Example of balanced and reflective news coverage

So, in Sweden we currently have another case of a person being brought to court for criminal negligence in his work. It is a nurse at the Swedish alarm call-centre who is accused for not having sent an ambulance  to a young man who said he could not breathe. The nurse answering the call saw all the signs of a panic attack and not the signs of a the really unusual spontaneously (without outer violence) broken spleen. The man eventually died.

Now, I am not an expert in this case, but I have followed the news reports. Most of them report how a nurse neglected all "the obvious signs" and the prosecutor also brought the nurse to court for manslaughter. The district court freed the nurse of the charges based on the reasoning that even though he should have sent an ambulance he did not cause the death of the young man, because the ambulance would not have made it in time and the outcome would not have been any different. The young man's mom has been active in discussing the case in media, and she has been upset, advocating for the need of assigning blame in the wake of harm.

The prosecutor has now appealed against the first verdict claiming that there is no excuse for not sending an ambulance when there are obvious signs of the need for it.

What the prosecutor misses here is the same as I usually react to. IF the signs were obvious the nurse would not have acted in this way. With hindsight it becomes so easy. To put yourself in the shoes of the people closest to the situation at the time is much harder. We need to have the focus that what people do make sense to them at the time, given their knowledge, history, experiences, working conditions, and always present goal-conflicts (conflicts that becomes so erased in the coverage of serious events). The nurse's assessment made sense at the time. He did not go to work to do a bad job. That is my starting point. That is also the starting point with prerequisites for fruitful organizational learning. Blaming "the bad apple" - the exception, the reckless component who broke the reliability of the whole, serves some aims (like redress of the grieving mom or a sense of control), but it effectively counteracts other aims (like organizational learning and long-term quality improvements). It guarantees a quiet and suspicious system. If you would like this reasoning outlined in Swedish please see my other posts on this theme.

As usual there have been few attempts to understand the reality of being an emergency call-centre nurse. Very few. And the result is that there are many questions left unanswered. Why did it make sense to the nurse not to send an ambulance? How many ambulances are available? How often are they sent to cases were they were not needed? How many calls are received from people with panic attacks? How flexible are the rules and procedures that the call nurses need to stick to? How has the call centers changed over the last couple of years?

But there are exceptions in the coverage. Hanne Kjöller, leader-writer at the Swedish news paper DN wrote this reflective article.  The topic is Correct according to the procedure can also turn out wrong and she sets the stage really nicely: "Law is governed by paragraphs, while care often is a question of adjustment and judgment. In court the lack of understanding for the two systems becomes obvious". She goes on with trying to understand normal work at an emergency call-centre, the goal conflicts inherent in the work, the index (procedure) governing how work is performed and how media has covered the case. I encourage everyone understanding Swedish to read the article. Also Hanne's wrap-up is really nice and reflective:

"Everyone claiming that the nurse should be convicted for manslaughter by negligence should explain how we in the future should be able to recruit people to the important task at the emergency call-centre, if it is so that they after four years of education, 30 years of experience, working in turns, low salary and great responsibility, run the risk of ending up in prison for an erroneous judgement".

Thank you Hanne for brining in some reflections and nuances to the debate.


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