What Is Just Culture In Healthcare?

What Is Just Culture In Healthcare
About Just Culture Just culture is an atmosphere of trust in which healthcare workers are supported and treated fairly when something goes wrong with patient care. Just culture is important to as it creates an environment in which people (healthcare workers and patients) feel safe to report errors and concerns about things that could lead to patient adverse events.

A list of Alberta organizations who are committed to creating a just culture, and by extension, a safety culture in our healthcare system.Information about just culture and its relationship to a safety culture.Information about just culture for different healthcare stakeholders including patients and families.Resources that can help organizations establish a framework and actions to support a just culture.An approach and tools for the fair assessment of people involved in a patient safety incident that considers their actions in context.

: About Just Culture

What do we mean by a just culture?

JUST CULTURE: CONCEPT AND PHILOSOPHY – A just culture balances the need for an open and honest reporting environment with the end of a quality learning environment and culture. While the organization has a duty and responsibility to employees (and ultimately to patients), all employees are held responsible for the quality of their choices.

• Two nurses select the (same) wrong vial of intravenous medication from the dispensing system. One nurse administers the drug, causing cardiac arrest. The other nurse realizes the switch when drawing the solution from the vial into the syringe at the bedside. How do we approach the nurses and investigate the situation? • The attending physician tells a resident physician to obtain a specific blood test. The resident forgets. Fearing the wrath of the supervising physician, the resident reports that the result is normal. How do we deal with this breach? • A surgical team does not perform a surgical time out on the grounds that no adverse events have occurred in the past. How do we handle this violation? • The night nurse supervisor reports to a medical director that the lead respiratory therapist was in the hospital at 4:00 am with alcohol on his breath. At a later date, the physician confronts the employee who vehemently denies alcohol abuse. Should the matter be dropped?

In only one of these scenarios does an adverse event occur, yet a just culture, with its insistence on a value-based culture and shared accountability, demands that all of these situations be addressed. However, individual practitioners should not be held accountable for mistakes made in a system they cannot control.3 In the first example, further investigation showed that the 2 vials of entirely different medications looked alike in shape, size, color, and print.

This accident waiting to happen did happen to the first nurse and her patient.
Human error was involved, but this nurse should be consoled and supported rather than punished.
The resident physician falsified patient data, which cannot be condoned and must be addressed.
Honest disclosure without fear of retribution is an important characteristic of a just culture.

The surgical team cannot function outside of the value-based principles designed by the organization. Although this surgical team has never been involved in an adverse event, one may occur in the future. As for the respiratory therapist, in a just culture we are concerned for the safety of our patients and we are concerned for and care about each other.

1 A constant concern about the possibility of failure 2 Deference to expertise regardless of rank or status 3 Ability to adapt when the unexpected occurs 4 Ability to concentrate on a task while having a sense of the big picture 5 Ability to alter and flatten the hierarchy to fit a specific situation

Mindfulness throughout an organization considers, but moves beyond, events and occurrences. Everyone in the organization is continually learning, adjusting, and redesigning systems for safety and managing behavioral choices.

What is an example of just culture?

Acknowledging that even experienced professionals make mistakes can lead to an open and safe reporting system where everyone can speak up without fear of reprisal. This can lead to shared learning from errors and an eventual culture shift that prevents errors from occurring again. This is ‘just culture.’

What are 3 elements of just culture?

Making Just Culture a Reality: One Organization’s Approach | PSNet Alison H. Page, MS, MHA | October 1, 2007 We’ve all been there.something goes wrong, a patient is harmed, and we, as medical directors, managers, and administrators, are forced to judge the behavioral choices of another human being. Most of the time, we conduct this complex leadership function guided by little more than vague policies, personal beliefs, and intuition.

Frequently, we are frustrated by the fact that many other providers have made the same mistake or behavioral choice, with no adverse outcome to the patient, and the behavior was overlooked.
Quite understandably, the staff is frustrated by what appears to be inconsistent, irrational decision-making by leadership.

The “” concept teaches us to shift our attention from retrospective judgment of others, focused on the severity of the outcome, to real-time evaluation of behavioral choices in a rational and organized manner. At Fairview Health Services, a large integrated delivery system in Minnesota, we identified addressing our culture as the primary opportunity to improve patient safety in 2001.

We focused on two key areas of cultural concern: the leadership culture that sets the tone and judges the behavior of others, and the culture at the point of care, or team culture. In 2003, we worked with the Minnesota Alliance for Patient Safety (MAPS), a multi-stakeholder group founded by the Minnesota Hospital Association, the Minnesota Department of Health, and the Minnesota Medical Association, to establish a state-wide initiative to create a culture of justice and accountability.

This effort includes hospitals, the professional boards, and the department of health. Establishing a just culture within an organization requires action on three fronts: building awareness, implementing policies that support just culture, and building just culture principles into the practices and processes of daily work.

Based on our experience over the past 6 years, let me give you examples of how you might do this. Raising Awareness Building awareness is the first step in any movement. To raise awareness we did two things. First, with the assistance of, president of Outcome Engineering, we conducted a survey of staff, medical leaders, managers, and administrators asking them various questions about how they thought the organization would respond to a given behavior by a clinician (e.g., bringing unauthorized equipment into the operating room for use in a surgery) if that behavior resulted in harm.

We then asked the same question, except this time the behavior resulted in no harm. The survey results were clear. Members of the organization had no clear sense of how people would be judged, or how they should be judged when their behavioral choice was the wrong choice.

And respondents consistently judged people more harshly if the behavior resulted in harm (). The survey results were a wake-up call for the organization’s leaders. Our second step to raise awareness was education. First, a small group of 10 key clinical and operational leaders attended a day-long session with David Marx to evaluate the just culture concepts and learn how we should proceed inside our organization and as a state.

Following this, 60 Minnesota health care leaders attended a 2-day summit sponsored by MAPS, which included the professional boards and the department of health, to deepen understanding of just culture and to better understand the perspective of the professional boards and public agencies.

The leaders who attended enthusiastically embraced the just culture concept, finding that it provides practical and useful principles and tools anyone can use.
We then conducted a “big bang” educational session for all operational and clinical leaders across the system.
Our message: “anyone who finds himself/herself in the position of judging the behavioral choices of other human beings” should attend the session.

Three hundred and fifty people were educated in an 8-hour training session with David Marx. The education included an overview of the concepts, education on the use of a set of algorithms that guide people through the process of classifying behavioral choices as “error,” “at-risk behavior,” or “reckless behavior.” Participants also practiced applying the algorithms to real-life scenarios.

In hindsight, conducting this mass education was very effective.
It caused the organizational perspective on justice and accountability to shift almost overnight.
We did not conduct education sessions for front-line staff on just culture, but instead we have woven the expectations for staff behavior, along with the concepts of error, at-risk behavior, and reckless behavior, into orientation and unit education sessions.

The behaviors we can expect:

Human error —inadvertent action; inadvertently doing other than what should have been done; slip, lapse, mistake. At-risk behavior —behavior that increases risk where risk is not recognized, or is mistakenly believed to be justified. Reckless behavior —behavioral choice to consciously disregard a substantial and unjustifiable risk.

Implementing Policies that Support Just Culture This might better be termed, “eliminate the policies that don’t allow you to incorporate just culture.” Policies that require punishment for errors, for example, won’t work. Sentinel event investigation policies that say, “We will only look at systems and not human behavior” won’t work.

Ideally, the organizational policies related to employee behavior expectations, consequences for behavior, and event investigation would incorporate the language of just culture.
Job descriptions, medical staff bylaws, and codes of conduct should incorporate the principles.
This will take time, so start by removing the policies that are barriers to just culture and work incrementally to build the philosophy in as you go.

Our organization is still in the process of incorporating just culture principles into policies, but we have eliminated the policy barriers to using the principles. For example, if you have policies that authorize punishment (e.g., written reprimand or dismissal) after a certain number of errors, or that predicate punishment on the severity of the outcome, get rid of them.

Building Just Culture into Organizational Practices and Processes Once the leadership group of the organization has grasped the concept and leaders buy in to the philosophy, you can begin to incorporate it into the work you do every day. I recommend not introducing just culture as a new initiative or it could become the “flavor of the month.” Instead, leaders should look at the challenges they face and ask, “How would I apply just culture principles to this situation?” If your organization’s priority is reducing harm related to misidentification of patients, for example, how would you work with the staff to understand and categorize behavioral choices as “error,” “at-risk,” or “reckless”? How would you clarify what the organizational response will be to each type of behavior? If a person makes an error, he/she knew the right thing to do, intended to do the right thing, and followed the right process, but made a mistake (e.g., misreads a label); he/she should be consoled and we should figure out a system that will prevent future errors.

If a person engages in at-risk behavior, he/she knows the right thing to do, but does otherwise because he/she does not see the risk or feels that the benefit of the chosen behavior outweighs the risk (e.g., does not wake a patient to check a name band), management must understand why people are engaging in this risky behavior.

Leaders must ask hard questions like, “How prevalent is this behavior? Why are people doing this? How can we put systems in place that will encourage or force the correct behavior? How can we help people perceive the risk that exists so they will make the right behavioral choice?” Lastly, the organization and clinical leadership should identify which behaviors will be considered reckless and are, therefore, punishable.

Reckless behavior is punishable regardless of the outcome of the behavior. Leaders must establish processes to know when someone is engaging in reckless behavior and be willing to punish those who engage in it. A given behavior may be considered “at risk” in one situation or organization and be considered “reckless” in another.

Consider this scenario.
In hospital “A,” a nurse, not wanting to disturb a sleeping patient, does not check a patient’s name band and administers an IV antibiotic to the wrong patient, who was allergic to that drug.
The patient has an anaphylactic reaction and ends up in the ICU on a respirator.
How do we judge this nurse’s behavioral choice not to check the name band before administering the medication? Do we punish her? Some organizations would punish the nurse (i.e., retrain, reprimand, or dismiss) because she violated the patient identification policy.

A just culture would want to know:

Was the nurse aware of the policy to check name bands? Was it possible to check the name band? Do all the nurses on the unit check name bands prior to administering medications? Why didn’t the nurse check the name band? Did she mistakenly believe it was better not to? Why?

The error in this scenario is administering the medication to the wrong patient. We determined the nurse’s behavior to be “at-risk” (and not “reckless”) because the nurse violated the policy for what she believed to be a good reason—allowing the patient to sleep.

It turns out that customer satisfaction scores had recently been reviewed at a staff meeting, and sleep interruption was identified as the number one concern of patients. In addition, the other nurses on the unit agreed that they have not awakened patients to check name bands many times. Now consider another scenario.

In hospital “B,” a patient checks in. A name band is applied, and the patient is told that all staff will be asking patients to spell their names and give birth dates before providing care or treatment. The patient notes that all care providers and transport personnel follow the procedure.

Now, let’s say a nurse does exactly the same thing as the nurse in the first scenario. She enters the room, observes the patient sleeping, and decides not to wake the patient to check the name band. A just culture would classify the nurse’s behavior as “reckless.” The policy was known, the policy was doable, and others were following the policy.

Within Fairview, we have incorporated just culture into our performance improvement initiatives, such as hand washing and patient identification. We identify what types of errors are made, what types of at-risk behaviors we see, and whether or not anyone is engaging in reckless behavior.

As we make improvements in the process, we make sure we design it to prevent error, make risk apparent, and discourage at-risk behavior. We also clarify what behavior will be considered reckless. Currently, we are incorporating just culture principles into team training. Just culture principles will help you change your organizational culture.

In 2001, an accident occurred in our interventional MRI room when a piece of equipment flew across the room and attached to the outside of the MRI while a patient was in the tunnel. The event investigation that followed focused on system solutions and staff behavior.

The department established safe processes and expectations for staff training and behavior. All staff are screened for MRI safety themselves, participate in MRI safety training, follow check-in procedures, and wear pocketless scrubs to minimize the opportunity to forget something in a pocket. Six years later, in 2007, a physician entered the room wearing scrubs with pockets, disregarding the prompt from colleagues to stop.

Administration was notified. The conversation that ensued among operational and medical leaders focused on categorizing the behavior as error, at-risk, or reckless and, from that, determining whether the physician should be consoled, coached, or punished.

Alison H. Page, MS, MHA Chief Safety OfficerFairview Health ServicesFigure

Figure. Survey question: How would our organization respond to a surgeon who uses an unauthorized piece of equipment in the operating room? Percent of respondents who believed Fairview would discipline the surgeon if. This project was funded under contract number 75Q80119C00004 from the Agency for Healthcare Research and Quality (AHRQ), U.S.

Department of Health and Human Services. The authors are solely responsible for this report’s contents, findings, and conclusions, which do not necessarily represent the views of AHRQ. Readers should not interpret any statement in this report as an official position of AHRQ or of the U.S. Department of Health and Human Services.

None of the authors has any affiliation or financial involvement that conflicts with the material presented in this report. June 8, 2023 – June 9, 2023 April 20, 0223 – June 8, 2023 : Making Just Culture a Reality: One Organization’s Approach | PSNet

What are the key principles to just culture?

Through Just Culture, we will: be respectful in how we engage with those involved; be transparent in the evaluation processes used; hold our system, ourselves and others accountable; and learn from mistakes and close calls to improve safety and performance.

What is just culture tool?

The Just Culture Tool was created to help evaluate colleagues or employees involved in a medical error and to better understand the relative contribution of human and system factors in an error, near miss or unsafe condition.

Is Just Culture the same as culture of safety?

Integrating Principles of Just Culture Into the Survey Process – Just culture encourages transparency and error reporting while creating a balance between blame-free and punitive environments that ensure accountability. With just culture, rather than only focusing on outcomes, an organization examines behavioral choices, thereby reducing severity bias.7 Similar to previous descriptions of just culture, for the purposes applying just culture to the nursing home survey process, we group behaviors that may cause harm into 3 categories ( Table 2 ).7 The first category is human error, where an unintentional failure that is beyond the control of humans causes or almost causes harm.

From an organizational perspective, this includes adverse events as a result of factors that are outside of an individual’s control. Just culture does not call for punishment or sanction of individuals with behavior that involves human error. Rather, it aligns with safety culture principles by supporting acceptance of risk along with system redesign to prevent future errors from happening.

In the context of a nursing home survey, adverse events that occur despite a nursing home’s efforts to prevent them should not incur deficiencies or other punitive measures. Integrating this aspect of just culture into nursing home surveys would require a process that forgoes assessments based only on scope and severity, in favor of an evaluation that examines reasonable steps taken to prevent the adverse event.

One example is a resident who falls and experiences an injury requiring hospitalization. In just culture, the survey team would review overall efforts to prevent falls from occurring, including staff education on fall risk factors and prevention strategies, medication reviews, and handrails along with other environmental modifications to support safe mobility.

The survey team would also account for choices made by the resident and family to choose mobility despite a clear recognition of an increased fall risk, recognizing the adverse event occurred as a result of shared decision making and despite prevention strategies.

The second category is at-risk behavior, which occurs when individuals and/or organizations either do not recognize a risk as a consequence of a choice or otherwise minimize or justify the risk.
Under just culture, the response to at-risk behaviors includes removing barriers to safe choices, removing any rewards associated with at-risk behaviors, and coaching individuals and/or organizations to recognize the consequences of their choices.

At an organizational level, at-risk behaviors are the most challenging to identify and also the areas of greatest opportunity. In the context of a nursing home survey, if the ultimate goal is to improve resident safety, adverse events due to at-risk behaviors should require a remediation plan that includes staff education and coaching as well as objective improvement in process and outcome measures.

The nursing home might choose to rely on their Quality Assurance and Process Improvement (QAPI) committee to develop a remediation plan. The severity or magnitude of the problem might also lead to requests for assistance from regional Quality Improvement Organizations (QIOs), state or jurisdictional health agencies, or even nearby hospitals.

It is not the role or function of regulatory survey teams to provide this type of coaching to nursing homes, as this construct has potential for conflict of interest that could undermine their role in sanctioning reckless behavior. An example of at-risk behavior is of nurse who does not change his or her personal protective equipment (PPE) between providing wound care for sacral wound and a surgical site wound on the leg.

The reasoning expressed is that PPE is stored far from the resident’s bed and that using the same gloves to change multiple dressings should not be harmful as it is the same resident. Although no harm is intended, the nurse should recognize the risk of cross-contamination and infection in the wounds.

Even if in this instance there is no demonstrable harm, under the rubric of just culture, the survey team would put the nursing home on notice to correct the behavior within a specified time frame. The resulting process improvement plan should include several features:

• staff education about transmission-based precautions and how to use PPE • coaching on proper donning and doffing of PPE • adapting the system to ensure PPE supplies and trash receptacles are convenient to rooms with residents on transmission-based precautions • process measure —surveillance for how often rooms do not have adequate supplies of PPE • outcome measure —surveillance for wound infections acquired in the nursing home.

The survey team would need to reassess the nursing home, perhaps limiting its scope only to infection control and prevention issues. If the nursing home demonstrates that it has addressed the at-risk behavior, the survey team would take no further action.

If the nursing home has not sufficiently rectified the at-risk behavior, the survey team could elect to take punitive action. The third category is reckless behavior, which involves a conscious disregard of a substantial and unjustifiable risk of harm. Similar to others, we have grouped reckless behavior with the more severe categories of knowingly causing harm and intentionally causing harm.23 Reckless behavior is outside of what is accepted as the norm and may be self-serving.

Just culture calls for punishment or sanction of individuals who engage in reckless behavior. Under the existing process, survey teams may invoke any of several punitive measures, including civil monetary penalties, withholding reimbursement from CMS, and even closure.

Examples of reckless behavior by individuals include drug diversion or continued refusal to properly wear a mask during the COVID-19 pandemic, despite repeated education and coaching.
At the organizational level, reckless behavior might manifest as a severe cost-cutting or intentional understaffing.
The COVID-19 pandemic offers a striking example of a missed opportunity for applying the principles of just culture.

At least 1 nursing home in Washington state, the epicenter for COVID-19 infections in the United States, received significant fines following an initial outbreak of SARS-CoV-2.24 These sentinel events were severe enough to require assistance not only from local and state health departments but also from the Centers for Disease Control and Prevention (CDC).

The observations by the CDC shed light on the novel nature of SARS-CoV-2 and informed subsequent infection prevention and control activities across the nation.
Nevertheless, CMS fined the nursing home more than $600,000 dollars for not providing “quality care and services for residents during a respiratory outbreak,” among other concerns.25 A survey team trained in principles of just culture would have forgone assessing the scope and severity of the deaths due to SARS-CoV-2 and instead evaluated the behavior and actions of the nursing home.

The survey team would have recognized that, especially in early 2020, several circumstances were beyond the control of the nursing home staff: a novel pathogen with a long incubation period, insufficient knowledge of transmission, a new disease with a variable set of clinical symptoms, no diagnostic tests, no experience in treating COVID-19 infections, and no pathogen-specific medications.

A second example also comes from early in the pandemic.
Nursing homes that reported higher numbers of COVID-19 cases did not receive Phase Three of Provider Relief Funds under Coronavirus Aid Relief and Economic Securities Act (CARES Act) as a consequence of what was interpreted as poor infection prevention and control practices.26 Although this may have been true for some nursing homes, the practice also penalized nursing homes that were early adopters of a universal testing strategy to limit the spread of COVID-19 in their buildings.

Eventually, CMS recognized the benefits of this approach and required all nursing homes to engage in universal testing of staff and residents.27 In the example above, applying the principles of just culture would call for CMS to recognize that some nursing homes with high care rates had actually engaged in innovative behaviors supportive of patient safety.

What are 5 examples of culture?

From Wikipedia, the free encyclopedia The following outline is provided as an overview of and topical guide to culture: Culture – a set of patterns of human activity within a community or social group and the symbolic structures that give significance to such activity.

What is a Just Culture and its impact on a culture of safety?

In a Just Culture, employees feel safe and protected when voicing concerns about safety and have the freedom to discuss their own actions, or the actions of others in the environment, with regard to an actual or potential adverse event.

What are the types of just culture?

CONCLUSION – A Just Culture identifies 3 types of behavioral choices: human error, at-risk behavior, and reckless behavior. It establishes a fair and transparent process for evaluating errors and determining a course of action based on the quality of the behavior and not on the outcome of the error.

Just Culture is a model of shared accountability where both management and staff are held accountable. This model can be integrated into any health care setting by classifying behaviors associated with errors and providing consistent follow-up with employees. Setting realistic expectations, instilling safety values, and promoting accountability within the workplace will help to promote a Just Culture as an organization strives to develop patient-centered pharmacy services.

By using an algorithm as a guide, the pharmacy leader can begin to develop a culture that balances accountability and systems failures and promotes error-free and patient-centered pharmacy services.

What are the 3 C’s of culture?

The Significance of Company Culture – Our training team travels across the country, visiting furniture stores with varying cultures and levels of performance. From our experiences, we know that one thing is for sure: company culture drastically impacts any person who interacts with your business.

In today’s world of retail, consumers prioritize companies that make them “feel good.” A culture of positivity starts at the top and makes its way to your customer.
Now more than ever, employees are looking for employers that are a “culture fit.” A strong culture can equate to happier employees that want to stay with your organization.

By reducing employee turnover, a positive culture allows owners to focus less on hiring and more on the growth of their business. When consumers, employees, and owners are happy and moving in the same direction- success takes care of itself. When people are happy, this, in turn, keeps shareholders satisfied.

Culture can make or break an organization at every level. Our first “C” of culture is communication. Communication is an essential part of building any great company culture. Without solid communication, employees are left with contradicting messages, customer experiences that lack follow-up, undefined processes, and a lack of direction across the entire organization.

Not only can poor communication lead to a negative experience for employees and consumers, but it can also cost us profits. If your organization requires a revamp in the way communications happen- don’t worry ! We have a few great tips to get you started.

Educate your Team, Ensure your Company’s Mission, Goals and Vision are clear. Clearly define the direction the company is heading in. Lead by Example. Leaders set the tone & pace of the organization. Leaders fanatically reinforce the importance of having a healthy and welcoming company culture by making decisions that support it.

Practice and display Servant Leadership. Be proactive versus reactive. Avoid Misinformation. Provide clear communications that are as informative and transparent as possible, leaving no room for misunderstanding. Clear communications lead to execution. Develop Concrete Processes and Procedures,

Validate that all departments have up-to-date and accurate standard operating procedures available to anyone who needs them. Be sure to communicate changes to processes and procedures consistently and frequently. Validate the receipt of information through assessments and behavioral checkpoints. Establish Open Lines of Communication : share and welcome thoughts and ideas.

Make sure everyone is heard and understood through Skip-Level Meetings. Encourage regular Team huddles to keep everyone aligned. Above all, practice vulnerability. When you are open and honest, your team will be too! While improving communication isn’t always easy, it is one of the fastest ways to improve your overall company culture.

Another critical part of creating a positive company culture is establishing and living a solid set of Core Values. While most organizations see the importance of having their core values, few organizations take the time to ensure the products and services they offer come from companies that share the same values.

With your products and services being an extension of your brand, you can’t afford to partner with businesses that offer the same level of service and commitment that your organization provides. There are several ways to find products and service providers that will strengthen your Core Values.

First and foremost, check your supplier’s Core Values, Most organizations publish their core Values on their website or use them in presentations. Researching the company virtually is a fantastic way to see who, exactly, you are partnering with. Look for products that are backed and guaranteed, Whether this means finding products that offer extended warranties or finding insured service providers will give your customers peace of mind in knowing their investments are secure.

Prioritize partners with a history of service excellence. One of the easiest ways to do this is by looking up the business through the Better Business Bureau. While “googling” and researching customer feedback may be helpful, this research only provides one-off situations.

The BBB offers a researched summary of how the business operates. Partner with companies that are as fanatical about the overall customer experience as you are! Find vendors that offer professional training and support, Great Partners invest in their organization and yours with high-quality training experiences.

You work hard to build your brand and maintain a positive reputation. Don’t settle for anything less than what you deserve when looking for products or service providers! Lastly, we bring you the third “C” of Culture—Commitment to Excellence. Coming up with ideas and plans is only the first part of improving your culture.

How you execute these ideas and strategies will determine your success.
We are what we do every single day.
If we want excellence, we must continuously strive for it and build teams with the same passion.
Consistency is key.
There are many ways that you can set your organization up for success.
Train your Trainers,

Utilize vendor relationships to train your trainers on the products and services you provide. The more confident your leaders and trainers are, your team will be more confident. Develop Strong Leaders, Take the time to coach and mentor the Leaders in your organization.

Ensure your leaders clearly understand your company culture and help them make decisions that align with your organizational direction.
Owners should train Leaders to identify coaching opportunities and when that coaching opportunity should be for an individual, small group, or company-wide.
This piece is essential – don’t generalize.

A lack of courage or laziness often leads to broad communications that reach individuals or groups that don’t need the coaching or reminder. Don’t discipline everyone for the actions of a few. Hire the Right People, Ensure you’re asking the right questions to find employees who match your culture.

Don’t settle for an imperfect match.
Take the time required to find a quality candidate.
Consider elements outside of “years of experience.” Hire for attitude and train for skill.
Hiring the right people might not always be easy, but it’s easier than firing the wrong people.
Make sure that your training and development opportunities are ongoing.

It is common in company culture to make a big push around a “new” initiative, only to see the performance spike and then crash within months. Your company culture experiences must be ongoing to keep your team engaged. As they say- where focus goes- energy flows.

Also, check out ProtectALL’s Quick Click Solutions video on company culture for more leadership and management resources from HFA. is an HFA Solution Partner.

: Improve your Company Culture with the 3 Cs of Culture – HFA

Why is it called just culture?

What Is Just Culture? Changing the way we think about errors to improve patient safety and staff satisfaction “Just Culture” refers to a system of shared accountability in which organizations are accountable for the systems they have designed and for responding to the behaviors of their employees in a fair and just manner.

Employees are accountable for the quality of their choices and for reporting errors and system vulnerabilities. At Brigham and Women’s Faulkner Hospital, leadership is committed to fostering a Just Culture where patient safety is improved and our staff feel more secure in the decisions they make. “We know that creating a safe and transparent environment encourages reporting of mistakes and hazards and ultimately improves the care we provide to our patients,” says BWFH Chief Medical Officer Dr.

Peggy Duggan. However, our recent Safety Culture Survey results revealed that staff at BWFH do not always feel comfortable speaking up when they see something that threatens patient safety and/or they feel blamed when errors occur. “Our goal in implementing Just Culture is to create a strong culture of safety where staff are managed fairly when involved in an error, mistake or adverse event,” continues Dr.

Duggan. The process of implementing the Just Culture concept is not one that happens overnight. “We’re trying to build an infrastructure to embed this methodology,” says Director of Risk Management and Compliance Joanne Locke who is spearheading the process. “It’s going to take some time. Right now we have a Just Culture Steering Committee.

Eventually we will have a Just Culture Advisory Group and Advisors.” So far, managers and supervisors have been invited to take part in training sessions with Paul LeSage, the Just Culture Advisor with SG Collaborative Solutions, LLC, who has been hired by Partners HealthCare.

LeSage describes Just Culture as an art and not a science.
It’s something that evolves over time, but gets easier as we learn to look at our workplace through a different lens.
This approach is about looking for risk, not fault,” he says.
Working in a Just Culture means more security around the decisions you make.

It means recognizing that humans aren’t perfect and that when you make a mistake you are going to be embraced in the process of trying to understand why the error was made rather than be punished for your mistake,” says LeSage. “For frontline staff that boils down to more security in reporting and being open about errors.” Implementing Just Culture means changing the way we look at our systems and our people.

It is not an easy process.
However, LeSage believes BWFH will be successful.
I think BWFH has a leadership-down commitment that is phenomenal to see.
So I think you are poised and ready,” he says.
BWFH’s size, as a relatively small community hospital, has you uniquely positioned to get it done faster than a really huge organization would.” For resources, staff may visit the Just Culture page on our intranet,

: What Is Just Culture? Changing the way we think about errors to improve patient safety and staff satisfaction

What is the opposite of a just culture?

From Wikipedia, the free encyclopedia Just culture is a concept related to systems thinking which emphasizes that mistakes are generally a product of faulty organizational cultures, rather than solely brought about by the person or persons directly involved.

In a just culture, after an incident, the question asked is, “What went wrong?” rather than “Who caused the problem?”.
A just culture is the opposite of a blame culture,
A just culture is not the same as a no-blame culture but is a culture where individuals are accountable for their willful misconduct or gross negligence.

A just culture helps create an environment where individuals feel free to report errors and help the organization to learn from mistakes. This is in contrast to a “blame culture” where individual persons are fired, fined, or otherwise punished for making mistakes, but where the root causes leading to the error are not investigated and corrected.

In a blame culture mistakes may be not reported but rather hidden, leading ultimately to diminished organizational outcomes. In a system of just culture, discipline is linked to inappropriate behavior, rather than harm. This allows for individual accountability and promotes a learning organization culture.

In this system, honest human mistakes are seen as a learning opportunity for the organization and its employees. The individual who made the mistake may be offered additional training and coaching. However, willful misconduct may result in disciplinary action such as termination of employment—even if no harm was caused.

Work on just culture has been applied to industrial, healthcare, aviation and other settings. The first fully developed theory of a just culture was in James Reason’s 1997 book, Managing the Risks of Organizational Accidents, In Reason’s theory, a just culture is postulated to be one of the components of a safety culture,

A just culture is required to build trust so that a reporting culture will occur. A reporting culture is where all safety incidents are reported so that learning can occur and safety improvements can be made. David Marx expanded the concept of just culture into healthcare in his 2001 report, Patient Safety and the “Just Culture”: A Primer for Health Care Executives,

Why do we need just culture?

The Promise and Practice of a Just Culture Focus on Consistency of Purpose By Topic: Safety Quality Culture of Safety Just Culture High Reliability By Collection: Safety What Is Just Culture In Healthcare Leaders whose organizations have made big safety gains will tell you that a high-reliability safety culture is one of shared learning characterized by an atmosphere of trust. Members of the workforce feel safe speaking up when they make an error or encounter circumstances that could lead to harm.

And, since these high-performing organizations recognize that most errors are due to flawed systems, not individual negligence, they’re listened to and supported.
It’s a cornerstone of high-reliability industries that’s now widely referred to in healthcare as “just culture.” In the guide, Leading a Culture of Safety: A Blueprint for Success, ACHE and the IHI Lucian Leape Institute include just culture as one of six core domains for driving to zero harm.

A just culture holds people accountable for following procedures and protocols (when they’re in the patient’s best interest) but unites teams in working for the common good. The ethos: Forget finger-pointing. Let’s learn from this error and improve this system.

Let’s correct this process before someone gets hurt.
See a problem? Call it out.
Evidence suggests it’s an environment many healthcare organizations still struggle to embrace.
Since launching in 2004, the Agency for Healthcare Research and Quality’s Surveys on Patient Safety Culture have found nonpunitive responses to errors to be the top area for improvement.

The 2018 survey found that more than half of staff respondents believe event reports are held against them and kept in their personnel files. A study of U.S. hospitals published in the April 2018 issue of the American Journal of Medical Quality sheds further light on blame culture’s persistence in healthcare.

Seventy-nine percent of respondents reported that their institutions have adopted a just-culture process, and more than half believe it has had a positive impact.
But the study found no correlation between just-culture adoption and hospital performance or event reporting.
The core of what we do is make sure that patients feel safe that the care they receive will be reliable, consistent and deliver the outcomes they and their families expect.

– Robert A. Cherry, MD, FACHE, FACS, UCLA Health Though some experts say the reasons vary, including that just culture errs in its emphasis on distinguishing blameworthy from blame-free events, leaders whose institutions have succeeded in developing a learning climate of openness around error reporting have a different take.

Just culture is only one aspect of a larger safety strategy, but it’s an essential one, and it needs ongoing work, they say.
Healthcare Executive spoke with three leaders about their experiences and what organizations can do to bring just culture to fruition.
UCLA Health: Flattening the Hierarchy to Encourage Safety Reporting “The core of what we do is make sure that patients feel safe that the care they receive will be reliable, consistent and deliver the outcomes they and their families expect,” says Robert A.

Cherry, MD, FACHE, FACS, chief medical and quality officer at UCLA Health. Where does just culture fit in with that? “Just culture is not the complete solution, but it’s a tool that complements our efforts to be a high-reliability organization and enhance the patient experience,” he says.

To be able to learn every day from events and near misses, you need an environment in which raising concerns is not only normal but expected. That’s not something you accomplish by running through a couple of initiatives. It needs to be relentless. We’re never satisfied. – Stephen E. Muething, MD, Cincinnati Children’s Hospital At UCLA Health, just culture means shared accountability and an intentional effort to flatten the vertical, hierarchical structure under which hospitals have traditionally operated.

“It’s important to have high-functioning teams working toward the same goals, but to do that, you have to have safe, transparent conversations in which people feel like they’re talking with their peers rather than feeling they’re in a command-control situation,” Cherry says.

Because of UCLA Health’s size, the organization used a phased approach that began with a formal assessment of cultural perceptions followed by the development of a cadre of 40 culture champions “chosen for their skill in facilitating change and introducing just-culture principles in their units,” explains Anet Sinanyan, patient safety director.

In 2016, UCLA Health introduced a reporting system for documenting near-miss and actual harm events called Safety Opportunities for Improvement, built to overcome the limitations of the previous homegrown system. “We encourage everyone to memorialize their understanding of an event in SOFI,” says Cherry.

Most harm events are addressed locally, with appropriate subject matter experts and department leaders informed in near real time via automatic notifications.
Incident review committees look more closely at events and trends that might offer opportunities for learning and improvement across broader swaths of the system.

As in many organizations, events that look like judgment errors at first often turn out to be systems and process issues. These cases undergo a root-cause analysis and corrective action planning. Root-cause analyses and significant trends are shared with the clinical excellence committee and the system board.

Last year, UCLA Health introduced a dashboard that lets teams access data in SOFI at hospital and departmental levels and use that data for continuous improvement. The dashboard gives users easy access to reporting data for their own department and for all of UCLA Health. Users can easily drill down into specific areas with a few clicks, says Sinanyan.

The health system also holds monthly patient experience rounds in which clinical and nonclinical leaders talk with patients, families and staff, and then share findings and improvements. Findings that need to be addressed are logged in a tracker and saved on a website specific to the rounds, where they’re followed to make sure they’re resolved in a timely manner.

UCLA Health also presents “good catch” awards for incident reporting, with a personal note from CEO John C.
Mazziotta, MD, PhD, to individuals whose clinical skills and judgment have prevented harm.
Teams and individuals go back to their units and talk about how supported they felt in articulating their concerns, and that good feeling gets around,” Cherry reports.

“When we deal with issues in a transparent, constructive way, people see we have a culture that values their opinions, and they begin speaking up.” Just culture is about accountability for underlying systemic problems to improve safety and prevent harm.

It’s also about people feeling safe saying, ‘I made this mistake. Let’s find out why.’ – Anthony J. Warmuth, FACHE, Cleveland Clinic Cincinnati Children’s Hospital: A Focus on “Psychological Safety” Just culture doesn’t work in isolation, but it’s a critical part of the continuous learning system that is the bedrock of high-reliability organizations, says Stephen E.

Muething, MD, chief quality officer at Cincinnati Children’s Hospital. “It allows you to create the learning cycle that’s necessary to make real progress in patient safety,” he says. Cincinnati Children’s Hospital has been committed to high reliability for 15 years, Muething says, and though it is still far from where it wants to be, “when people visit to learn from us, they’re struck by how openly and actively we learn from events every day.

Everybody’s talking about what they can do better and what they learned.
They don’t take joy in not finding problems; they take joy in finding them.” The hospital embarked in 2019 on a culture refresh focused on psychological safety.
This initiative included training for all 15,000 leaders and staff on empowering front-line employees to voice safety concerns during active events.

“Some of our front-line people said that they still feel that their concerns won’t be listened to or appreciated. There’s still some fear they’ll be told they’re wrong, so they may wait for someone else to speak up,” says Muething. All leaders underwent four hours of training and then led training for their teams on the importance of sustaining an environment in which team members feel confident they will be supported if they identify a potential concern during the delivery of care.

Our clinicians have done great work without just culture, so it can be hard for some to accept the fact that culture change is necessary,” Muething observes. The hospital uses the power of individual stories to guard against complacency, a danger in any organization. “If someone is harmed in our organization, whether it’s an employee or a patient, we talk about it openly.

You have to make this real for people so they can connect it with the work they do,” he says. The hospital also holds open sessions to help employees extrapolate lessons learned and improvements made based on safety events to their part of the organization.

To be able to learn every day from events and near misses, you need an environment in which raising concerns is not only normal but expected,” Muething says.
That’s not something you accomplish by running through a couple of initiatives.
It needs to be relentless.
We’re never satisfied.” Cleveland Clinic: Consistency and Commitment Deliver Superior Results “There are limitations to just culture, but I think those limitations are usually self-imposed when we’re not being effective change agents or when we’re unclear about what just culture is,” says Anthony J.

Warmuth, FACHE, executive director of enterprise quality and safety at Cleveland Clinic. “Just culture is about a cultural transformation. If you practice what you preach, you will see results.” Organizations that buy into the misperception that just culture means lack of accountability will run into trouble, Warmuth believes.

“Just culture is about accountability for underlying systemic problems to improve safety and prevent harm. It’s also about people feeling safe saying, ‘I made this mistake. Let’s find out why.'” Though the seeds were planted about 10 years ago, Cleveland Clinic has been intentionally focused on high reliability for the past five years, and just culture is an integral part of the transformation.

“We think actively about what could go wrong, speak up when we see conditions that could cause harm, and work together to drive improvement every day,” he says. “Are we there yet? No. It’s a journey.” That journey has included the realization that harm can happen in a variety of ways, in nonclinical as well as clinical settings.

We usually think of harm in terms of medical errors, but lack of empathy can harm a patient, too,” he says.
Similarly, a billing specialist working on a claim that a patient is having difficulty understanding should be thinking and speaking up about ways to improve billing to enhance clarity and accuracy.

“Our commitment as a learning organization involves listening actively, learning from each other and leading together,” says Warmuth. Toward that end, senior leaders regularly go on rounds to talk with patients about their experience and what the health system and care team could be doing better.

The commitment to learning also involves fostering a learning environment by giving employees multiple avenues through which their voices can be heard.
Last year, CEO Tomislav Mihaljevic, MD, introduced a “speak up” award to recognize individuals whose safety error reporting has led to significant improvements or prevented harm.

Cleveland Clinic has also developed a good-catch reporting system that allows a staff member to submit a concern by answering a few quick questions. Timely feedback and follow-up when errors are reported are essential. “If someone presents a safety issue and it goes into a black hole, they’ll probably never report another one again,” Warmuth says.

In addition, Mihaljevic and his leadership team hold daily huddles to discuss indicators from across the organization, including safety events, “so we’re not reacting to an event a month after it’s happened,” says Warmuth.
Leadership’s timely, clean line of sight into safety is really important.” Susan Birk is a Chicago-based freelance writer specializing in healthcare.

: The Promise and Practice of a Just Culture

What is just culture model?

Ultimately, the Just Culture model is about creating an open, fair and Just Culture, creating a learning culture, designing safe systems, and managing behavioral choices. The model sees events not as things to be fixed, but as opportunities to improve understanding of both system risk and behavioral risk.

What is just culture policy?

A just culture policy is a high level statement of the values and commitment of an organization to treat healthcare workers fairly when a patient is harmed or nearly harmed by healthcare delivery. It is an important step in being open with healthcare workers and patients about what to expect in a situation where patient safety has been compromised.

A board policy will be more high level and make a general commitment to a just culture for the organization. It is a clear signal that just culture is a leadership priority. An operations policy will be more specific and set expectations for processes and procedures.

Another option is to create a policy guidelines document that commits the organization to embedding a just culture approach into all organizational policies and procedures, not just those that relate to situations in which patients are harmed or almost harmed by healthcare delivery.

What is the fair and Just Culture procedure?

Commitment to a Fair and Just Culture A Fair and Just Culture balances the need to have a non-punitive reporting and learning environment (i.e. an environment that is not focussed on attributing blame and administering punishment), with the need to hold persons accountable for their actions.

What is characteristic of a just culture?

Recognizes that competent professionals make mistakes. Acknowledges that even competent professionals will develop unhealthy norms (shortcuts, ‘routine rule violations’). A just culture has zero tolerance for reckless behavior.

What is the opposite of a just culture?

In a just culture, after an incident, the question asked is, “What went wrong?” rather than “Who caused the problem?”. A just culture is the opposite of a blame culture, A just culture is not the same as a no-blame culture but is a culture where individuals are accountable for their willful misconduct or gross negligence.

In a blame culture mistakes may be not reported but rather hidden, leading ultimately to diminished organizational outcomes.
In a system of just culture, discipline is linked to inappropriate behavior, rather than harm.
This allows for individual accountability and promotes a learning organization culture.

Work on just culture has been applied to industrial, healthcare, aviation and other settings.
The first fully developed theory of a just culture was in James Reason’s 1997 book, Managing the Risks of Organizational Accidents,
In Reason’s theory, a just culture is postulated to be one of the components of a safety culture,

Why do we need just culture?

And, since these high-performing organizations recognize that most errors are due to flawed systems, not individual negligence, they’re listened to and supported. It’s a cornerstone of high-reliability industries that’s now widely referred to in healthcare as “just culture.” In the guide, Leading a Culture of Safety: A Blueprint for Success, ACHE and the IHI Lucian Leape Institute include just culture as one of six core domains for driving to zero harm.

Let’s correct this process before someone gets hurt.
See a problem? Call it out.
Evidence suggests it’s an environment many healthcare organizations still struggle to embrace.
Since launching in 2004, the Agency for Healthcare Research and Quality’s Surveys on Patient Safety Culture have found nonpunitive responses to errors to be the top area for improvement.

Seventy-nine percent of respondents reported that their institutions have adopted a just-culture process, and more than half believe it has had a positive impact. But the study found no correlation between just-culture adoption and hospital performance or event reporting. The core of what we do is make sure that patients feel safe that the care they receive will be reliable, consistent and deliver the outcomes they and their families expect.

Just culture is only one aspect of a larger safety strategy, but it’s an essential one, and it needs ongoing work, they say.
Healthcare Executive spoke with three leaders about their experiences and what organizations can do to bring just culture to fruition.
UCLA Health: Flattening the Hierarchy to Encourage Safety Reporting “The core of what we do is make sure that patients feel safe that the care they receive will be reliable, consistent and deliver the outcomes they and their families expect,” says Robert A.

To be able to learn every day from events and near misses, you need an environment in which raising concerns is not only normal but expected.
That’s not something you accomplish by running through a couple of initiatives.
It needs to be relentless.
We’re never satisfied.
Stephen E.
Muething, MD, Cincinnati Children’s Hospital At UCLA Health, just culture means shared accountability and an intentional effort to flatten the vertical, hierarchical structure under which hospitals have traditionally operated.

Most harm events are addressed locally, with appropriate subject matter experts and department leaders informed in near real time via automatic notifications.
Incident review committees look more closely at events and trends that might offer opportunities for learning and improvement across broader swaths of the system.

Last year, UCLA Health introduced a dashboard that lets teams access data in SOFI at hospital and departmental levels and use that data for continuous improvement. The dashboard gives users easy access to reporting data for their own department and for all of UCLA Health. Users can easily drill down into specific areas with a few clicks, says Sinanyan.

UCLA Health also presents “good catch” awards for incident reporting, with a personal note from CEO John C. Mazziotta, MD, PhD, to individuals whose clinical skills and judgment have prevented harm. “Teams and individuals go back to their units and talk about how supported they felt in articulating their concerns, and that good feeling gets around,” Cherry reports.

It’s also about people feeling safe saying, ‘I made this mistake.
Let’s find out why.’ – Anthony J.
Warmuth, FACHE, Cleveland Clinic Cincinnati Children’s Hospital: A Focus on “Psychological Safety” Just culture doesn’t work in isolation, but it’s a critical part of the continuous learning system that is the bedrock of high-reliability organizations, says Stephen E.

Everybody’s talking about what they can do better and what they learned.
They don’t take joy in not finding problems; they take joy in finding them.” The hospital embarked in 2019 on a culture refresh focused on psychological safety.
This initiative included training for all 15,000 leaders and staff on empowering front-line employees to voice safety concerns during active events.

Our clinicians have done great work without just culture, so it can be hard for some to accept the fact that culture change is necessary,” Muething observes.
The hospital uses the power of individual stories to guard against complacency, a danger in any organization.
If someone is harmed in our organization, whether it’s an employee or a patient, we talk about it openly.

To be able to learn every day from events and near misses, you need an environment in which raising concerns is not only normal but expected,” Muething says.
That’s not something you accomplish by running through a couple of initiatives.
It needs to be relentless.
We’re never satisfied.” Cleveland Clinic: Consistency and Commitment Deliver Superior Results “There are limitations to just culture, but I think those limitations are usually self-imposed when we’re not being effective change agents or when we’re unclear about what just culture is,” says Anthony J.

Just culture is about accountability for underlying systemic problems to improve safety and prevent harm. It’s also about people feeling safe saying, ‘I made this mistake. Let’s find out why.'” Though the seeds were planted about 10 years ago, Cleveland Clinic has been intentionally focused on high reliability for the past five years, and just culture is an integral part of the transformation.

We usually think of harm in terms of medical errors, but lack of empathy can harm a patient, too,” he says.
Similarly, a billing specialist working on a claim that a patient is having difficulty understanding should be thinking and speaking up about ways to improve billing to enhance clarity and accuracy.

The commitment to learning also involves fostering a learning environment by giving employees multiple avenues through which their voices can be heard. Last year, CEO Tomislav Mihaljevic, MD, introduced a “speak up” award to recognize individuals whose safety error reporting has led to significant improvements or prevented harm.

In addition, Mihaljevic and his leadership team hold daily huddles to discuss indicators from across the organization, including safety events, “so we’re not reacting to an event a month after it’s happened,” says Warmuth. “Leadership’s timely, clean line of sight into safety is really important.” Susan Birk is a Chicago-based freelance writer specializing in healthcare.

: The Promise and Practice of a Just Culture

What is a just and learning culture?

Implementing a just and learning culture What Is Just Culture In Healthcare This case study provides information about what the training covers and how it can be practically implemented even during the pandemic. The trust estimates that the just and learning culture has provided economic benefits of roughly £2.5million since 2016.

In 2016, Mersey Care NHS Foundation Trust began to implement a ‘just and learning culture’ within their organisation. The culture fundamentally changed the way it responded to incidents, patient harm, and complaints against staff. After seeing the benefits in their own organisation, the trust partnered with Northumbria University to create a just and restorative learning training package for other organisations to follow.

Mersey Care NHS Foundation Trust estimates the economic benefit of a just and learning culture in their organisation to be roughly £2.5 million. This is made up of:

A reduction in suspensions by 95 per cent and disciplinary investigations by 85 per cent since 2014. At the same time the trust has increased its workforce by 135 per cent.
An increase in reporting of adverse events.
An increase in staff who felt encouraged to seek support.
An increase in staff who felt able to raise concerns about safety and unacceptable behaviour.

Mersey Care’s reliance on HR processes and practises which focused on rules, violations, and consequences were not seen to be working for its employee relations disciplinaries. Costs associated with suspensions were rising. So too were legal costs, agency costs for backfill absenteeism, and staff turnover.

The organisation decided on a new approach.
Steps to implement a just and learning culture were taken.
This type of culture involves creating an environment where staff feel supported and empowered to learn when things do not go as expected, rather than feeling blamed.
So far, the trust has trained over 400 individuals at Mersey Care in the just and learning culture way.

The trust intends to provide further training across the organisation during the autumn. There has also been appetite from other trusts to learn from Mersey Care and in collaboration with Northumbria University, it has developed an accredited programme to enable other organisations to take part in the training too.

Typically, training is provided face-to-face. This year, due to the COVID-19 pandemic, the trust plans to deliver the training via a blended digital learning approach. Mersey Care worked closely with Northumbria University to develop engaging training in a virtual setting to help learners to get the most out of the new way of training.

The programme is aimed at managers, patient safety leads, operations managers, staff side colleagues, OD and HR. It is requested that a board member commits to supporting those who attend the training and provides an opening comment or letter to attendees to endorse their attendance and permission to enact their learning.

The programme includes four days of facilitated teaching over three weeks. It is delivered through a variety of live speaker and group facilitated sessions, self-directed learning through workbooks and filmed role plays and presenter sessions. This blended digital learning approach aims to retain an authenticity that could have been lost via an e-learning package.

Considerations have also been given as to how to ensure that those who attend the training feel psychologically safe. This is more challenging in an online setting, so adaptions such as shorter days and less days per week of virtual training have been factored in.

Training online is tiring and having no more than eight learners and a tutor is considered best practice to ensure meaningful engagement. The course material can be completed individually or in small groups. Reflective learning is built into the programme. Upon completion of the third week, participants take three actions back to their organisations to work on.

Six weeks after that, participants complete a post-programme action learning set. This is a new step to enable the trust to evaluate and understand what is working well with the programme, and what might need to be adapted to work better for learners.

The aim of the programme work is to allow participants to implement what they have learnt into their own organisations and accelerate the transition from Mersey Care’s experience.
Mersey Care’s staff survey shows safety, morale and performance have all improved.
Research the trust commissioned shows staff feel more engaged, open and able to speak up.

There have been increases in staff morale and job satisfaction, staff engagement among senior leaders has increased and so has staff motivation. The research found there is an increased feeling from staff that they work in an ‘open and accommodating work environment that facilitates honesty and learning’.

This is directly linked to the just and learning culture and training the trust provides. The trust continues to assess the economic benefit of a just and learning culture (estimated to be roughly one per cent of turnover) and look at the impact it has on women, black, Asian and minority ethic (BAME) staff and other underrepresented groups.

Mersey Care NHS Foundation Trust’s vacancy rate currently stands at 3.5 per cent. They have a waiting list for district nurses in some areas and other professions. The organisation’s just and learning culture is seen to be a large part of that pull. Great strides have been taken at Mersey Care, but the trust admits it do not always get it right.

When training online, use smaller groups of up to eight or nine people (including the presenter), this way everyone’s face can be seen on the software and it makes the session more interactive.
Get board support to show the organisation’s commitment to the training.
It is easier to create a psychologically safe environment when everyone is in the same room, it is harder to do online, but just as important to the success of the training.
Giving people the chance to analyse a situation with hindsight and by asking the question ‘what happened and how can we understand it?’ can be powerful as they understand all of the factors and context behind a decision.

Watch, as told by the staff themselves.
Further details on Mersey Care’s Just and Learning culture can be found, and you can register your interest in attending,
For more information about the work in this case study, contact Amanda Oates, Executive Director of Workforce, Mersey Care NHS Foundation Trust: or Kristina Brown, Northumbria University:

: Implementing a just and learning culture