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Cancel the cover culture

Cancel the cover culture

Medical error remains rife. The Australian Institute of Health and Welfare reported 26,995 potentially avoidable deaths in 2020 among people under the age of 75 in Australia. While this ‘age-standardised’ rate has been the lowest reported in 10 years, there is clearly room for improvement.

Recently, there has been an alleged spate of ‘potentially avoidable deaths’ reported in regional NSW hospitals - not all of these were reported to, or investigated by, the coroner - whose role is to determine the facts surrounding a person’s death and, if found preventable, make systemic recommendations going forward.

Without ensuring a supportive environment of openness and transparency, but promoting one that encourages blame and ‘finger-pointing’, we perpetuate a culture of ‘avoidance and fear’ where errors or oversights in care are concealed, and resourcing issues are ignored, rather than addressed.  

This ‘cover culture’ is a grave impediment to patient safety and fundamental clinical governance.

Sadly, speaking up about patient safety is often considered to be ‘a career-ending move’ - even now, in 2022.  It appears we have made little progress since the publication of ‘To Err Is Human’ twenty years ago.  We still struggle to be open and transparent when it comes to errors in healthcare, or ‘near misses’ and resource challenges which represent potential risks to patient safety. 

How can we do better? 

Theoretically, the answer is simple and comes down to fostering a better culture, which includes psychological safety – but this is easier said than done. Individuals delivering care are not only inherently fallible but have unique agendas based on their values, influenced by the environments in which they operate.  The medical hierarchy and training structure support a culture of competition more than collaboration, and deference over ‘speaking up’. Just as there exists a power imbalance in the doctor-patient relationship, there can be a power imbalance in the doctor-doctor relationship – and often a tension between other health practitioners, the organisation within which they operate, and the perceived legal landscape (which adds an additional layer of ‘fear’).  All of this, together with an intrinsic culture of blame – in contradistinction to one of learning and continuous improvement – inevitably undermines care.  

Care must always be delivered in a patient-centric manner – circumventing practitioner ‘ego’ - so we must promote a culture that supports this, authentically. Mistakes are inevitable  (for ‘to err is human’) - what we must learn to gain, from the pain, are precious opportunities for continuous improvement.

If you're looking to improve your knowledge of culture, enrol in our Building Culture & Collaboration Workshop.

All accessed on 26/8/22:  

 ‘Deaths in Australia’.  AIHW, 9 June 2022 (last updated).  Accessed at: 

‘Causes of Death, Australia’.  Australian Bureau of Statistics, 29 September 2021.  Accessed at: 

C. Fellner.  ‘Doctors demand end to ‘culture of cover up’ after string of patient deaths’. WA Today, 16 July 2022.  Accessed at: NSW hospitals in crisis as doctors demand ‘culture of cover up’ to end (

C. Fellner.  ‘ Doctors left dying dad ‘spouting blood’ after horror hospital fall’. The Sydney Morning Herald, 11 July 2022. Accessed at: Port Macquarie Base Hospital doctors left dying dad ‘spouting blood’ after fall (

A. Hucko. ‘The culture around errors in medicine needs to change’.  BMJ, 24 January 2020. Accessed at: 

L. T. Kohn et al. ‘To Err is Human: Building a Safer Health System’.  Institute of Medicine (US) Committee on Quality of Health Care in America, 2000.  DOI:  10.17226/9728. Accessed at:

S. Crane.  ‘Reporting and Using Near-miss Events to Improve Patient Safety in Diverse Primary Care Practices: A Collaborative Approach to Learning from Our Mistakes’.  JABFM, Jul 2015, 28 (4) 452-460; DOI:10.3122/jabfm.2015.04.140050. Accessed at: 

‘Optimised Workforce, Optimised Outcomes’.  AICG, 7 February 2022. Accessed at: 

M. M. Walton.  Hierarchies: the Berlin Wall of patient safety. Qual Saf Health Care, 2006 August; 15(4):229-30. DOI: 10.1136/qshc.2006.019240. Accessed at: Hierarchies: the Berlin Wall of patient safety - PMC (