LETTERS: When we were housemen, medical officers, paediatricians and sub-specialists in the Health Ministry (MOH) from 1977-1997, there were no major reports of bullying or harassment in the nation's premier healthcare institution.

Doctors then enjoyed the firm and no-nonsense leadership of a director-general (DG) of health who walked the talk, apart from the work ethic of a baby-boomer generation, much different from the present gen Y.

There are multiple factors contributing to the current culture of fear and blame. Uppermost is the failure of healthcare leaders to develop a work culture that is safe for training and learning, which is essential for the delivery of quality healthcare that enhances patient safety.

This is the paradigm of a just culture, a contemporary systems thinking, where medical errors are examined holistically. The factors may be a faulty organisational culture or systems errors, and are not merely attributable to the healthcare worker (HCW). 

Targeting the HCW involved in the error is prevalent in a blame culture. An individual may be at fault, but frequently the system is also culpable. Punishing the HCW without transforming the faulty system only perpetuates the problem rather than solving it.

A blame culture creates a climate of fear that results in poor patient safety culture where errors tend to be hidden rather than spoken about openly. A poor safety culture and the blame culture perpetuates poor performance, which in turn becomes a "justification" for labelling juniors as incompetent and of poor quality. A vicious circle is established.

Based on the unprecedented case, we implore those highest in office to be exemplary and promote a just culture. All the healthcare leaders must walk the talk.

The terms of reference, standard operating procedures and the playbook of a just culture in the workplace must be crafted, shared and amplified; and it must be embraced and operationalised by all leaders at all levels of the ministry.

The prevalent blame culture must be eliminated. It has been the major source of a toxic working environment apart from causing more medical errors.

An analysis of the available data on bullying is pertinent and they must address the gaps and the need for more contemporary research and data. And within this framework for action, there must be studies on poor morale, HCW fatigue, burnout and workplace culture in the ministry.

They must establish a fool-proof grievance mechanism for all staff to report bullying without fear of being identified and further victimisation. There must be a strong support system for bullied staff, especially those with suicidal thoughts.

An operational algorithm of investigating complaints from all staff must be in place and implemented without fear or favour.

The Health Ministry must work closely with the Human Resources Ministry to draft legislation against workplace harassment.

With the Higher Education Ministry, they must ensure that the affective domain of learning is given due emphasis and attention; and any mental health issues are promptly addressed in the medical schools.

The Health Ministry must give regular feedback to the Malaysian Medical Council on the quality of graduates from the many medical schools to empower it to accredit them or sanction those not up to the mark.

It is obvious that the task force named by the minister to look into healthcare work culture is not inclusive. This exclusivity mindset in the Health Ministry was one of the major failures of the healthcare leaders to tame the Delta wave from its onset in October 2020 until the inclusive team of the Greater Klang Valley Task Force took over command and flattened the Covid-19 pandemic trajectory within a short space of time.

DR MUSA MOHD NORDIN,

PROFESSOR DR AZIZI OMAR

Paediatricians, Damansara Specialist Hospital,

Kuala Lumpur

https://www.nst.com.my/opinion/letters/2022/05/797087/stop-blame-culture-healthcare