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What’s the first step to implement a Just Culture?


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The first step to moving toward a just culture is to determine just what kind of culture currently exists within the organization. The Joint Commission's leadership standard LD.03.01.01 states that leaders create and maintain a culture of safety and quality throughout the hospital. Furthermore, LD.03.01.01's first element of performance requires that leaders regularly evaluate the culture of safety and quality using valid and reliable tools. The easiest way healthcare entities can accomplish this is by conducting an initial, in-depth culture of patient survey to determine what the organization's current culture is and then conducting regular follow-up surveys to evaluate progress.

By conducting a survey, the organization determines whether its values are in accordance with a just culture. If it values safety, effectiveness of care, equity in the provision of care to all patients, and protecting and respecting the dignity of all who walk through the hospital doors, then it would probably be fairly safe to say that the organization is on the right track. In most instances, you can tell whether an organization values a just culture just by looking at a few practices. For example, an organization that does the following has demonstrated a culture of safety:

  • All job descriptions include being accountable for ensuring patient safety during the course of performing their duties
  • Incident reporting is valued to assist the organization with identifying possible patterns and trends and is promoted by the implementation of a user-friendly system
  • There is an attitude of teamwork and open communication in which all team members are treated as equal partners in proving patient care, and continuously exhibit behavior that allows staff to be comfortable drawing attention to potential hazards without fear of reprisals
  • Staff and leadership consider promoting patient safety and preventing patient harm as a clear top priority


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

(July 2011)