Human scapegoat

When looking for explanations for mystifying human conduct, the explanation people arrive at often only point to a scapegoat or shift the mystery to something else. People ask, I wonder what got into... 

Perversions of the sacrificial principle (purgation by scapegoat, congregation by segregation) are the constant temptation of human societies, whose orders are built by a kind of animal exceptionally adept in the ways of symbolic action. 

Accountability versus blame. Health care professionals are accountable for their work. They have a responsibility to possess current knowledge and competence in the work they perform they also have a responsibility to acknowledge the interdependence they have in their performance. In addition, they must appreciate how systems work and understand that people are the human components of systems, both contributing to failure and creating safety. Blame focuses on a scapegoat rather than on the pursuit of deeper understanding about failure. The traditional blame, shame, and punish methods have not worked to improve safety. Blameless versus punitive or retaliatory. A blameless environment is one where the front line is comfortable reporting failures and near misses so they can be studied in this kind of environment, the front line even feels compelled to report failures. A punitive or retaliatory environment creates an atmosphere where sharp end staff members are afraid to disclose failures and near misses, and in this way opportunities to learn from mistakes are eliminated. 

Accident or failure versus human error. The term accident describes a breakdown in a system that is complex and needs analysis. The term error suggests that only one factor, usually noted as the mistake of a human being, is the cause. If human error is assigned as the cause of harm, learning stops because a scapegoat has been identified. 

Assigning human error as the cause of medical accident allows the health care culture to reinforce an illusion of restored safety when the individual in error is removed. This approach denies the existence of system failures, identifies a scapegoat, and prevents learning. It truncates the ability to predict and prevent future adverse events. Later, after the human cause of an accident is removed, another human being will step into place. The same conditions and factors can be reassembled, and the stage is set for the medical accident to recur. 

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