Competition can help drive improvement up to a point, after which it may perpetuate unnecessary harm.

We’re nurtured in competitive environments from an early age. Throughout school we’re constantly being graded and ranked.

We are conditioned to compete.

When a peer makes a mistake they may be perceived as lesser than us. Further, because we learn about the specific mistake we’re unlikely to make it in the future, standing us above others who do.

If left intact the conditions which allow the mistake may give us a competitive edge.

Instead of improving the system to prevent others making the mistake we may deride colleagues who make it.

‘So someone drew an unknown clear liquid out of a random bowl somewhere and injected into a patient and it’s a chlorhexidine problem? Sounds like poor nursing judgement to me.’

‘Just don’t be bloody lazy. It’s not a difficult job. If you can’t tell the difference between chlorhexidine and anything else you don’t deserve the label of ODP.’

‘If you’re going to take an amp of chlorhex and draw it up into a syringe marked anything else, then you should be bloody struck off. That’s not a mistake you can make.’

‘It’s not the drug, but human error that caused the problem.’

‘We were always expected to read the label in my day.’

‘None of my patients have suffered from any error by me. I don’t make errors.’

Each of these statements, from different healthcare staff, refer to the accidental administration of indistinct chlorhexidine. They focus on the individual who has made the mistake.

Competition in this instance is unhealthy.

A more constructive approach requires collaboration focusing on patients to ensure they receive the best possible care. Remove the unnecessary hazard and patients won’t be harmed by it.

We’re all human – we all make mistakes.

Indistinct chlorhexidine persists in hospitals throughout the world, hundreds have been killed and injured because of it and patients continue to suffer (see here).


  1. Cathy Welch

    Western society celebrates the hero, denegrates falability, so we brush our own mistakes under the carpet lest anyone should judge (including ourselves). Our own happiness and success takes priority because we are raised in an ‘Everyone for themselves’ culture of personal responsibility. But human success is not the result of individual heros, it is the product of collaboration, underpinned by acceptance that no one person can do it all, or always get it right, no one is perfect- ‘two heads are better than one’.
    But in our search for affirmation we mistake perfection for success, and as such we want to hide anything that might be perceived as weakness, whilst commenting on others’ failings, further diverting attention away from our own. So we bury our ‘mistakes’, try to forget about them. And so no one else can learn from them either


      Thank you Cathy. Extremely well written. If patient safety is to improve we need a collaborative approach.

  2. Gordon french

    Competition is possibly the greatest inhibitor to engaging our brains in achieving patient safety. It destroys cooperation, it inhibits the creativity of the quiet and it is, unfortunately, endemic in medicsl professionals…a group of high intelligence who waste the opportunity to make a difference because of it!

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