kate had been trying to get in touch with this client all morning so she took the call while filling the (5ml) syringe absent-mindedly and then laid it down. When she finished the call, someone asked Kate to sign an insurance form so when she picked up the half-full syringe again, she didn’t check the volume and went ahead and administered it to the patient. It was only when she went to remove the needle from the syringe that she realised what she had done. A silly mistake? But how often do we read something in the VDS newsletter and think: “that could so easily have been me”?

From a young age, we quickly rush to blame: “He broke my toy car; he did it on purpose!” But in the adult world, when we break things down, as we see above, the story is more multifaceted than it first appears.

Of course, in situations of true negligence or sabotage, the appropriate lines of discipline must be followed. But such an event is extremely rare – particularly so in a profession heavily weighted towards high performance and, furthermore, compassionate care.

We have incredibly high standards for ourselves in the veterinary profession. And rightly so. We want to perform to the best of our ability for the animal patients under our care, for the clients who care deeply for their animal, but also for ourselves; there is huge gratification in a job well done. So, when things go wrong, we don’t like it. We have high expectations that extend to the performance of those with whom we work. It is so easy to blame. That person was the one holding the scalpel at the time, and therefore it is their “fault” that something went wrong. But this sort of causation is a massive oversimplification with huge human ramifications. The fallout for the team member being blamed gives rise to the well-recognised concept of a “second victim”. Who hasn’t felt the heavy weight of guilt when we have made a clinical error? Are we even our own worst enemy in this? As type A, high-performing individuals, we lay huge responsibility at our own feet. And when things go wrong, we can blame ourselves heavily when perhaps we shouldn’t.

We must recognise that error is fundamentally learning

Take the example of a young child using an open cup for the first time. The child spills their drink, but we don’t reprimand them for their error and brand it as such! We see it as a learning event – they learn that the water may come out the top of the cup, they need to gauge how full it is and how much to tilt the cup to drink. So, at what point in life do we lose the concept of “error” being a chance to learn? When do errors become shameful events to be briskly reprimanded, and the person firmly instructed “don’t do it again”?

A rampant blame culture cultivates secrecy whereby errors are to be ashamed of and hidden. If we hide error then the chances are the same mistake will be made again; most likely not by that same individual because as vets/VNs we tend to hold ourselves tightly to account, but by another individual repeating the same task. Surely, we have a responsibility to our team and the patients under our care to discuss our errors and set structures in place which mitigate against them. And furthermore, we have a responsibility to cultivate a workplace where error is spoken of openly without fear of retribution so that we can reduce the chance of a recurrence in future.