One of the findings of the recent review of the Lucy Letby case is the focus of the Countess of Chester hospital on reputation over patient safety. 

Various commentators have noted that they were not alone; reputation seems to trump all, to the extent that those who threaten it, such as whistleblowers, are forced to sign NDAs or may be quickly dispatched. 

But this approach misunderstands the nature of reputation. 

Reputation broadly means what you are known for – and any organisation will be known for different things depending upon the people in focus. 

Staff will have one take on an organisation, patients may have quite another. Those who have a positive experience – say a lifesaving procedure – will see a hospital differently from those who have been harmed. 

Underpinning the current approach to reputation management seems to be an assumption that a veneer of unimpeachable excellence can be maintained. That's an odd approach given how dangerous public health is. In any sphere of human activity there will be a blend of excellence, competence, incompetence, underinvestment and plain errors. Sadly, from time to time, there will be far worse. That's the way of the world. 

So to focus on maintaining a ‘good reputation', one suffused with the idea of infallibility, is to simply ask for trouble. It's that approach that leads to vilifying those who challenge. It means sweeping uncomfortable truths under the carpet. It means always insisting that ‘lessons will be learned' – they never are. And it means finding ‘bad apples' who can take the blame when things go wrong as they inevitably will. 

Why not accept the reality of organisational life? Things will go wrong. Accept that there are many reasons. Sometimes they are simple errors. Sometimes it's more complex. But in the midst of it all, acquire a reputation for always being open about it, always inviting challenge, always being willing to hear contrary voices and importantly always really learning. 

It might mean a few very uncomfortable conversations with people who really ought not to be in the jobs they occupy. But if people are out of their depth, they really should be doing something else. 

If you could assure your staff and your patients that you will do these things unflinchingly, you'll quickly acquire a reputation worth protecting.