In medicine this workplace atmosphere, complicated by perverse economic incentives and weak systems of accountability, contributes to a hospitalculture marked by a lack of a sense of communal ownership in the overall delivery of care.
It is more than three years since the scandal triggered by unusually high death rates at Stafford hospital provoked deep unease over the culture of care in the health service.
He says that a culture of openness and transparency is essential to avoid repeating the mistakes at Stafford Hospital - where abuse and neglect led to hundreds of deaths.
The idea of trying to create a zero-harm culture has come out of a global recognition that some patients needlessly suffer or die in hospital because of errors.