Isn't it time we created the space needed to allow NHS organisations to fail and learn rather than to fail and be put to shame? 

People make mistakes. In the airline industry, where mistakes can be fatal to many, pilots both anticipate and practice for worst-case scenarios. But in health and social care, a culture of denial, obfuscation, spin and blame can prevent errors from either being acknowledged or learned from by those who need to do so.

Often the way to assuage the public face of failure is to sacrifice a lamb – the career, reputation or position of someone deemed to have committed the error. And while this might satisfy the calls for change, this very act can prevent the fundamental rethinking needed to enable learning to take place. NDAs make this still worse. 

Three things can drive this approach. First, trusts and public sector organisations can behave as if they were brands. Anything that potentially besmirches their standing and cultural value needs to be purged. So rather than acknowledging that all activities of public sector are inherently risky, reputation managers are deployed to rid the corporate body of any ill, lest it pollute the greater whole. 

Second, egoistic leaders may not wish to countenance the possibility that things can go wrong on their watch. This can foster a culture of denial (it didn't happen) or distancing (it happened before I got here or in an area beyond my reach). 

Third, the possibility that current failure may emerge (it's probably happening in every organisation at some level somewhere) can drive leaders to suppress uncomfortable truths. Whistleblowers are not welcomed – they help puncture carefully created myths about organisational brilliance. 

But these internal drivers are only part of the story; external factors also make life for leaders all but impossible, loading them up with never-likely-to-be-fulfilled expectations. Errors can be magnified through social media. A single but catastrophic error in a trust or council can lead to their name being eternally associated with one thing. I won't name names but we all know who they are, it can be hard to disaggregate such labels from the organisation in question, even though whatever happened may have done so years ago and even though everyone concerned will probably have moved on. 

And while their power may be diminishing, the tabloids are powerful framers of reality. Senior leaders live in dread of being splashed across the front page of even a regional daily. And as for the Mail, Express, Telegraph or The Sun – a page lead can kill even the most promising career. The fact is that the complexity and risk inherent in health and social care is nuanced and rarely works in black and white.

But none of this is helping. When money is tight, every ounce of value must be squeezed out of every failure. Here are three suggestions. 

First, actively manage expectations. Every patient or service user should be fully appraised of the risk inherent in their treatment or activity. This can and will be awkward. Not everyone will necessarily understand this. And certainly few will want to hear about the possibility of ‘worst case scenarios'. It's important that there is widespread understanding of risk in public services. The tabloids won't like it (it's not admitting defeat) but given that they're fuelling expectations, it matters. 

Second, all failures should be publicly acknowledged and shared. Everyone should be learning from everyone else's errors. If you can learn from others' mistakes, it saves time in having to learn from your own. And rather than using spin to mitigate or soften the public blow, comms should be deployed to ensure that local audiences understand what happened, how, what has been learned and what is being done to prevent a repetition. 

Finally, recognise that talking about failure doesn't manifest it. Rather, it's about anticipating it, stopping it upstream if possible and getting ready to take action as and when it occurs. It will. But unless leaders are prepared to deal with it openly and honestly, it will be pushed underground and those who fail will be exited. 

And that, with the loss of talent and learning, is the worst kind of failure, isn't it? 

If you have a left-shift view to share please contact l.peart@hgluk.com