PRESENTED BY
Dr. Nina Beaman CMA (AAMA)
Professor at Aspen University, Bryant &
Stratton College and Stevens-Henager
College
OBJECTIVES
The participants will be able to
1. Define just culture.
2. Describe how just culture can be applied to medical assisting.
3. Given presented case studies of unjust culture in
healthcare, analyze and describe how just culture could
have been used with these case studies.
4. Evaluate the culture at the participant's workplace.
5. Create an action plan to adapt just culture at the
participant's workplace
ACCORDING TO THE INSTITUTE OF MEDICINE
(IOM, 2000)
Preventable errors were the
leading cause of death in the
United States!
THE JOINT COMMISSION (2009) REQUIRES
That all errors and near miss
incidents be reported and analyzed.
IN A JUST CULTURE
It is assumed that all humans make errors. (IOM,2000)
Everyone in the organization should report problems
that might affect safety or cause an error, so the
situation can be fixed (New Mexico Nurse, 2008).
The purpose of reporting errors is to seek solutions, not
to lay blame (Morris, 2011).
IN A JUST CULTURE
Healthcare professionals are accountable not only for
reporting errors, but for reflecting on the situations
which caused them (Scalise, 2006).
Recreating simulated incidents can help healthcare
professionals find solutions to problems (Hader ,
2006)
Transparency occurs because learning from disclosure
is encouraged (Apold, Daniels, & Sonneborn, 2006)
WHERE DID NURSING LEARN THIS FROM?
The Aviation Industry.
Pilots are evaluated on teamwork. Crew are expected to
report any potential problems, no matter their rank.
All members of the crew share responsibility for
safety, as do members of the healthcare team
(Decker, 2007).
WHEN IS MINDFULNESS PARTICULARLY
IMPORTANT?
Example:
When handing off a patient to another healthcare
professional (Popovich, 2010)
Can you think of other times?
DID YOU SELECT ANY OF THESE?
Change of shift
During emergencies
During busy times in the office
When multiple people are assigned the care of a patient
and do not communicate well
During complex procedures
When the healthcare professional is fatigued
When the patient is vulnerable or debilitated
HOW CAN MANAGERS PROMOTE JUST
CULTURE?
Frankel, Leonard, and Denham (2006)
suggested that nurse managers can best
supervise by modeling a just culture, being
available to speak to employees during
WalkRounds, and by building team spirit. This
could be applied to the medical office.
MARX (2001) CLASSIFIED ERRORS
Human error
Negligence
Reckless behavior
Intentional rule violation
HUMAN ERROR
Most common
Slips, Mistakes and Lapses (Reason, 2008)
Not intentional
Example:
Forgetting to document performance of a task.
Intervention:
Best solved with troubleshooting system flaws that may have lead to
the problem. For example, if nurses commonly forget to document
care, a checkbox system to remind them of tasks might help.
NEGLIGENCE
“Failure to exercise skill, care, and learning expected of a prudent healthcare
provider or to recognize unjustified risk.” (Marx, 2001).
Frequently occur when medical assistants are tired or distracted.
Sometimes a culture grows that “cuts corners” and does not understand the risks.
Example:
Medical assistants pull out medications for several patients to save time.
Interventions:
Need to seize opportunity to educate medical assistants and set clear expectations.
Need to address the culture that cuts corners.
RECKLESS BEHAVIOR
“Conscious disregard for risk.” (Marx, 2001)
These medical assistants know the risk, and disregard the correct behavior anyway.
For example:
When drivers speed, they believe they will not be hurt . . . or caught.
Medical assistants may believe that they will not be caught or disciplined if they leave the
unit without notifying anyone.
Intervention:
Behavior must be addressed and changed (Morris, 2011).
Disciplinary action and coaching is necessary.
INTENTIONAL RULE VIOLATION
Individual chooses to knowingly violate rule.
Includes impairment, illegal behavior, stealing, lying, self-serving behaviors, and ethical
violations.
For example:
The medical assistant chooses to drink before working, steals medications, lies about
performing tasks, create rumors about other employees
Intervention:
Usually should lead to termination and reporting to necessary authorities but should be
investigated with an open mind because systemic or ethical issues may play into the
dynamic somewhat.
WHAT IS THE CULTURE AT YOUR WORKPLACE?
Take a few moments to reflect on your workplace:
Is it a just culture?
If so, how are you supporting this culture?
If not, what can you do to promote a just culture
there?
If the culture clashes with your personal ethics,
what can you do about it?
TIPS FOR CREATING A JUST CULTURE AT WORK
Begin by modeling correct behavior yourself.
Influence others by sharing what you have learned from
this presentation.
Use literature review to provide evidence for change.
Encourage all employees to examine the work culture
and change it to a just culture.
Point out examples of unjust culture at work.
Listen intently when others share their opinions about
needed system changes.
CREATE THE JUST CULTURE BY USING SHARED
GOVERNANCE TO MAKE THOSE CHANGES.
Remove and report employees who intentionally violate
rules and trust.
Counsel those who are reckless about the risks of their
behavior.
Educate those who are negligent on the effects of their
behavior.
Change the system that leads to human errors.
WHAT IS YOUR ACTION PLAN TO PROMOTE JUST
CULTURE?
Who do you need to involve?
How will you communicate the
expectations?
How will you motivate all the employees
to embrace the culture?
DID YOU INCLUDE?
Key managers
Yourself
Your team of healthcare professionals
HOW WILL YOU COMMUNICATE IT
Sharing evidence from research
Bringing up the subject at meetings
Encouraging discussion through your professional
organizations
Modeling just culture behavior yourself
HOW WILL YOU MOTIVATE OTHERS?
Educate others on the advantages to medical assistants,
patients, employees, and families.
Creating a just work culture will help your venue to
attract and retain good employees.
Create the positive environment in which employees will
want to come to work to share in the culture!
CHANGE STARTS WITH . . .
REFERENCES
Apold, J., Daniels, T., & Sonneborn, M. Promoting collaboration and
transparency in patient safety. The Joint Commission Journal on Quality
and Patient Safety, 32, 672-675. Retrieved from EBSCOhost.
Dekker S. (2007). Just culture: Balancing safety and accountability. Burlington,
VT: Ashgate.
Frankel, A. S., Leonard, M. W., & Denham, C. R. (2006). Fair and just culture,
team behavior, and leadership engagement: The tools to achieve High
reliability. Health Services Research, 41(4P2), 1690-1709.
doi:10.1111/j.1475-6773.2006.00572.x
REFERENCES
Hader, R. (2006). A "just culture" proves just right. Nursing Management, 37(6), 6.
Retrieved from EBSCOhost.
Institute of Medicine. (2000). To err is human: Building a safer health system.
Retrieved from http://books.nap.edu/openbook.php?record_id=9728&page=26
Joint Commission, The. (2008). Facts about the 2009 national patient safety goals.
Retrieved from
http://www.jointcommission.org/patientsafety/nationalpatientsafety/goals/
Marx, D. (2001). Patient Safety and the "Just Culture": A Primer for Health
Care Executives. New York, NY: Columbia University. Available at:
http://www.mers-tm.org/support/Man_Primer.pdf
REFERENCES
Morris, S. (2011). Just culture-changing the environment of healthcare
delivery. Clinical Laboratory Science: Journal of the American Society for
Medical Technology, 24(2), 120-124. Retrieved from EBSCOhost.
New Mexico Nurse. (2008). Just culture. New Mexico Nurse, 53(1), 4. Retrieved
from EBSCOhost.
Popovich, D. (2011). 30-second head-to-toe tool in pediatric nursing:
Cultivating safety in handoff communication. Pediatric Nursing, 37(2), 5559. Retrieved from ProQuest Nursing & Allied Health Source. (Document
ID: 2321542841).
REFERENCES
Reason, J. (2008). The human contribution: Unsafe acts, accidents and heroic
recoveries. Burlington, VT: Ashgate.
Scalise, D. (2006). The see-through hospital. Hospital Health Network, 80(11),
34-40. Retrieved from EBSCOhost.