Objective: In this first paper the role and dynamics of blame in the context of medical critical incidents is examined. Blame pathologies are described and the complex nature of medical adverse events and the environment are explored.
Methods: The literature is examined and a case scenario explored.
Results: Evidence regarding effects of a 'blame culture' on clinicians and organizations is presented. In an accompanying second paper the place of accountability in relation to clinicians and health organizations is elucidated.
Conclusions: The necessary conditions for an accountable, responsive, fair and transparent health culture are proposed.