Features  |   May 2017
A Tale of Two Anesthesia Departments: What’s Culture Got to Do With It?
Author Affiliations
  • Monica W. Harbell, M.D.
    Committee on Patient Safety and Education
  • Tal Levy, M.D.
    Committee on Patient Safety and Education
  • Melanie J. Donnelly, M.P.H., M.D.
    Committee on Patient Safety and Education
  • Della M. Lin, M.D.
    Committee on Patient Safety and Education
Article Information
Education / CPD / Ethics / Medicolegal Issues / Patient Safety / Features
Features   |   May 2017
A Tale of Two Anesthesia Departments: What’s Culture Got to Do With It?
ASA Monitor 05 2017, Vol.81, 18-21.
ASA Monitor 05 2017, Vol.81, 18-21.
These scenarios demonstrate the stark contrast between two types of organizational cultures: blame culture and just culture.
Blame culture has been defined as an organizational attitude that seeks to blame the individual involved in an error, accepting no institutional accountability for mistakes and errors. This promotes the cover-up of errors and blame-shifting among individuals, cultivating distrust and fear within departments. Blame culture is not often intentionally created, but evolves out of a highly rules-oriented, compliance-driven management style. In this culture, management may believe their workers are apathetic, when instead they are not providing input or ideas due to fear. This control-based style of management, as explained by Khatri et al.,1  “does not allow much learning to take place in the health care delivery process and sets in motion a vicious cycle in which greater incidence of medical errors leads to greater control and regulation of employee behaviors, further strengthening the blame culture.” It has been suggested that blame culture in health care is a likely factor contributing to the unacceptably high rates of medical error.1 
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