When trying to have a safe health care system, culture matters. A lot. The idea of a culture can be boiled down to “it’s the way we do things around here. We can train people all we want, but much of the way a new employee will behave, regardless of training, depends upon the culture.
In trying to improve safety, many places are working toward something called a Just Culture. Such a culture allows an atmosphere of trust in which people are encouraged (even rewarded) for providing essential safety-related information, even if that information is hard to hear. People are willing to speak up, even in the face of authority gradiants. Individuals are willing to speak up when they may have made a mistake. The reason such trust exists in a place with a Just Culture is because individuals believe that they will not be held accountable for system failures that are often as much the cause of a mistake as the individual themself.
This may make it sound as though place with a Just Culture never hold people accountable for their behaviors but that is not the case. A Just Culture has a clear dilintation about where the line must be drawn between acceptable and unacceptable behavior. Individuals that flaunt rules or who go beyond the scope of their competencies are held accountable and are disciplined. People who cannot learn the needs of the job may have to be removed or moved to an areas where they may be more successful. People who cannot safely do their work are dealt with, but it is done in a manner that is transparent and fair.