Just Culture in Healthcare
As a manager you can control two things: “the system that is designed around their employees and the behavioral choices they make in that system.
“Just Culture” is not just another catch phrase or an excuse for the way things are. It’s a concept that’s been around for some time. Originally used in other industries such as aviation, the concept centers on blame and accountability in the work place. David Marx JD discusses the concept on Web M&M as it relates to healthcare.
The notion of just culture looks at three types of human fallibility as it relates to individual choices and job performance. Marx contends that as a manager you can control two things: “the system that is designed around their employees and the behavioral choices they make in that system”.
Three categories of human failure are discussed: Inadvertent human error - we catch ourselves doing something without realizing we are doing it. Marx provides an example of us speeding while driving our car. We’re driving along and we notice we are gong a bit faster than we want to. We make the required correction and all is well.
Risk behavior – we are busy, time is short, and in an effort to become more efficient we cut corners, skip a few steps in the process or perhaps omit the process to complete the task and save time. Not conforming to two patient identifiers when labeling blood samples, omitting some or all of the five rights to medication administration, not washing your hands before a patient contact, or not performing a time out before surgery are a few examples. This type of human failure is more conscious in nature. It increases the risk of harm or a bad outcome, an at-risk-behavior.
Reckless behavior – is when there is a conscious choice that puts someone else in harm’s way. Marx uses the drunk driver as an example where one may not want to purposely do harm to someone else, but the choice they make by driving in this case puts others at risk. Thank goodness reckless behavior is rare in healthcare, but it does occur.
Human fallibility as Marx points out is the biggest contributor to harm and potential harm in healthcare organizations. It is the risk behavior category that tends to fall out more than others, the predisposition to end up with the ball in the gutter if you will. Training programs, coaching and mentoring are all done in an attempt to develop good choice making and establishing acceptable behaviors. When and individual regularly makes choices that are at risk in nature, the system accountability must be designed so that this type of person is not allowed to stay in the system and put patients in unsafe places.
Other key aspects of the just culture concept include reporting and follow up. Healthcare organizations must develop reporting channels for undesirable behaviors and the institution must follow through with nonbiased approaches to mitigating these behaviors. There must not be a double standard. Marx refers here to the doctor versus nurse issue.
You’ll meet a surgeon who will argue that he or she has never had an event. But a person’s choices dictate the likelihood of the future event. And it’s these choices that we’re going to hold people accountable for. Nobody is suggesting that the surgeon is accountable for the harm to the patient. That’s an organizational accountability. But the surgeon is accountable for the quality of choices he or she makes, irrespective of any future event.
The interview is very thought provoking and if you have a minute I recommend the read. Marx gives us some good tidbits to ponder when it comes to accountability, blame, medical errors, punitive actions, and patient safety.
About the Author
Mike Pringle is the creator of Mike’s ViewPoint, where he provides his perspective on various Healthcare issues. He currently works at Falmouth Hospital and has over 20 years of Nursing experience. Mike has a Bachelor’s Degree in Nursing, a Masters Degree in Public Administration with a healthcare emphasis and specializes in both Emergency and Critical Care Nursing. Mike’s experience includes being the Executive Officer (2nd in Command) Combat Military Medical Facility as well as being a Nursing Supervisor at his current position.
nurse recruiter responds:
Posted: March 30th, 2008 at 3:07 pm →
nurse recruiter…
Well spoken. I have to research more on this as it is really vital info….