Published: 26/05/2005, Volume II5, No. 5957 Page 33

Gerry Armitage, lecturer, school of health, Bradford University

You do not have to spend much time talking with health professionals to learn that many are concerned about a litigious culture that has apparently swept into the NHS.

The public are now making their mark as service users. Not only are they being consulted about healthcare provision; they have developed an inclination to take legal action if standards of care are not to their satisfaction.

Complaints are clearly on the up, but that is not the whole story.

Many practitioners appear to still feel unsure about reporting an error or adverse event, and the phenomenon of under-reporting - generally accepted in patient safety research - appears to support this. But an unrealistic fear of litigation from an apparently vengeful patient should not increase concerns about reporting.

We need as many incident reports submitted as possible. We can all learn from them, and they might help us reflect on some of the information that patients want as well as being a good accompaniment to an apology to the patient.

But many clinicians are reluctant to report their errors. So why errors and why poor reporting? We already know that healthcare is increasingly complex, and requires complex systems of delivery. It is also a system which is often operating at full capacity - and sometimes beyond.

Although there are heavy demands on healthcare education and training, the mandatory inclusion of error theory should be seriously contemplated.

Understanding the thought processes, human behaviours and environmental conditions that contribute to an error seems eminently practical. As does familiarising practitioners with James Reason's work on hazards and defences and how through a series of individual and system anomalies, the toughest of defences will become porous. It is often the best people that make the worst mistakes, and when humans report an error their explanation of events can be unfortunately biased.

Introducing error theory to health professionals such as nurses, often when they are already in designated risk-management posts, is too little too late. It is their combined actions with those of other health professionals that produce the most worrying adverse events, so here is another opportunity to enrich the mixture of inter-professional learning with some meaningful content.