"Healthcare Systems in Ghana Must Move Away from the Blame Culture" - Professor Aaron A. Abuosi at an Inter-College Lecture

Professor Aaron Asibi Abuosi of the Department of Public Administration and Health Services Management, University of Ghana Business School (UGBS), has noted that “the call to move from a blame to a just culture is rooted in the fact that, a just culture is a balance between a blame-free culture and a punitive culture.” 

Prof. Asibi Abuosi made these remarks when he delivered an Inter-college lecture series on the topic: “From a blame to a just culture: An imperative for patient safety in Ghanaian hospitals”. The lecture was organised by the College of Humanities and chaired by the Provost of the College, Professor Daniel Frimpong Ofori.

Prof. Abuosi set the pace for his lecture by indicating that his presentation will dwell on the preliminary results of research he conducted together with faculty from the Department of Economics, UGBS and the Department of Community Health Nursing, which was funded by the University of Ghana Research Fund Multidisciplinary grant for 2020. 

Prof. Abuosi posited that whereas patient safety is fundamental to the provision of healthcare in all settings, avoidable adverse events, errors and risks associated with healthcare remain major challenges to patient safety globally. “Every year, large numbers of patients are harmed, or die because of unsafe healthcare, creating a high burden of death and disability worldwide, especially in low and middle-income countries. On average, an estimated one out of ten patients is subject to an adverse event while receiving hospital care in high-income countries”, he stated.  He added that evidence suggests that 134 million adverse events, due to unsafe care, occur in hospitals in low- and middle-income countries, contributing to around 2.6 million deaths every year.

Noting that per recent estimates, the social cost of patient harm can be valued at US$ 1 trillion to 2 trillion a year, thus a background to why World Health Organization (WHO) in 2019, declared 17th September as World Patient Safety Day. Prof. Abuosi reported further that the blame culture has been identified as part of the occurrences of adverse events that compromise patient safety in the healthcare industry. “The blame culture has the tendency to deter healthcare providers from reporting errors, and once errors are not reported, there is no way a hospital can learn from similar adverse events to prevent their future recurrence”, he opined.

Prof. Abuosi mentioned that a former President of WHO World Alliance for Patient Safety, Liam Donaldson, asserted that “Human error is inevitable. We can never eliminate it. We can eliminate problems in the system that make it more likely to happen”. He also added that a renowned global health expert, Dr Lucian Leape, a Professor of Harvard School of Public Health noted that “The single greatest impediment to error prevention in the medical industry is that we punish people for making mistakes”.  Throwing light on these assertions, Prof. Abuosi emphasised the need to move away from the blame game to a just culture that encourages error-reporting, among other things.

A cross-section of participants at the lecture

Prof. Abuosi reiterated that avoidable adverse events (including healthcare-associated infections, medication errors, pressure ulcers, wrong-site surgery, etc), errors and risks associated with health care remain major challenges to patient safety globally. “As a result of this, large numbers of patients are harmed or die because of unsafe health care, creating a high burden of death and disability worldwide, especially in low- and middle-income countries”, he added. Emphasising his point, he referred to a maternal death case at a hospital in the Eastern Region in 2006, which resulted in a legal tussle.   “Another case occurred at a Children’s Hospital in the United States in 2010, where a nurse accidentally gave a sick baby a fatal dose of medicine”, he added.  Prof. Abuosi further made references to other cases in hospitals in Ghana and asserted that these cases are prevalent in Ghana and other low- and middle-income countries because the healthcare system in these areas is largely characterised by a blame culture rather than a just culture.

He mentioned that a blame culture is characterised by finger-pointing, naming and shaming as well as punitive response to error. “Whereas a just culture that tends to ask ‘what’ caused an incident; thus, encouraging investigations beyond the ‘person’ to the ‘system’, a blame culture tends to be fixated on the question ‘who’ caused the incident; thus, investigations are aimed at gathering evidence to implicate the staff involved. Blame culture is a deterrent to error-reporting, as people find ways of shelving errors for fear of blame and its attendant consequences. This does not promote organisational learning, thus making the tendency for the recurrence of errors high,” he added.

Prof Abuosi noted that at the national level, Ghana subscribes to the WHO Global Patient Safety Action Plan 2021–2030: towards eliminating avoidable harm in health care. He also announced that in view of the research findings generated by researchers in the University of Ghana which show evidence of the blame culture, the Government of Ghana through the Ministry of Health and its agencies, would need to take concrete measures to move from the blame to a just culture to ensure improved patient safety in Ghana.

Professor Abuosi concluded his lecture by expressing how the reporting of adverse events is low, in spite of the high rating of patient safety. “To resolve this menace, healthcare systems in Ghana must move away from the blame culture to a just culture”, he reiterated. Prof. Abuosi expressed the need to adopt the principles of High-Reliability Organizations (HRO) such as the aviation and nuclear industries, as these principles have contributed to their low records of accidents and other adverse events. “Two of these principles are the adoption of a just culture and the acknowledgment of human fallibility and the inevitability of error,” he stated.

Professor Daniel Frimpong Ofori in his closing remarks congratulated Prof. Abuosi on an insightful lecture. He noted that the recommendations and suggestions given by the lecturer cut across the length and breadth of the nation's socio-economic system and can be applied in every sphere of life.

The lecture was attended by a cross-section of faculty members from the College of Humanities, students and staff of the University as well as friends and family members of the lecturer.