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No name—no blame
  1. Geoffrey Hughes
  1. Correspondence to Professor Geoffrey Hughes, Department of Emergency, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia; cchdhb{at}

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‘The NHS in England can become the safest health care system in the world. That will require unified will, optimism, investment, and change... rules, standards, regulations and enforcement have a place in the pursuit of quality, but they pale in potential compared to the power of pervasive and constant learning’; so says Donald Berwick, the wise elder statesman and guru of health care improvement, advocate of a ‘no name—no blame’ approach to clinical error and, incidentally, a former advisor to Barack Obama. His report to the British Government, released in August, is a master class in common sense and wisdom.1

Some statements worth noting:

  • Patient safety problems exist throughout the NHS: the whole NHS should strengthen patient safety now and into the future

  • NHS staff are not to blame: it is not scientifically justifiable to blame the staff or label them as uncaring, unskilled, or culpable. There may be exceptions, but most staff want to do a good job, to reduce suffering and be proud of their work

  • Incorrect priorities do damage: The Mid Staffordshire tragedy and wider quality …

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.