Just Culture
April 4, 2017About Healthcare Practice in Saudi Arabia
April 4, 2017
LEVELS of the Culture of Safety Program
Hospital Leaders acknowledge that the healthcare environment is a high-risk environment and seek to align vision/ mission, staff competency, and fiscal and human resources from the boardroom to the frontline.
The role of senior leadership is a key element to designing, fostering, and nurturing a culture of safety. Engaged senior leaders are critical to an organization’s successful development of a culture of safety. Engaged leaders drive the culture by designing strategy and building structure that guide safety processes and outcomes identified administrative leadership as one of the most significant facilitators for establishing and promoting a culture of safety.
Creating a culture of safety must begin with the Chief Executive Officer (CEO), but it must permeate throughout every level of the healthcare system. Leadership’s commitment and education on safety culture is key to an organization’s move toward a safety culture. Leaders require basic insight into safety problems and need rationales for focusing on patient safety. They need to be educated on the science of safety and the power of data.
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 just culture
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).
- System (reporting)
Cultivation of a reporting culture is the next critical step in creating a safer organizational culture. Once a just culture is in place, the workforce should feel safer reporting errors and near misses. However, important psychological and organizational barriers to reporting are likely to remain. For example, people are naturally reluctant to confess mistakes and risk blame or the possibility that reports will be kept on permanent record and held against them in the future.
Also, workers may be skeptical that reporting errors, particularly those that reveal system weaknesses, will actually spur managerial actions that lead to meaningful change. As a result, staff may come to believe that event reporting requires more time, effort, and risk than it is worth.
Hospital leaders continuously support potential strategies to overcome these barriers and encourage a reporting culture that include maintaining the confidentially of those who report adverse events; granting partial indemnity against disciplinary procedure; separating the report collection and analysis functions; and delivering timely feedback to the entire organization.
- Teamwork
Is one of the critical elements in safety culture. Teamwork is treating patients with increasingly complex disease processes and with increasingly complex treatments and technologies requiring stronger efforts toward applications of teamwork and collaboration among caregivers to achieve a system-wide culture of patient safety.
Teamwork means a spirit of collegiality, collaboration, and cooperation exists among leaders, staff, and independent practitioners. Relationships are open, safe, respectful, and flexible.
- Training
Even with an effective incident and near miss reporting system in place, Hospitals also works to develop a learning culture to truly reap the benefits of institutional memory that stem from the capacity to uncover and track safety risks. In order to accomplish this learning culture, leaders encourage the manifestation of a systems approach to understanding human error, and can lead to systemic reforms rather than local repairs. As a general concept of the implementation of a safe culture, Hospitals believes that safety variances that occur within healthcare practices provide learning opportunities, challenging and transforming the basic assumptions that brought about the unsafe act.
- Patient Involvement
Patient care is centered on the patient and family. The patient is not only an active participant in his own care; but also acts as a liaison between the hospital and the community. Hospitals embrace the patient and family as the sole reason for the hospital’s existence. It promises to value the patient by providing a healing environment during the hospitalization and also to promote health and well-being as a continuum of care.
It is the responsibility of the hospital leadership to commit to patient-centeredness as a core value. Leaders should challenge the medical staff and all employees to make every effort toward focusing on the patient and offering the patient an exemplary experience marked by caring and compassion. Hospitals allow and empower patients to be participatory in their care decisions.
Efforts to engage patients in safety efforts have focused on three areas: enlisting patients in detecting adverse events, empowering patients to ensure safe care, and emphasizing patient involvement as a means of improving the culture of safety.
Hospitalized patients are routinely surveyed about their satisfaction with the care they received, empowering them to speak up having found that patients often report errors that were not detected through traditional mechanisms such as chart review.
Patient stories can be used to put a “face” on system failures leading to potentially serious adverse events. Stories enhance the richness of description and create an atmosphere where discussion can lead to safety action.
