What is a just culture?
Culture is a set of shared attitudes, values, goals, and practices that characterize an organization. A just culture is a small part of a larger healthcare organizational culture – ‘the way we do things around here’ – that strives to make care as safe as it can be.
In a just culture* . . .
Healthcare workers are treated with respect and feel supported when something goes wrong or nearly goes wrong with patient care.
The actions of people involved when something goes wrong are assessed fairly. The process focuses on understanding why people acted the way they did by considering the context and contributing system factors while minimizing the influence of bias.
Healthcare workers are only held accountable for their actions. Accountability is always assessed in the context of the situation including contributing system factors.
Healthcare organizations and health profession regulators agree on and communicate proactively about what accountability for one’s actions means in the setting of a patient safety incident, how accountability will be assessed, and how a response appropriate for the situation is chosen.
Healthcare workers and patients feel comfortable to raise concerns and report errors and threats to patients’ safety because they know the actions of individuals involved will be assessed fairly.
Shared values, beliefs and attitudes about safety guard against naming, shaming, and blaming people if something goes wrong with care delivery.
Just culture beliefs and attitudes
Fairness and transparency are essential to build trust.
Healthcare delivery is complex and people are not perfect. The system within which people work influences their actions – it can be designed to support people to do the right thing, but may also contribute to unsafe conditions and situations in which patients are harmed. In a just culture there is a focus on identifying system factors that contribute to errors so that changes can be made to improve safety.
Healthcare workers who trust the process to assess their actions when something goes wrong are more likely to report system factors that create unsafe situations and threats to patients’ safety.
When a patient is harmed by care delivery, the actions of those involved are assessed without consideration of the patient outcome.
Just culture behaviours
Support and treat healthcare workers with respect, dignity and compassion when they are involved in situations where a patient was harmed or nearly harmed.
Avoid blame and quick judgments about the actions of an individual.
Proactively inform healthcare workers about what it means to be held appropriately accountable for one’s actions. Actions stemming from reckless behaviour may be subject to discipline; intent to harm will result in legal action.
Hold people appropriately accountable for their actions by assessing their accountability in the context of the situation including contributing system factors.
Follow a systematic approach to understanding why people took the actions they did in the context of the situation.
Be aware and take steps to minimize hindsight bias (‘if I knew then what I know now’) or outcome bias (the greater the harm, the greater the consequence) when assessing a person’s actions.
Actively look for system factors that contributed to the situation where a patient was harmed or nearly harmed, and make changes to reduce the risk of the same problem happening again.
*The following aspects of organizational culture are part of a patient-provider partnership culture. They are important to patient care but are beyond the scope of this website:
- Ensuring that patients are treated with respect, dignity, trust and openness when something goes wrong with their care.
- Cultural safety for patients where care is delivered in a way that recognizes and respects the cultural norms and identity of the individual.