Q: What exactly does the term just culture mean?
A: Just culture revolves around a foundation of trust and accountability that relies on open communication, integrity, and common goals, which allow staff members to report safety concerns, errors, and near-miss events in a nonpunitive environment. Historically, healthcare errors and near-misses were dealt with in a punitive fashion. Individuals were held accountable for all error occurrences and variations in practice; in other words, a "blame culture." Looking at other industries, healthcare organizations learned that this isn't the best approach when seeking to ensure safety and improve quality. The reason? Fear of losing one's job, fear of retaliation, and fear of career derailment. That's why the basic components of trust and integrity are so vital to the success of just culture in any organization.
It must be instilled within your organization's cultural makeup that all employees feel safe reporting errors and safety concerns. Individuals won't immediately be punished for errors; rather, there's a thorough investigation into the causative factors that led to the error. Not only should it be acceptable to report, it should also be expected. Processes, staffing, and barriers need to be reviewed without malice or prejudice. Employees are assured that the issue is dealt with fairly based on fact finding and not assumptions.
The development of a just culture must start at the top. Employees at every level need to feel safe, and that sense of safety comes from the executive leadership team insisting on and role modeling just culture behaviors. Competencies for managerial staff are essential in the development of a pervasive culture of trust and appropriate accountability. It must be understood that there's a constant focus on strategically seeking best practices and implementing them to result in increased workplace satisfaction, organizational efficiency, and patient safety, as well as optimal clinical outcomes. Along with this must come the realization that best practice doesn't equal cookie cutter practice.
Another core component of creating a successful culture transformation is the engagement of frontline staff. Although the organization's tone is set at the top, it's maintained at the point of care. If employees aren't engaged and don't buy in to the concepts and practice, just culture is doomed to fail. Teaching best practices at every level is essential. Why are we doing what we do? How does it fit into practice? How can we logically and safely accomplish our best practice goals? What's a fair, reasonable process that maintains achievable and measurable safety standards?
Policies and protocols should always be written with the doers at the table. Investigations into errors and process concerns must be evaluated with frontline staff involvement. Transparency and integrity are vital to a just culture and feed its success at every level. Take some time to look at your organization's policies and practices. What role does each layer from the top down play in policy and procedure development? How are errors dealt with? What's the format for process improvement teams and remediation? What ideas do you have that could resolve barriers within your organization's culture? Nurses are the best source to obtain efficient and creative solutions to improve workplace culture, so share your insight!