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Safety, not blame in NZ public hospitals

MEDIA RELEASE 30 June 2003
Public Affairs Ph: 463 5873; Fax: 463 5108

Snakes and ladders – safety, not blame in NZ public hospitals

Moving from a culture focused on managing blame to a culture that enhances human performance is at the heart of patient safety in New Zealand’s public hospitals. Policies to do this must allow for the health care system’s complexity.

This paradigm is explored in Snakes and Ladders: The Pursuit of a Safety Culture in New Zealand Public Hospitals, a book by Dr Peter Roberts, jointly published by Victoria University’s Institute of Policy Studies and Health Services Research Centre.

Dr Roberts’ book, to be launched on 1 July 2003, focuses on enhancing human performance to establish a safety culture in public hospitals – nationally, organisationally and professionally.

“Enhancing human performance, rather than trying to manage human error, promises more scope for reducing harm to hospital patients,” says Dr Roberts.

“This focus on culture and safety recognises the key role of complex relationships in the provision of public health services. It leads to a more informed policy debate and better policy choices than simply trying to impose control over peoples’ behaviour.”

Two streams of data inform Dr Roberts’ approach.

Firstly, top public hospital management provided policy and procedure documents about safety priorities and middle management completed a checklist of institutional resilience to safety shocks. This gave a national “snap shot” and was used to compare staff attitudes.

Secondly, Dr Roberts colleagues responded to a nationwide ‘safety attitudes’ survey - completed by 72 percent of the staff from 20 New Zealand public hospital Intensive Care Units. The survey results were compared to a recent UK survey using the same questionnaire. The safety attitudes questionnaire was adapted from one used for more than 20 years in aviation.

Once asked why an intensive care specialist would study policy, Dr Roberts replied that poor policy is more dangerous to his patients than the flesh-eating bug.

Many reviewers have commented that his focus on culture and enhancing human performance has messages for many parts of the public service, not just health care.

In 2002 Dr Roberts received his Master of Public Policy degree from Victoria University with Distinction and was awarded the Prime Minister’s Prize. His Master’s thesis, on which his book is based, won him the inaugural Holmes Prize for Public Policy Research.


Dr Roberts has been a specialist intensive care and consultant physician at Wellington Hospital since 1983. He is a graduate of Hampden-Sydney College, Virginia, and West Virginia University School of Medicine. His advanced medical training was in Toronto, Massachusetts and Sydney. From 1997 to April 2003 he was National President of the Association of Salaried Medical Specialists and was awarded the 2001 NZMA Chairman’s Award for Services to Health.

Snakes and Ladders will be launched at Victoria University’s Rutherford House, Room 610, Level 6 at 5pm on Tuesday, 1 July.


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