the-lancet---culture-and-health.pdf

For reversal of the systematic neglect of culture in

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for reversal of the systematic neglect of culture in health, the single biggest barrier to advancement of the highest attainable standard of health worldwide. Culture and health Introduction On Feb 6, 2013, a crowd gathered outside London’s Queen Elizabeth II Conference Centre across from Westminster Abbey. They were there to hear the verdict of the Mid Staffordshire NHS Foundation Trust commission that investigated the causes of hundreds of preventable patient deaths in just one NHS hospital system in the West Midlands between 2005 and 2009. On the day of the announcement of the commission’s findings, aggrieved families, policy makers, and mem- bers of the press assembled to hear the results. They all wanted to know on whose shoulders the blame for this travesty could be placed. As the crowd listened, the commission’s lead attorney, Robert Francis, announced that no specific group or person could be held accountable for such malpractice. The real villain was culture—culture caused these crimes of neglect to occur, and the culture of the UK’s NHS was responsible. As one newspaper put it: “The victims and their families were not happy. The culture of the NHS is not something that can apologise and try to atone. The culture of the NHS cannot be punished for its misdeeds. They wanted to see someone held to account. But the verdict was clear. ‘It was’, Francis announced, ‘not possible to castigate: failings on the part of one or even a group of individuals’. There was no point in looking for ‘scapegoats’. The guilty party was the ‘culture of the NHS’. It was the culture that had ignored ‘the priority that should have been given to the protection of patients’. It was the culture that ‘too often did not consider properly the impact on patients of actions being taken’.” 2 However, members of the Care Quality Commission, the group that oversees health quality in the UK, were subsequently charged with participating in a “tick-box culture”, “presiding over a dysfunctional organisation” with a “closed culture”, 3 and were themselves partly held responsible for the failings of the Mid Staffordshire Trust. Culture, here, supersedes direct actions of nurses and doctors, hospital boards, local and regional health regulators, health policy makers, local and national politicians, and even referring family doctors as sources of blame. Indeed, responsibility is extended to the culture of the very commission established to regulate the effect of cultures of practice on health. Nowadays, in assessments of health and health-care provision, to blame culture, however defi ned, is not uncommon. Culture, as this example shows, cannot be merely equated with ethnic group or national allegiance. We all participate in locally defi ned forms of behaviour that not only produce social cohesion, but that limit our ability to see the subjective nature of our values, our perceived responsibilities, and our assumptions about objective knowledge. In this
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