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Safety 101 Syllabus: Lead and Reward a Just Culture

By Topic: Safety Quality Culture of Safety Just Culture High Reliability By Collection: Blog Safety


Abstraction of individuals walking across two scales

The COVID-19 pandemic created countless challenges for healthcare providers, but some silver-linings-minded leaders believe the health crisis also accelerated innovation in quality and safety.

In a March/April 2021 Healthcare Executive column, Richard Brant, MD, CPHQ, medical director for quality and patient safety at West Virginia University Medicine Children’s Hospital, expressed his belief that the heightened activity catalyzed by the pandemic will ultimately help organizations move along the journey to zero harm.

Between the momentum many organizations have created toward improving safety culture during the pandemic, and with June being National Safety Month, now is an excellent time to revisit best practices for preventing harm.

One step to achieving zero harm is establishing and maintaining a just culture. Leading a Culture of Safety: A Blueprint for Success describes a just culture as one that “focuses on identifying and addressing systems issues that lead individuals to engage in unsafe behaviors, while maintaining individual accountability by establishing zero tolerance for reckless behavior.”

In a just culture framework, reporting errors, lapses, near misses and adverse events is encouraged, and the workforce is supported when systems break down and errors occur. A just culture is not a blame-free environment but an environment that acknowledges that punishing people for mistakes discourages reporting, fails to correct problems in the system and sets up the likelihood of recurrence.

“To be able to learn every day from events and near misses, you need an environment in which raising concerns is not only normal but expected,” Stephen E. Muething, MD, chief quality officer at Cincinnati Children’s Hospital, told Healthcare Executive. “That’s not something you accomplish by running through a couple of initiatives. It needs to be relentless.”

Here are eight tactics outlined in the blueprint for building the foundation of a just culture:

  • Educate your board, leadership and workforce about just culture through integrated training programs.
  • Develop and implement a decision-making process and application of just culture that is behavior-based, rather than harm-based.
  • Ensure an organizationwide leadership commitment to just culture frameworks and accountability that are aligned across all departments.
  • Create an interdisciplinary just culture champion team to review organizational policies, provide training and ensure policies are being followed at all levels.
  • Identify metrics to track performance on just culture implementation.
  • Align systems and standards for just culture across all organizational departments, including Human Resources.
  • Ensure employees are well-trained in just culture algorithms and tools and utilize them in daily activities and decisions.
  • Publicly reward positive examples of just culture.

Leading and rewarding a just culture is one of six domains outlined in Leading a Culture of Safety: A Blueprint for Success. Recommit to your journey to zero harm this National Safety Month by reviewing the other five domains outlined in previous blog posts:

  1. Establish a Vision for Safety
  2. Build Trust, Respect and Inclusion
  3. Select, Develop and Engage Your Board
  4. Prioritize Safety in Selection and Development of Leaders
  5. Establish Organizational Behavior Expectations

You can also download the full blueprint, take the Culture of Safety Organizational Self-Assessment and sign the We Lead For Safety Pledge