One big difference could be this. Candour is much easier when no-one has been harmed or died, and your future is not on the line, and ‘just culture’ is defined in EU law (e.g., EU Reg 376/2014). E.g., in ATC candour is about mostly losses of separation between aircraft.
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I wonder what was in mind to provide a safe environment for people to talk? Transport sectors have no parallel as passengers/families rarely meet professionals. Some lessons from Überlingen (aviation) and Santiago de Compostella (rail, ongoing).
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Wish I could tell you. I just know the medical world has thrown its full might behind resisting a statutory individual duty of candour for decades. Essentially defending a doctor's lawful right to lie to patients. Perhaps my first envious glance towards aviation now makes sense?
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I can certainly understand it. But pilots and air traffic controllers nearly never talk to pax and families (of course, fatalities very rare but when they occur, they occur in large numbers).
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With Überlingen (https://en.m.wikipedia.org/wiki/Überlingen_mid-air_collision … - see 'Aftermath') there was long delay in candour and apology. With Santiago de Compostela, families do not accept responsibility placed on driver in official report (http://www.tandfonline.com/doi/full/10.1080/21665044.2015.1129889 …)
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So I wonder if some clinicians' concerns are about the details of how to have these kinds of conversations (where, when, who facilitates, how, under what conditions, etc). Not excusing or advocating any point of view (have family history of harm) but curious about implementing.
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You raise a great point, because these are indeed difficult conversations in and of themselves. Not all are well equipped to undertake them, so training there would be good. But they don't get it, because their (1 & only choice of) employer don't want them to tell the truth.
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Those are all the tricky implementation issues (assuming feasible solution) that are neglected in the hurry to 'do something'. Need full in involvement to design the 'how'.
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You're absolutely right. We're discussing aspects of how it all needs to be designed and implemented with care, but the will to do any of it is lacking in the current environment. Vested interests with the power to enforce it, demand a different response.
End of conversation
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