IngentaConnect Creating a Fair and Just Culture: One Institution's Path Toward O...

Authors: Connor, Maureen; Duncombe, Deborah; Barclay, Emily; Bartel, Sylvia; Borden, Charles; Gross, Elizabeth; Miller, Carol; Ponte, Patricia Reid

Source: Joint Commission Journal on Quality and Patient Safety, Volume 33, Number 10, October 2007 , pp. 617-624(8)

Publisher: Joint Commission Resources

Abstract:

Background: Health care organizations have begun to move toward a nonpunitive, or "blame-free," process when analyzing medical errors and near misses. The Dana-Farber Cancer Institute's (Boston) "Principles of a Fair and Just Culture," define for staff and managers behavioral expectations when an error occurs.

Creating the Principles of a Fair and Just Culture: The principles focus not just on patient safety but on a culture of safety and transparency in all the organization's functional areas, including nonclinical departments such as information services, administration, and research.

Incorporating the Principles into Practice: Introducing the principles is a gradual process, one that requires continual education and discussion among staff at all levels and a commitment to examining and changing many of the systems, policies, and procedures that guide the organization's work. A survey conducted in January 2007 revealed that the clinical areas had sustained higher-than-average scores and that the nonclinical areas showed improvement.

Discussion: Changing a long-standing culture of blame, control, and disrespect to one that embraces principles of fairness and justice and standards of respectful behavior is a major undertaking. Educating and involving clinical and administrative leaders, who work directly with staff and play a pivotal role in translating the principles into practice, is especially important.

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Creating a Fair and Just Culture: One Institution's Path Toward Organizational Change