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You can't fix a systemwide problem by simply blaming or retraining individuals. When systems are broken, workers respond in counterproductive ways. They try "workarounds," as when a nurse guesses at a doctor's unreadable handwriting on a prescription because she is afraid to ask. Or they withhold information to avoid responsibility, wanting someone else to make a decision even if it is wrong. Blaming individuals can also make it harder to recruit and keep the most qualified employees. (In child welfare, talented caseworkers too often give up on investigating troubled families and gravitate to handling adoptions.)

-- Olivia A. Golden


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