When something goes wrong in the corporate world, it’s not unusual for staff to wonder if they’ll suffer the consequences for a botched client meeting, late product launch, or drop in sales. But when something goes wrong in the healthcare setting, the stakes are often higher. Medical errors can physically hurt people—a misdiagnosed medication, a nonsterile tool, or a mishandled surgery. Given the gravity of the possibility of error, it’s no wonder that medicine has instituted new philosophies for handling mistakes internally. And the lessons of a philosophy called “just culture” are worthy of taking notice.
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A just culture allows staff members to report safety concerns, errors, and near-miss events in a nonpunitive environment. Historically, leaders look to find blame when these types of errors and near misses occurred. However, the “blame culture” leads to fear and intimidation rather than a productive effort to make improvements. Institutions that have implemented a just culture find that when punishment is not the first response, a safer and healthier workplace results.
This is not to say that one can go about willfully causing harm. Instead, the model identifies three types of typical behaviors when something goes wrong. There is human error, which is inadvertent action or a slip or lapse that occurs without ill will. Next, at-risk behavior has more consequences because it is a behavioral choice that increases the probability of a problem. And last, the most serious category is reckless behavior, which is a behavioral choice to consciously disregard a substantial and unjustifiable risk.
All of the three behavior types generate a response from leadership. Reckless behavior, the worst of the three, is managed through remedial and often punitive action, such as dismissal. At-risk behavior is responded to with coaching and efforts to improve situational awareness. Human error is handled through better training, examining processes, and changing procedures.
Since human error is by far the most common of all behaviors, a just culture makes clear to employees that they are safe to report errors and concerns. In this type of environment, individuals are not immediately punished for mistakes; instead, there’s a thorough investigation into why the error occurred. Once a problem is reported, processes and procedures are reviewed without the assumption of wrongdoing. Staff members are actually encouraged to point out situations that call for improvement. Given this open atmosphere, they are often motivated to help design safe systems.
If all of this sounds like an intelligent method for addressing errors, know that it takes time to implement, especially if there has been a blame culture in the past. Leaders must steer teams away from years of pointing fingers and establish a foundation of trust and accountability, as well as shared goals, open communication, and respect for every staff member. It’s hard work, especially in environments that thrived on playing blame games. Often, there will be many on staff who can change their mind-sets but a few who simply cannot.
Of course, it’s natural to ask if health care is different from other industries in applying just culture. The answer is that many industries, particularly those that deal with high levels of risk, are exploring similar philosophies. In fact, pilot hero Captain Chesley “Sully” Sullenberger has endorsed just culture for aviation. He’s stated that his industry can gain from the emphasis on process control and continuous improvement through reporting and learning.
So, if even Sully’s on board, maybe a just culture is right for your organization? If you’re willing to take on the challenging task of implementing this philosophy toward handling errors, we’ll explore some tips tomorrow.