Implementing Just Culture to Improve Patient Safety

Abstract

Introduction: The number of deaths in the United States related to medical errors remains unacceptably high. Further complicating this situation is the problem of underreporting due to the fear of the consequences. In fact, the most commonly reported cause of underreporting worldwide is the fear of the negative consequences associated with reporting. As health care organizations along the journey to high-reliability strive to improve patient safety, a concerted effort needs to be focused on changing how medical errors are addressed. A paradigm shift is needed from immediately assigning blame and punishing individuals to one that is trusting and just. Staff must trust that when errors occur, organizations will respond in a manner that is fair and appropriate. Materials and Methods: An extensive review of the literature from 2017 until January 2022 was conducted for the most current evidence describing the principles and practices of “just culture” in health care organizations. Additionally, recommendations were sought on how health care organizations can go about implementing “just culture” principles. Results: Twenty sources of evidence on “just culture’ were retrieved and reviewed. The evidence was used to describe the concept and principles of “just culture” in health care organizations. Furthermore, five strategies for implementing “just culture” principles were identified. Conclusions: Improving patient safety requires that high-reliability organizations strive to ensure that the culture of the organization is trusting and just. In a trusting and just culture, adverse events are recognized as valuable opportunities to understand contributing factors and learn rather than immediately assign blame. Moving away from a blame culture is a paradigm shift for many health care organizations yet critically important for improving patient safety.