Non-Punitive Culture and Accountability

For many years, medical professionals have been held personally accountable for errors in health care service. The notion of the malpractice-prone inept physician has grown from the traditional system of blame, degrading the public perception of the profession and instilling current providers with a consistent fear of losing credibility. These professional concerns can be powerful enough to completely distract from the health of the patient, thus changing the perceived role of people in need from the primary focus to a mere scorecard.

The non-punitive approach to error management has been developed in direct response to the shortcomings that are evident in a blame-focused environment (Hellings et al., 2010). This system shifts the attention away from people, and fixes it upon the processes that are employed. While this system avoids many of the pitfalls that are common in traditional error management approaches, it introduces the new threat of perceived amnesty and subsequent declines in quality of services.

Clearly, it is not advisable to introduce a policy that is rigidly non-punitive, but the consideration of main principles from the theory in combination with reasonable personal professional accountability could produce a potentially ideal error management system. A combined method of error management would promote self-reporting, safety, and knowledge attainment without the fear of being excessively disciplined for infrequent minor infractions (Chassin et al., 2010). At the same time, the approach should leave room for further actions on a case-by-case basis, based on factors like error seriousness, uniqueness, and professional history. Accountability can be achieved in a non-punitive culture to create a just environment that promotes professional growth and error reductions.


Chassin, M. R., Loeb, J. M., Schmaltz, S. P., & Wachter, R. M. (2010). Accountability

measures—using measurement to promote quality improvement. New England Journal of

            Medicine, 363(7), 683-688.

Hellings, J., Schrooten, W., Klazinga, N. S., & Vleugels, A. (2010). Improving patient safety

culture. International Journal of Health Care Quality Assurance, 23(5), 489-506.