The benefit of this approach is that the process is up-front and transparent to the staff, which helps achieve trust and accountability.
A Just Culture, “Just Culture Not Blame, Also not Carefree”:
- Recognizes that individual practitioners should not be held accountable for system failings over which they have no control (8o% of medical error are system-driven).
- Recognizes many errors represent predictable interactions between human operators and the systems in which they work; and recognizes that competent professionals make mistakes.
- Acknowledges that even competent professionals will develop unhealthy norms (shortcuts, “routine rule violations”).
- Has zero tolerance for reckless behavior.
Establishment of a just culture is the first vital step in engineering a safer culture. While employees will be disinclined to report errors and near misses in a wholly punitive culture, a totally blame-free culture is equally undesirable given that some unsafe acts warrant retribution. Importantly, leadership strikes a balance between the systems approach that emphasizes organizational learning, and the need to retain personal accountability and discipline. In the end, hospital leaders must hold individuals accountable for the safety environment while also providing them with the security of knowing they will not be blamed for system failures beyond their control. In short, formation of a just culture requires the establishment of a zero tolerance policy for reckless conduct, counterbalanced by a widespread confidence that unintended unsafe acts will generally go unpunished (Please see Code of Ethics for Healthcare Practitioners, Ed. 2014).
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