Mid Staffs: bad apples, bad barrels or bad barrel makers?

What led to the poor quality of care at Staffordshire Hospitals – bad apples, bad barrels or bad barrel makers?

Speaking at the publication of his final report, Robert Francis QC said:

“I heard so many stories of shocking care. These patients were not simply numbers they were husbands, wives, sons, daughters, fathers, mothers, grandparents. They were people who entered Stafford Hospital and rightly expected to be well cared for and treated. Instead, many suffered horrific experiences that will haunt them and their loved ones for the rest of their lives.”

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Photo courtesy of ©iStockphoto.com/skodonnell

Philip Zimbardo’s TED talk  and book – The Lucifer Effect: How Good People Turn Evil – may provide some answers.

Zimbardo, famous for the Stanford Prison Experiment in the early 1970’s, which put normal people (good apples) in a bad barrel – the experiment was terminated after six days because of the disturbing behavior of the guards and depression and breakdowns suffered by the prisoners.  The study has parallels with the abuse of prisoners at Abu Ghraib. Zimbardo argues that situational and systemic factors – “bad barrels” – that can cause even good, decent people to carry out, support or tolerate evil acts.

Zimbardo argues that when something goes wrong we ask the wrong question:

WHO is responsible

Instead we should ask:

WHAT is responsible

There are three factors at play:

  • Dispositional – inside of individuals – the bad apples
  • Situational – external – the bad barrel
  • Systemic – broad influences: political, economic. legal power – the bad barrel-makers

In his book Zimbardo notes:

“I will argue that the most dramatic instances of directed behavior change and “mind control” are not the consequence of exotic forms of influence, such as hypnosis, psychotropic drugs, or “brainwashing,” but rather the systematic manipulation of the most mundane aspects of human nature over time in confining settings.” (p. 259)

So what creates evil doing:

  • Mindlessly taking the first small step
  • Dehumanization of others
  • De-individuation of self (anonymity)
  • Diffusion of personal responsibility
  • Blind obedience to authority
  • Uncritical conformity to group norms
  • Passive tolerance of evil through inaction, or indifference (16:43 mins)

Takeaways

More often than not, it is not a few bad appeals but systemic or cultural forces that create the conditions for evil doing.  On the video he states:

“…most of the time we are in institutions.  The Stanford Prison Experiment is about the power of institutions to influence behaviour” (13.11 mins)

So what needs to be done to prevent evil doing?

Firstly, change needs to occur at the level of the individual, the institution and the wider political, economic and legal system:

 “…so so want to change a person, you have to change the situation, want to change the situation you need to know where the power is in the system” (8:41 mins)

Secondly, we need to radically change the way that we think about events like this:

“…so you need a paradigm shift…  in all of these areas… the shift is away from the medical model that focuses only on the individual… and the shift is towards a public health model that recognises situational and systemic vectors of disease… bullying is a disease, violence is a disease” (18:52 mins)

Thirdly, we need heroes who are willing to speak up:

“What we need is “heroic imagination”…  people who are heroes in waiting…  to be a hero you have to be a deviant – you have to go against the powers of group cohesion” (19:52 mins).

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