Changing the 'blame' culture in the National Health Service:
She just wanted to understand the reasons for what happened and to hear his apology that she was unhappy with the treatment. A no-blame approach provided this for her and greatly benefited the dentist as well. Read about a real-life example on this page.
This page explains this approach and the reasons why it is an important and more effective approach to adopt.
The purpose of mediation is not to investigate to try to find the ‘truth’ about a situation. It simply acknowledges that there is a problem and assists the disputants in finding another way of viewing a situation or of responding to it that works for both of them - or all of them if there are more than 2 disputants.
Here's the opening part of a very old poem, which seems to be advocating a no-blame approach:
The perfect way is without difficulty
Save that it avoids picking and choosing.
Only when you stop liking and disliking
Will all be clearly understood.
A split hair’s difference,
And Heaven and Earth are set apart!
If you want to get the plain truth,
Be not concerned with right and wrong.
The conflict between right and wrong
Is the sickness of the mind.
From Hsin-hsin Ming by Seng-ts’an quoted in
The Way of Zen
by Alan Watts.
Often, people in dispute do not understand or even believe that mediators do not seek to allocate blame. There is such a strong culture of blame in our institutions and organisational practices that sometimes people have no alternative concept for dealing with disputes.
As an approach, the 'no-blame' idea is often seen as 'soft' or 'wishy washy'. People often expect mediators to ‘investigate’ and then find ‘in their favour’.
We don’t ever do either.
Our role in hearing about a dispute is not to come to some form of judgement about it and then present our decision, but to help the parties:
and through this............
The point is that a no-blame approach enables learning for the future in that it allows an open discussion of what has happened, so that all the issues can be taken into consideration, without the need to keep any from disclosure for fear of condemnation from others.
Many disputes remain in a rut simply because of the continuous 'blame approach' adopted by those involved, whether those in dispute themselves or others who are 'supporting' them.
In the 'blame approach', the focus is not on the problem and finding a way forward and learning for the future, it is simply on avoiding blame and redirecting it to others.
This article is written by Alan Sharland, Director of CAOS Conflict Management, London, UK
As a result, nothing changes.
The No-blame approach is often 'resisted' as an idea although it is starting to gain in popularity again within new thinking associated with the NHS. Where resistance still exists, those who promote its use now describe it as the Support Group Method.
So what is lost in a ‘blame approach’ situation and how does it prevent Effective Communication and how does a No-blame approach improve things?
Well, let's take complaints about National Health Service (NHS) practitioners for example.
An apology is often all that is wanted by members of the public who feel upset by an experience they have had at the hands of a health practitioner. But what they often get is a deluge of justifications and denials and avoidance of any clear response to their initial concerns.
|The Underlying Philosophies of Mediation:
I once mediated between a patient and a dentist regarding a conflict over the treatment given to the patient while she was under general anaesthetic. When I picked up the case it was about a year old and had about an inch thick folder of correspondence associated with it. It was the first NHS Complaint that I had mediated. It was over in an hour, fully resolved. I normally expect mediation meetings to last at least 2-3 hours.
Why was this resolved so quickly?
The main issues of dispute were what the patient read in letters responding to her complaint that more extensive work had been done on her teeth than she felt necessary. The dentist justified his actions in correspondence by saying they arose because the patient was "disruptive under anaesthetic" and "had poor oral hygiene".
This was interpreted by the patient as meaning she was somehow being ‘difficult’ even though she was unconscious, which she found ridiculous. On top of that she was offended to be told she had poor oral hygiene when she brushed her teeth regularly.
When given a chance to actually communicate effectively with each other, through the no-blame environment of a mediation, the patient explained her reasons for being upset and therefore for pursuing her complaint. The dentist was able to explain that in order to avoid any risk of misinterpretation for which he could be in trouble in any future proceedings arising from the complaint, he had to use recognised medical phrasing in his response.
|NHS Complaints Mediation is available from CAOS Conflict Management - The organisation set up by Alan to provide Mediation, Conflict Coaching and Conflict Management Training and Consultancy in London, UK. Click the link above for more details.|
So when he said "disruptive under anaesthetic" he meant that the patient was physically moving about, even though sedated, and so he was not able to do the more delicate work needed which would have prevented the need for the more substantial work he eventually had to fall back on to resolve the problem with the patient’s teeth.
He did not mean she was being ‘naughty’ or ‘deliberately difficult’ as she had understood it to mean. With regard to the description of her mouth as having "poor oral hygiene" he meant that a contributory factor in his decision to do what he did was the need to avoid infection arising from the common ‘bugs’ that exist in every person’s mouth, not this patient’s any more than anyone else’s.
His need to avoid any risk of blame in his previous responses by letter had escalated the impact of the situation on the patient who had made the complaint and hence the impact of the dispute on both of them.
The avoidance of a meeting for almost a year through fear of what might be said that may later be used against him (a fear instilled by his Medical Defence Union advisor), led to copious letters back and forth between his representatives and the patient’s, ultimately getting nowhere.
In around an hour, a straightforward discussion and clarification of each other’s views together with sketches by the dentist to explain what he did and why, resolved the problem that had led to anger and frustration for the patient, as well as a sense of powerlessness, of being patronised, ignored and criticised - all exacerbated by the situation being unresolved for a year.
The dentist had suffered distractions to his daily business through writing responses to the complaint, meetings with his representatives, worries about his reputation and puzzlement regarding why the patient was so persistent in her complaint.
Almost all of the subsequent complexity of the dispute arose from the fact that the culture of the NHS was about avoiding and defending against any allocation of blame, something that, clearly from the response of the patient when she finally met with the dentist, was not what she was seeking.
|For further discussion about the no-blame approach click here|
She just wanted to understand the reasons for what happened and to hear his apology that she was unhappy with the treatment. A no-blame approach provided this for her and greatly benefited the dentist as well.
When she understood, she was much less unhappy and more accepting of the necessity for the dentist's actions. Mediation, and its no-blame approach enabled Effective Communication to occur, enabling them to resolve the conflict by allowing for constructive responses to occur rather than the destructive responses that had littered its history.
Some people working for the NHS say that a lot of complainants are just looking for compensation and so this is the reason they have to put up such barriers to communication with the complainant.
While this could of course be true on occasions, there are two points in response to this.
1. Mediation is a confidential, without prejudice process and so any ‘admissions’ of fault will not be divulged elsewhere and so it is unnecessary to put up so many barriers to discussion of the issues. It is a no-blame approach!
2. It is often the case that complainants make demands for compensation simply because the intransigence and stonewalling by the organisation they are complaining about so angers them that they demand it as a way of trying to vent their anger.
This is the experience of many complainants about many organizations, the practice is by no means confined to the NHS.
Obviously this leads to a vicious circle where some people in organisations such as the NHS see complainants as being ‘gold diggers’ and so their response is to be even more defensive and non-committal. A destructive response to the dispute leads to reciprocal destructive and escalating responses from the complainant. And on it goes.
Consider how much time, stress and money is involved in this messy approach for any organisation that handles its complaints in this way.
Consider how much time, resources and money the NHS has to spare for such things, and how much of those resources could be saved via a no-blame approach to its disputes.
So why does it have to be necessary for mediation to be brought in for a no-blame approach to be taken?
Well, of course, it doesn’t, there just needs to be an understanding of why a no-blame approach can significantly improve the effectiveness of communication that occurs regarding a conflict, and then it can be put into practice by anyone.
Including you, if you choose to!
The No-blame approach from the Underlying Philosophies of Mediation relates strongly to the Principle of Effective Communication no. 7: That we challenge the behaviour, not the person, and to no. 9 – That it is ok to make mistakes.
"Blame gives us permission to remain where we are while pressurising others to tiptoe around our wounds. Blame does not heal and it does not produce change; forgiveness does." - Caroline Myss from her book Sacred Contracts: Awakening Your Divine Potential
See her video about forgiveness and other great videos by clicking HERE(opens new page)
When we stop focusing our energies and resources on finding someone to hang blame on for something that has happened, we can instead get on and look at what actions or behaviours occurred that led to it happening to learn how to avoid it and make a better response in the future.
This may be an accident or an oversight or some other problem, or it could be a destructive conflict that has arisen between people arising from this.
Only through adopting a no-blame approach can a conflict be resolved.
Hanging blame on someone doesn’t teach us anything about why a conflict arose or was responded to in a way that was destructive.
It just allocates blame, nothing more. It suppresses the conflict, thus avoiding it. It does not resolve it.
A no-blame approach is an acceptance of 'what is'. It takes an approach which deals with reality - that something has occurred that has caused stress, unhappiness, and other upsetting feelings. It seeks to learn from what has happened, not only how to deal with it differently in the future but also how to deal with the distressing feelings arising from it.
A blame approach rarely achieves this as it simply provides an opportunity to 'vent' the anger arising from this distress. It does not resolve and 'heal' that distress.
The example of the NHS complaint above shows the distinction between a no-blame approach and a blame-approach.
When a law is broken we assign blame and punish someone for their crime. Unfortunately in a ‘blame culture’ there is very little emphasis on the learning that can arise from a broken law. The emphasis is on finding out ‘who’, rather than on ‘what’ and ‘why’.
Please note that I’m not saying that if a law is broken or some other difficult situation occurs there is no need to identify who broke it or caused it, and they receive the punishment dictated by the laws of the land that we consent to live by as citizens of whichever country we live in.
But when the emphasis is almost entirely on finding blame with very little review of how it might be prevented in the future (other than simply to punish people and hope they don't do it again) the event has not provided an opportunity for anyone to learn.
And so we keep on doing what we’ve always done. And we keep on getting what we always got.
Here's a great blog article on 'no more blaming' that discusses this topic further.
When conflict is seen as something to be ‘avoided’ or ‘feared’, a no-blame approach is impossible and very little learning can occur when something goes wrong.
In a dispute where the focus is on allocating blame, time and energy is directed toward this rather than on learning. Those being accused focus their energies on justifying everything they did, and even concealing things they did, to avoid condemnation.
And so, no consideration of how things could have been done differently, or better, can occur as those being accused have to continuously prove they did everything 'right'. This lack of openness hinders learning, growth, greater connection between people.
Instead, via a no-blame approach, conflict can be recognised as inevitable, and unavoidable, as a rich source of learning and an opportunity for greater closeness and understanding between people.
What an opportunity. So often missed.
There is nothing either good or bad, but thinking makes it so.
William Shakespeare Hamlet, Act II Scene ii
Connect with Alan on Google+
Donate to this site:
If you feel this website has been of use to you, please make a donation via the button below.
Just the cost of a cup of coffee helps to keep this mainly ad-free site running.
THANK YOU! For any contribution you make:
Train to be a Mediator in London UK with CAOS Conflict Management:
There's also a FREE COPY of the e-booklet Listening, Summarising and Questioning - The Simple, Effective Skills of Conflict Resolution with every purchase of The Guide.
Some recent feedback on The Guide:
Dear Alan - I recently purchased The Guide which I think is excellent and highly useful in a personal and professional context. I am a teacher with the Skills Institute in Tasmania and I'm about to roll out communication training in Tasmania's only youth detention facility. I have an enormous amount of material regarding communication but none as succinct or as user-friendly as what you have developed.
Teacher-Human Services Skills Institute - Tasmania
I work at a homeless shelter/rehab and I teach a class on community living. This is a new field of employment for me. I can use this site for ideas for the class I teach.
This is going to be very interesting and educational for myself as well as others.
This site is a big help. Thank you!
TM, Kentucky, USA
Alan Sharland, author of the Communication and Conflict website is Director of CAOS Conflict Management, where he has a blog called CAOTICA, please visit by clicking this banner and if you like what you see please subscribe to CAOTICA.
Working with 'Bullying'? - This may interest you….
Hello Alan Sharland
Thank you SO MUCH for this article! It brings forward some very key points about the phenomenon of "bullying" which I have been pondering for some while. Among others, asking to what extent can/should the person on the receiving end of the bullying/perceived to be bullying take responsibility/initiate steps to shift the paradigm? How can this happen without implying that the recipient is somehow responsible for the bullying behavior?
Laurie McCann, Campus Ombuds, Univ Calif Santa Cruz
You have put together an awesome web site with lots of fantastic materials.
John Ford - Managing Editor Mediate.com
Hi Alan, ..... your site is great. I've been reading all the material and have to say its already made a difference in how I sort out/manage some of life's little problems. JH - West London, UK
This article is the BEST article on questioning I have ever read and I'd like, with your permission, to pass it along to our mediators.Your examples of both genuinely open and 'not-so-open' with explanations are very insightful.
ML - Canadian Govt. Agency
I have just spent hours on your site as I truly love the eclectic mix of reference material that you kindly share. From Gibran to Byron Katie and the fab youtube clips! I am making my free hugs poster as of now :-)
Anni with joyful smile :-)