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How does my organization establish a Just Culture that encourages nurses to report errors and near misses?


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It is important for hospitals and staff members to be continuously reminded that the primary, strategic focus for any healthcare entity should be patient-centered care that keeps patients safe. Patient-centered care should include a mechanism whereby hospital personnel and/or the medical staff are comfortable reporting any medical error through the appropriate channels in a continuous effort to improve the quality of care provided. It is also imperative that staff members be involved in the initiative for organizational cultural change, because if the staff isn't on board with the concept—even if the board and senior leadership are—the initiative will fail.

Now that the need for change is recognized, it is time to get started. This is an exciting journey, although at times it can be quite challenging. Still, staff want to do the right things for their patients; they want to provide the right care to the right patient at the right time and in the right setting. The overall goal of a Just Culture is to look beyond the individual when an error occurs. Making the individual aware of outcomes and holding the individual responsible for learning from his or her mistakes and to perform according to pre-set expectations in the future, while at the same time evaluating the processes leading up to the error, identifying breaks in those processes, and correcting them, the organization demonstrates its commitment to objectively understanding why the error occurred and adopting a systematic approach for addressing them without staff fearing there will be adverse consequences to them, personally or professionally.

Your action plan for getting started should include:

  • Assessing your organization's current culture of patient safety via the performance of a culture of patient safety survey.
  • Once findings are received, developing a plan for addressing those areas identified as needing improvement.
  • Once the plan has been implemented, communicating to staff just what the plan is, what is required of them to assure its success, and publicizing efforts made throughout the organization.
  • If policies, procedures or protocols require revision, including staff in the revision process to ensure that practice reasonably adheres to policy.
  • Communicating to and educating every staff member about all efforts currently being made to transition to a more just and patient-focused culture, including any changes in policy, expected performance and behavior. A regular report on progress should be made to convey this throughout the organization. Encourage staff to ask questions about any specific areas of concern.


Vivian B. Miller, BA, CPHQ, LHRM, CPHRM, FASHRM

(June 2011)