Error and Accountability in a No-Fault System: Maintaining Professionalism – Rebecca Babcock and Grant Gillett

No-fault systems of dealing with medical error have been mooted but are often criticised for removing or blunting professional accountability. An analysis of contemporary health care and the systems approach to medical harm suggests that the criticisms are misplaced. A no-fault system in fact encourages correction of harm and prevention of injury due to systems and personal professional error. It removes an unhealthy climate of name, shame and blame, and an unrealistic image and set of expectations on health care professionals. By contrast a tort-based system fosters bitterness and an adversarial forensic lottery that perpetuates harmful practices and does little to identify and analyse the causes of misconduct and injury. What is more, a tort-based system can remove direct incentives for personal and institutional change through third-party risk sharing that mitigates any penalties on those who need to change their behaviour. Thus the criticisms of no-fault systems to deal with medical harm draw on populist but ill-thought reactions to a problem that can cause truly awful damage to both patients and the professionals who try to help them.