Tips to Implementing Policies that Support a Learning, Just, and
Accountable Culture
The purpose of evaluating key organizational documents is to review for
inconsistencies. A timeline should be developed to revise policies and procedures to
incorporate language from the MAPS Statement of Learning, Justice, and
Accountability and the Learning, Just, and Accountable Culture concepts/language,
including the three Learning, Just, and Accountable Culture behaviors (human error,
at–risk, reckless). Duties of managers are explicit (this is about seeing risk, designing
safe systems and coaching/mentoring of staff). Duties of staff are explicit (the
processes, but also looking for risk, reporting hazards and making safe behavioral
choices)
These policies/procedures include:
- Quality and patient safety plan
- New Employee orientation
- Job descriptions
- Discipline policies
- Incident/Occurrence reporting
- Patient safety event/error reporting
- Sentinel event investigation policy and process
This might better be termed, "eliminate the policies that don't allow you to
incorporate Learning, Just, and Accountable 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 a Learning,
Just, and Accountable 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 a Learning, Just, and Accountable Culture and work
incrementally to build the philosophy in as you go. 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,
eliminate them.1
1
Alison Page, Making Just Culture a Reality: One Organization's Approach, Perspectives
on Safety, AHRQ M&M, internet citation:
http://www.webmm.ahrq.gov/perspective.aspx?perspectiveID=50)