The flow of blame in an organization may be a primary indicator of that organization's robustness and integrity. Blame flowing downwards, from management to staff, or laterally between professionals or partner organizations, indicates organizational failure. In a blame culture, problem-solving is replaced by blame-avoidance. Confused roles and responsibilities also contribute to a blame culture. Blame culture reduces the capacity of an organization to take adequate measures to prevent minor problems from escalating into uncontrollable situations. Several issues identified in organizations with a blame culture contradicts high reliability organizations best practices. Blame culture is considered a serious issue in healthcare organizations by the World Health Organization, which recommends to promote a "no-blame culture", or just culture, a means to increase patients safety.