Just Cultures

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Mentor: How much do you know about what roles organizational culture plays in an establishment like ours?

Employee: From observation, I think it determines the delivery of healthcare services.

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Mentor: Well, that is vague. Considering the increasing expectations in healthcare, we have developed and built upon cultures that portray professionalism besides improving the commitment of the management and other professionals in the facility. One such culture is the just culture, it is important to note that assigning blame to others for our own mistakes is in our nature as human beings. It is a strategy of self-preservation. The behavior of assigning blame to others results in the growth of a blame culture, which is the absolute opposite of the just culture. The just culture is grounded on the understanding that we make mistakes and, as a result, a room for error and subsequent learning ought to be allowed (McCall & Pruchnicki, 2017). For example, we expect nurses to make mistakes while using the new technologies we provide them with because they lack exposure. However, it does not mean that they should make the same mistakes forever. We expect them to learn and master the use of such technologies; to enable this, we provide all necessary support, especially through training.


Employee: That is very informative. Does just culture relate to the concept of accountability?

Mentor: Of course, in fact, one of the primary strengths of the just culture is that it promotes accountability within our organization. Unlike the blame culture, we have noted that a just culture results in higher levels of commitment and willingness to take risks among employees. Implementing a just culture in our context (healthcare) has resulted to open and honest reporting of incidents and a higher sense of responsibility and accountability, which have a positive effect on the outcomes of intervention (Khatri, Brown, & Hicks, 2009). I define accountability as the willingness of an individual to affirm his/her responsibility over the performance of a particular duty. Irrespective of the outcome, you as an employee should have the will to own-up your performance in your duty. We acknowledge both success and failure and then tailor strategies to uphold good performance by eliminating the chances of future failures.

Employee: I tend to think admitting mistakes is only possible if tasks have clear accountability and metrics to evaluate the outcome.

Mentor: That is true. It is why I always plead with my colleagues in the senior management positions to avoid ‘playing along’ when the blame culture becomes apparent because such behavior may undermine our authority in promoting the just culture.

Patient Safety

Mentor: Back to your point about culture determining healthcare delivery, as I have told you, the just culture promotes accountability, which has a positive impact on the outcome of intervention – this includes patient safety. Ideally, patient safety is boosted by the implementation of an open and honest reporting framework that is likely to thrive under a just culture. The reporting I champion for does not only facilitate timely response to any errors that may affect the patient’s safety but also enables our facility to prevent the occurrence of errors in the future. I believe the perception of responsibility over the wellbeing of the patient can prompt the healthcare giver to become more indulged and dedicated towards the provision of top-notch services. This just culture promotes the participation of our employees in the decision-making process and, as a result, it is likely that we adopts effective strategies aimed at the promotion of patient safety besides there being collaboration across the board.

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Employee: Now I understand the crucial role culture plays in our organization. Thank you.

Mentor: It is my duty to coach you and it is for the benefit of our organization.

1. Khatri, N., Brown, G., & Hicks, L. (2009). From a blame culture to a just culture in health care. Health Care Management Review, 34(4), 312-322. http://dx.doi.org/10.1097/hmr.0b013e3181a3b709

2. McCall, J. & Pruchnicki, S. (2017). Just culture: A case study of accountability relationship boundaries influence on safety in HIGH-consequence industries. Safety Science, 94, 143-151. http://dx.doi.org/10.1016/j.ssci.2017.01.008

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