What Is Just Culture? Changing the way we think about errors to improve patient safety and staff satisfaction

“Just Culture” refers to a system of shared accountability in which organizations are accountable for the systems they have designed and for responding to the behaviors of their employees in a fair and just manner. Employees are accountable for the quality of their choices and for reporting errors and system vulnerabilities. At Brigham and Women’s Faulkner Hospital, leadership is committed to fostering a Just Culture where patient safety is improved and our staff feel more secure in the decisions they make.

“We know that creating a safe and transparent environment encourages reporting of mistakes and hazards and ultimately improves the care we provide to our patients,” says BWFH Chief Medical Officer Dr. Peggy Duggan. However, our recent Safety Culture Survey results revealed that staff at BWFH do not always feel comfortable speaking up when they see something that threatens patient safety and/or they feel blamed when errors occur. “Our goal in implementing Just Culture is to create a strong culture of safety where staff are managed fairly when involved in an error, mistake or adverse event,” continues Dr. Duggan.

The process of implementing the Just Culture concept is not one that happens overnight. “We’re trying to build an infrastructure to embed this methodology,” says Director of Risk Management and Compliance Joanne Locke who is spearheading the process. “It’s going to take some time. Right now we have a Just Culture Steering Committee. Eventually we will have a Just Culture Advisory Group and Advisors.”

So far, managers and supervisors have been invited to take part in training sessions with Paul LeSage, the Just Culture Advisor with SG Collaborative Solutions, LLC, who has been hired by Partners HealthCare. LeSage describes Just Culture as an art and not a science. It’s something that evolves over time, but gets easier as we learn to look at our workplace through a different lens. “This approach is about looking for risk, not fault,” he says.

“Working in a Just Culture means more security around the decisions you make. It means recognizing that humans aren’t perfect and that when you make a mistake you are going to be embraced in the process of trying to understand why the error was made rather than be punished for your mistake,” says LeSage. “For frontline staff that boils down to more security in reporting and being open about errors.”

Implementing Just Culture means changing the way we look at our systems and our people. It is not an easy process. However, LeSage believes BWFH will be successful. “I think BWFH has a leadership-down commitment that is phenomenal to see. So I think you are poised and ready,” he says. “BWFH’s size, as a relatively small community hospital, has you uniquely positioned to get it done faster than a really huge organization would.”

For resources, staff may visit the Just Culture page on our intranet Vitals.