Temporary Doctors, Permanent Blame: How a Hospital Misattributed Poor Outcomes
A real-world example of Ultimate attribution error in action
Context
A 300-bed regional hospital experienced intermittent staffing shortages and relied increasingly on locum (temporary) physicians to cover night and weekend shifts. The core clinical team (permanent staff) was cohesive and long-standing, while locums rotated in for blocks of one to three weeks.
Situation
Over a six-month period the hospital noticed a rise in readmissions and a drop in patient satisfaction scores tied to weekend and night shifts covered by locum doctors. Department leads and many permanent clinicians began explaining the problems by pointing to locum competence and attitudes rather than considering system-level factors such as handover quality, protocols, or resource availability.
The bias in action
Managers and senior clinicians praised the core team’s weekend successes as evidence of their superior skill and dedication, attributing any rare mistakes to heavy caseloads or bad luck. Conversely, when adverse incidents occurred on locum-covered shifts, they were described as proof that temporary staff were inattentive or insufficiently skilled. Discussions at clinical governance meetings centered on vetting and replacing locums rather than auditing handover processes, staffing ratios, or the clarity of weekend protocols. Locum doctors quickly sensed they were distrusted, which hurt morale and made open discussion of system problems less likely.
Outcome
The hospital increased use of agency locums but also initiated stricter credentialing and a higher rejection rate of applicants, believing this would solve the problem. The underlying system issues — inconsistent handover templates, limited access to on-site diagnostics at night, and unclear escalation pathways — remained unaddressed, so outcomes did not improve as expected. Tension between permanent staff and locums increased, causing communication breakdowns that further degraded patient experience.
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