From the staff development bookshelf: Anticipated goals of implementing a just culture

Staff Development Weekly: Insight on Evidence-Based Practice in Education, March 16, 2012

No matter how much planning and communicating is done to prepare for a change in culture, folks will still be leery and mistrustful until they actually see the new, more positive attitude in action. To that end, setting goals that have been developed collaboratively by leadership and staff is essential to the successful transition toward implementation of a just culture.

Obviously, the primary goal for any organization, regardless of culture, is to provide safe, high-quality care-this goal should be at the top of the list. However, there should be additional goals that address specifically what the organization wants to achieve by implementing a new, fairer way to look at medical events. The following are some examples for such goals:

  • Every person affiliated with the organization in some way is cognizant and aware of the fact that healthcare is a risky business. Every person understands that there are inherent risks to the provision of care and that, on occasion, there will be mistakes made.
  • Every staff member understands that although occasional mistakes will be made, staff should continuously work to identify and control or manage hazards or potential hazards. In fact, in a just culture, folks are actually always looking for ways in which an error could occur so that proactive efforts can be made to prevent errors from happening.
  • It is clearly understood that willful or intentional violations of policy or protocol will absolutely not be tolerated.
  • Employees and leadership clearly understand and agree on what is acceptable and unacceptable behavior.
  • Employees are encouraged to proactively report anything thought to pose a potential safety hazard.
  • When hazards or adverse medical events are reported, they are analyzed using an objective method of evaluating why the event occurred. Identified patterns and trends are reviewed and shared with staff and actions are taken to address them.
  • Hazards and medical errors, and actions to control them, are tracked and reported regularly at all levels of the organization.
  • Employees, volunteers, contracted individuals, and medical staff are all encouraged to develop and apply their own skills and knowledge to enhance organizational safety. In this case, it's okay to use those critical thinking skills and consider thinking outside the box to achieve the organization's goals.
  • Staff and management feel free to communicate openly and frequently concerning safety hazards, medical errors, potentially compensable events, etc.
  • Lessons learned should be discussed openly and regularly following an event occurrence so that leadership and staff can share with others what not to do in the future and also to prevent recurrence of a similar event.
  • Feedback regarding reporting and adverse events is provided. Staff are interested in hearing whenever an adverse event is reported and appreciate knowing what the outcome of any adverse event, including what actions were taken to address why the event occurred, if there was anything they could have done differently to avert the event's occurrence, etc.

Book excerpt adapted from Creating a Just Culture: A Nurse Leader's Guide by Vivian B. Miller, BA, CPHQ, LHRM, CPHRM, FASHRM.

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