‘Bad apples’: time to redefine as a type of systems problem? (BMJ, 10 May 2013)

Summary

In the early 21st century, the patient safety movement began to talk about system safety. Recognising that people are inherently fallible, advocates for patient safety proposed that it was wrong to blame individual clinicians for poorly designed systems that were full of error traps. However, in a 2013 BMJ editorial, Kaveh G Shojania and Mary Dixon-Woods argue that we must also take seriously the performance and behaviours of individual clinicians if we are to make healthcare safer for patients. They draw on research showing that ‘bad apples’—individuals who repeatedly display incompetent or grossly unprofessional behaviours—clearly exist. This is never more evident than today, when we read about the conviction of nurse Lucy Letby.