Tuesday 20 August 2019

Playing blame game sets us up for failure

Because of the public's desire for blame, it affects the way politicians behave

'The Government's scoping inquiry, headed by Dr Gabriel Scally, is tasked with finding out some of the basic facts.' Photo: Mark Condren
'The Government's scoping inquiry, headed by Dr Gabriel Scally, is tasked with finding out some of the basic facts.' Photo: Mark Condren

Eoin O'Malley

The State giveth, the State taketh away. If it's taking away a square metre of your front garden this could net you €25,000. Those less lucky, whose cancers were not detected in a screening programme, and who were then not informed when it was discovered that their screens were misread, will receive ex-gratia payments of €2,000.

This isn't the value the State is putting on the pain caused to the women and their families, the offer seems just an unfortunate example of the State dealing with the cancer screening issue badly.

Well that's what we think. But the most notable aspect of the scandal is how little we know. We're still not certain of basic facts - such as whether the US laboratory contracted to read the slides from the smear tests were worse than labs in Ireland doing the readings.

That hasn't stopped people apportioning blame. There's an assumption that the HSE acted badly, that the US lab was chosen purely based on cost, that the US labs had a lower detection rate than the Irish ones, and that had this screening been done in Ireland some of the 18 women would be alive. But we don't know this.

The Government's scoping inquiry, headed by Dr Gabriel Scally, is tasked with finding out some of the basic facts. It's looking at why the HSE did not disclose the failure to detect, the quality of the testing, the tendering of contracts, and how CervicalCheck operated.

He's already frustrated with the task. Having waited to be sent the relevant documentation, he was eventually sent scanned copies of the files, rather than the original digital files. Scally pointed out to RTE's Drivetime last Tuesday, 'It is almost impossible to conduct an inquiry dealing with thousands and thousands of files without being able to [digitally] search the documentation'.

The HSE responded that the reason it did this was for unspecified technical problems, but that it was 'trying to ensure documents were issued as quickly as possible'. The assumption is that there is a cover up going on.

Is it possible that even where harm was caused - as seems clear here - nobody did anything wrong? How could that be? Someone's surely to blame.

Think about why schools don't let kids run in many school yards anymore. The schools aren't trying to cause harm to kids - though they are. They can point to insurance claims. They are just trying to protect public money, to avoid harm. Actually, to avoid blame.

The problem is that because of the public's desire for blame, and especially head-on-a-plate blame, it affects the way officials, politicians and even school principals behave. Rather than try to provide the best service they can, or provide answers in a straight way, they actively try to avoid blame. We end up with systems and protocols for everything.

The fact that humans are biased to notice and punish failure, but not see or reward success, is key. Why should I go out of my way to do something good? It's more important to avoid making mistakes. We call it accountability, which sounds good, but perhaps there's bad accountability as well.

Ministers want to avoid blame, so they outsource decisions to expert groups. Setting up the HSE insulated ministers from blame for clinical or management errors.

In the CervicalCheck screening case there was a decision to outsource the screening of testing. It appears the minister was not the key decision maker. This decision was not just on cost grounds, but also because of lengthy delays in and variable quality of the many small labs doing the screening here. Arguably those delays were a danger to the women being tested. In tendering the quality of the screening, timeliness, capacity to handle large volumes, and cost were factors.

But at the time of the decision, the focus of TDs was on the loss of jobs in their constituencies if screening were concentrated in big US labs. For James Reilly there was a concern about the loss of capacity to carry out the screening here, because if it were carried out abroad for two years, then any clinicians here would have lost their capacity to practice. But most TDs' concern was purely parochial. They didn't care about quality, just lost jobs at a time of massive job losses.

Exactly what weighting each criterion was given in the decision to award a contract is not clear - Scally might uncover that. Had an official not chosen the cheapest bid, presumably he or she would have been worried of the repercussions. To avoid blame it is easier to award the contract to a large well-established lab with a low cost. And it is easy to defend it. You have run a cost-benefit analysis. The officials aren't making the decision, the numbers are. No one will get fired for that.

It happens in other areas of the public service procurement. It is easier for Finance departments to ensure simple regulatory compliance than save money. It might cost more, but it satisfies procurement rules designed to save money. Throughout the public service you are not allowed to simply book flights from an airline's website. Instead we go through the lengthy and more costly process of booking through a travel agent - remember them? No one is to blame.

With some exceptions, such as Stephen Donnelly, most of the work of the opposition parties on the cancer scandal seems to be assign blame first, find out what happened later, and figure out what to do comes a distant third.

The former head of the HSE had to go, but we're not sure he did anything wrong. Head-on-a-plate accountability makes it harder to fix problems. It decreases the chances people will reveal mistakes they made. An air-accident approach might be better. In those cases, any mistakes, even near-misses are reported and investigated. People don't get blamed, and because of that we learn more from mistakes.

We complain that the State is too inflexible and conservative. We can't have it both ways. The blame game sets us up for failure - that's OK, so long as I didn't do it.

Eoin O'Malley is the director of the MSc in Public Policy at Dublin City University

Sunday Independent

Today's news headlines, directly to your inbox every morning.

Don't Miss