Chris Lancelot on...defensive management

We all know about the problems of practising defensive medicine, but what about the problems generated by defensive management?

The chief objective of defensive management is to be able to prove that if anything goes wrong it isn’t your fault. Like defensive medicine, defensive management is expensive, time-wasting and concentrates on shifting the blame rather than doing the job. Its chief aim is to avoid being found out — or alternatively, to shift the blame on to someone else.

In the NHS defensive management means that all doctors are assumed to be Shipmans, all GPs are incompetent or money-grubbing fraudsters, all male doctors are sexual predators and all nurses are unable to give injections — until proved otherwise, by a qualification, a criminal records check or a visit from the primary care organisation. As a fully trained professional, I find this demeaning, nit-picking and obnoxious.

Defensive management is why fully qualified doctors and nurses are required to produce extra bits of paper to prove they can perform specific tasks. It also explains the rise of the ‘naming, shaming and blaming’ culture which, assisted by the Freedom of Information Act, can prevent the open but private acknowledgement of personal errors for fear of later public exposure.

Defensive management is intrusive and inefficient, and hinders the NHS from performing its primary task of caring efficiently for the sick.

The antidote is simple: create a climate in which the admission of faults actually gains kudos for the employee. If NHS staff know that owning up to mistakes does not lead to vilification, public exposure or a reprimand then it creates a climate of honesty and openness and a desire to learn from mistakes. Rather than worrying about their reputation, staff can concentrate on doing their job. In addition, if being open about errors brings praise rather than blame then management will be flooded with ideas on how to improve the system.

Abandoning defensive management should not only be a national priority: it’s also an immensely powerful practice principle. We have a no-blame culture in our own practice. It makes staff feel valued and creates a relaxed atmosphere. As a result everyone enjoys their work and performs it to the highest possible standards. What could be better?

Dr Lancelot is a GP from Lancashire. Email him at GPcolumnists@haymarket.com

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