Just Culture Collaborative
Jill Hanson and Stephanie Sobczak
Certified Just Culture™ Champions
WHA
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Today’s Call
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Review the Just Culture Collaborative Plan
Culture of Safety Foundations
What is a “Just Culture”
Readiness Assessment
Resources
Next 30 days
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Partnership for Patients
In addition to the ten core topics, WHA must offer
collaborative specific to Culture Change:
1. Just Culture
2. Comprehensive Unit Based Safety Program
3. Leadership Engagement
*Transforming Care at the Beside will be offered under the
Aligning Forces for Quality grant which continues until at least
May 2013.
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Why Just Culture?
From July 2011 WHA survey, 35 hospitals interested in Just Culture
Please describe which Safety Culture and/or Team Communication efforts would your
hospital benefit from in the next 12 months?
Team STEPPS
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44%
35%
29%
Just Culture
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56%
Bedside Report
SBAR / DESC / IPASS the BATON
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32
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44%
51%
44%
46%
Checklist adoption (surgical, med admin, hand-offs, etc)
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51%
Culture Mapping (a visual display of communication patterns among staff)
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44%
8%
Comprehensive Unit Based Safety Program (CUSP)
Transforming Care at the Bedside (TCAB)
Multidisciplinary Rounds
Team / Safety Huddles
Other, please specify
WHA Survey of QI Managers, July 2011
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WHA’s Approach
1. Two Certified Just Culture™ Champions
2. Benchmarked other successful collaborative work
3. Connected with other Just Culture ™ hospitals in
Wisconsin
4. Learn what hospitals are currently doing for
incident reporting (incl. RWHC’s Safety Zone)
5. Work with Outcome Engenuity staff , Fiona
Lawton and David Marx as advisors to the
project.
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Poll Question #1
Please describe your hospital’s familiarity with Just
Culture:
a. Our hospital has adopted Just Culture
b. Our hospital is in process of adopting Just Culture
c. Only individuals in our hospital know about or
have worked in a Just Culture hospital
d. We understand the general concept behind
Just Culture
e. Not very familiar – have heard of Just Culture
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What is Just Culture?
Concept developed by David Marx (Outcome
Engenuity), based on the work of James
Reason and others.
A systematic approach to understanding adverse
events, consistently consoling or coaching
employees and fairly applying discipline when
indicated.
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The Key to Becoming a Just Culture
Only part of it is the use of the Just Culture Algorithm
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Poll Question #1 Answers
Please describe your hospital’s familiarity with
Just Culture:
a. Our hospital has adopted Just Culture
b. Our hospital is in process of adopting Just
Culture
c. Only individuals in our hospital know about or
have worked in a Just Culture hospital
d. We understand the general concept behind
Just Culture
e. Not very familiar – have heard of Just Culture
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The Key to Becoming a Just Culture
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What’s the Problem?
“The single greatest impediment to
error prevention in health care is
that we punish people for
making mistakes.”
Dr. Lucian Leape
Professor, Harvard School of Public Health
Testimony before Congress on Health Care Quality Improvement
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Dangerous Shortcuts
84 percent of respondents say that 10 percent
or more of their colleagues take dangerous
shortcuts and 26 percent say these shortcuts
have actually harmed patients.
Source: The Silent Treatment study
Incompetence
82 percent of respondents say that 10 percent or
more of their colleagues are missing basic skills
and as a result, 19 percent say they have seen
harm come to patients.
Source: The Silent Treatment study
Disrespect
85 percent of respondents say that 10 percent or
more of the people they work with are
disrespectful and this undermines the ability or
willingness to share concerns and speak up about
problems.
Source: The Silent Treatment study
Makes You Wonder…..
What is happening in our
hospital?
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Measuring the Culture of Safety
• AHRQ has made available the Hospital Survey on Patient
Safety Culture (HSOPS) since 2004.
• Comparative Data is available for 2007 – 2010.
• The 2010 database has 885 hospitals and 338,607 staff
responses.
• On average, hospitals submitted 383 completed surveys
for a response rate of 56%.
• Wisconsin has 50 hospitals that have submitted data for at
least two years in succession.
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Poll Question #2
Does your hospital apply the AHRQ Hospital
Survey of Patient Survey on a regular interval
(every two years or less)?
• Yes
• No
• Have, but need to do it more frequently
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Very Different from “Satisfaction”
(But much more difficult to “fix”)
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Trending Patient Safety Culture
AHRQ Data vs. Wisconsin (N=50)
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Nat- Most
WI Most Recent n=50
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AHRQ Item Level Data
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AHRQ Item Level Data
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AHRQ Item Level Data
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AHRQ Item Level Data
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Poll # 2 Answers
Does your hospital apply the AHRQ Hospital
Survey of Patient Survey on a regular interval
(every two years or less)?
• Yes
• No
• Have, but need to do it more frequently
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Staff Safety Assessment
Just two (2) very important questions for any clinical unit:
Hospitals enrolled in WHA’s Partners for
Patients initiatives have had teams using
this assessment, or a variation of it.
If this applies to your hospital, speak
with your teams about what they
learned.
Disclaimer information here…
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Adopting a Just Culture is:
 Creating an open, fair and just culture
 Creating a systematic, consistent,
repeatable approach to incident review,
coaching and discipline
 Creating a learning culture
 Designing safe systems
 Managing behavioral choices
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Adding Value to the Experience
Please consider:
 Having adopted Just Culture and are experienced – please be
willing to share stories of success and challenges.
 Planning to adopt Just Culture and are just beginning –
please ask questions.
 Willing to share examples of wording in policies and
procedures – before and after Just Culture adoption.
 Consider sharing case examples for learning.
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More Than An Algorithm!
1. Aligning policies; Learning how to set and achieve
expectations; learning how to make value-supportive
decisions
2. Designing safer systems
3. Managing behaviors (before needing to use the
Algorithm)
4. Improving learning systems – both predictive and
proactive (FMEA) AND reactive (RCA/Investigations)
5. Embed the justice framework in the organization
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WHA’s Just Culture Collaborative Approach
Assessing
Readiness
(Aug to Oct)
Getting Started with
Just Culture
 What is a Just
Culture?
Assessing Readiness Culture
 Organizational
Readiness
Assessment
Assessing Readiness Processes
 Review Incident
Reporting Process
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Implementation
Application
Case Studies
(Nov to Jan)
(Feb to Apr)
(May to Jul)
Implementation –
Phase 1
 Just Culture and
the Disciplinary
Process
Implementation –
Phase 2
 The Just Culture
Algorithm
Application – Event
Case Studies on High
Investigation
Risk Scenarios
 Event Investigation  High Risk Clinical
Processes
Implementation –
Phase 3
 Training Managers
& Staff
Application - Consoling Case Studies on Non Consoling
Clinical Scenarios
Employees
 Non-Clinical
Scenarios
Application – Coaching Case Studies on Daily
 Coaching At-Risk
Occurrences
Behaviors
Repetitive
At-Risk Behaviors
Constructing Your Team
Senior
Leadership
Human
Resources
Middle
Manager(s)
This is the minimum
representation
recommended.
Medical Staff?
Quality
Improvement
??
Risk
Management
Legal?
Trustees?
Front-Line Staff?
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Readiness
Just Culture can’t be implemented from the
bottom or the middle.
Senior leadership must drive the change and
be passionate about the reasons for change.
Don’t create another “flavor of the month” –
this is too important.
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Tools to Assess Readiness
 Part One: Organizational Assessment
A tool to review hospital organizational
practices, policies and procedures and how
closely they align with Just Culture attributes.
 Part Two: Individual Assessment
A tool to assess leader’s and manager’s
perception of organizational culture.
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Organizational Culture Assessment
A 13 item questionnaire exploring:
• Organizational policies
• Adverse event investigation
• Human resource approaches
Completed by the Patient Safety Officer
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Individual Assessment
This 20 item questionnaire explores the
following critical behavioral markers:
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Coaching
Reporting
Responses to human error
Responses to reckless behavior
Severity bias
Transparency
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Individual Assessment
Questionnaire is completed by 10 to 15 leaders within
each organization
Organizational Leaders include the following:
• Chief Nursing Officer
• Medical Officers
• Directors or managers of human resources, quality
and risk management departments
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Scoring the Assessments
Organizational Readiness Assessment – Scoring
Guide
• Weighted questions with a maximum of 22 total
points
Individual Assessment of Organizational Culture
• Questions based on five point Likert scale with a
maximum of 40 total points per survey taken
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Where to Find on the WHA Quality Center
Just Culture Page via:
• Webinars Getting Started Webinar
• References & Toolkits
• Just Culture Organizational Readiness Assessment
• Just Culture Organizational Readiness Assessment-Scoring Guide
• Individual Assessment of Organizational Culture*
*Available on the WHA Quality Center for download or WHA can work with you to develop
an on-line individual assessment questionnaire
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Poll #3 Question
Based on today’s information, how likely is your
hospital to continue participating in this
collaborative?
a. Very Likely
b. Not sure yet
c. Not Likely
 Answers will be shared next month
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The Next 30 Days
RECOMMENDED ACTION ITEMS
Determine membership and convene your Just Culture
implementation team
Read and discuss the Silent Treatment article -ORConduct a Staff Safety Assessment
Conduct Organizational Readiness Assessment
 Organizational Assessment for Team Discussion
 Individual Assessment
Review most recent AHRQ Survey Results
Tools available on WHA Quality Center:
• Just Culture Resources
• Recorded Webinars
• Discussion Area
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Thank You!
Any Questions?
Jill Hanson and Stephanie Sobczak
Certified Just Culture™ Champions
WHA
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