Just Culture
WeCare Morning Report #4
Overview
Just culture describes an organizational environment where human error and personal accountability are balanced in a way that does not punish people for weaknesses in a system or for human fallibility. While just culture is considered an organizational quality, it implies that individuals that work within such organizations feel psychologically safe to have open dialogue about existing practices, concerns, and mistakes[1].
A blame culture is diametrically opposed to just culture. In organizations where a culture of blame exists, people are unwilling to report errors because they fear criticism and repercussion(s). A culture of blame forces health workers to protect themselves rather than the patient. It hinders continuous improvement because it focuses on assigning accountability to individuals even for system-level failures.
In a just culture, there is joint accountability between the individual and the larger organization. The organization is accountable for the systems it implements and supporting their staff in making safe choices within those systems. The individual is accountable for the safety of their decisions.[2]
Use of Just Culture to Promote Patient Safety
One way to delineate between individual and system-level errors is to perform the ‘substitution test’[3]. We substitute the person involved in a patient safety breach with another individual from the same work area and with similar training. Then ask the question: ‘Would this new individual have made the same error?’. If the answer is ‘yes’, then systemic deficiencies are at the root of the error rather than lapses in an individual’s behavior.
Individual behavior can fall into three categories: human error, at-risk behavior, and reckless behavior. Actions taken by organization supervisors depend on the category of behavior. [4]
Conclusion
In just culture, we recognize that the majority of errors are from faulty system design or normal human behavior and target error investigation toward prevention rather than punishment. Organizations can use many available resources to promote the values of just culture among the individuals who experience it.
For more information:
- www.justculture.org (Free book download and resources at https://www.justculture.org/just-culture-resources/)
- Performance Management Decision Guide 2009. Healthcare Performance Improvement, LLC
- Khatri, Naresh, Gordon D. Brown, and Lanis L. Hicks. "From a blame culture to a just culture in health care." Health care management review 34.4 (2009): 312-322.
- Reason, James. "Achieving a safe culture: theory and practice." Work & Stress 12.3 (1998): 293-306.
- Scott‐Cawiezell, Jill, et al. "Moving from a culture of blame to a culture of safety in the nursing home setting." Nursing forum. Vol. 41. No. 3. Blackwell Publishing Inc, 2006.
References:
[1] Khatri, Naresh, Gordon D. Brown, and Lanis L. Hicks. "From a blame culture to a just culture in health care." Health care management review 34.4 (2009): 312-322.
[2] Outcome Engenuity, LLC. “Just Culture: Health Services Overview.” Justculture.org (2012). Accessed Feb 20, 2015. URL: https://store.justculture.org/wp-content/uploads/flipbooks/healthcare/healthcare.html.
[3] Johnston, N. "Do blame and punishment have a role in organizational risk management." Flight Deck 15 (1995): 33-36 cited in Reason, James. "Achieving a safe culture: theory and practice." Work & Stress 12.3 (1998): 293-306.
[4] https://www.justculture.org/getting-to-know-just-culture/