Creating a Just Culture: Protecting Our Healthcare Workers
By Josh Williams, Ph. D.
A recent incident at the Cleveland Medical Center got national attention when a patient was given the wrong kidney during an operation. Two hospital staff were removed from their jobs pending an investigation.1 Some may applaud this action as frustration mounts with ongoing reports of human error in the medical community.
So, the question is: Is firing people really the answer?
In a previous blog, empirical evidence demonstrated the benefits of human performance (HP) tools to minimize human error and reduce:
- Communication breakdowns
- Operating delays
- Post-operative complications
- Overall mortality and morbidity rates
The same benefits from HP that help patients also apply to health care workers. Long hours, insufficient sleep, and dwindling personnel have created a cocktail of unprecedented pressure and stress for hospital staff in the COVID era. Creating a “just culture” in healthcare environments provides a lifeline for these employees to operate in a fair and supportive environment.
Progressive leaders work to create a “just culture” where human error is viewed as an opportunity to learn and improve instead of occasions to punish. Within this framework, safety is not viewed as the absence of events, but rather the presence of solid, reliable defences against inevitable human error. While this doesn’t (and shouldn’t) eliminate personal accountability, there is a much greater emphasis on establishing a true learning culture. In these environments, people speak up with each other more to share best practices, discuss lessons learned, and provide helpful feedback.
This creates a more proactive culture to actively mitigate errors. It also changes the narrative from “blame and train” to “fix the system” when mistakes happen. In this environment, punishment is rare and is reserved for willful negligence or repeated intentional violations.
When a just culture is actualized:
- The work environment is more positive and supportive
- Best practices are better shared across the organization
- Close call and minor injury reporting increases
- Incidents are less likely with patients and workers
- Turnover decreases
Why it Matters
Cultivating a “just culture” benefits health care organizations and workers. Bringing issues to light in a supportive environment, instead of sweeping them under the rug, boosts ongoing learning and improvement. This improves safety culture and helps minimize human error.
At Propulo, we help healthcare leaders create a just culture to support employees and reduce human error and incidents.