JUST CULTURE
Mission Statement
To establish an open and fair culture through improved management of organizational risk.
Vision Statement
HOSPITAL is a model of Just Culture. With a persistent focus on patient safety, we take accountability for
the quality of our decisions and systems, openly evaluating and improving them.
What Is Just Culture?
The term “Just Culture” applies to workplace justice, how adverse events and behaviors are addressed,
and how employee and employer work together to maximize their effectiveness across all organizational
values – safety, economic, moral, and ethical.
Duties
Within our organization, employees are tied together and to the organization through a set of duties.
These duties spring from duty to our work, human resources policies, departmental policies, laws and
regulations governing our work, as well as commitments made to each other during the course of
business. These duties take three forms:
The Duty
Explanation
The duty to avoid causing
unjustified risk or harm
A general duty to not create unreasonable or unjustified risk or
harm to each other, e.g., duty to avoid causing harm to
patients, visitors, and fellow employees. This duty includes
physical, emotional, and financial harm.
The duty to follow a
procedural rule when working
within the organization
An explicit duty to follow rules created within the system
designed by our employer, regulator, professional society, or
local group, e.g., duty to follow medication protocol, duty to
follow patient restraint policy, duty to report adverse events.
The duty to produce an
outcome for the organization
An explicit duty to produce a result through a system that the
employee controls, e.g., duty to be at work on time, duty to
avoid harassment, duty to wear an identification badge.
In any circumstance within the work environment, these three duties can overlap. An employee is always
subject to the duty of not causing harm. Additionally, there may be overlapping duties to follow rules and
duties to produce outcomes.
Risks
The Breach
Human error
At-risk behavior
Reckless behavior
Explanation
Slip, lapse, or mistake. Inadvertent action where the action
was not intended.
A behavioral choice to do other than desired, where doing
so involves a good faith belief that the action was justified or
that the risks of deviation are minimal.
Actions involving a conscious disregard of substantial and
unjustifiable risk of harm.
In general, employees are expected to produce required outcomes tied to specific policies that specify
outcomes within the control of the employee (e.g., time and attendance, dress code). Additionally,
employees are expected to avoid reckless behavior of any kind as reckless behavior involves the
recognition and disregard of substantial and unjustifiable risk.
The vast majority of organizational risks involve human errors and at-risk behaviors of employees
(whether staff or manager). When a breach occurs, the organization commits to an open and just culture
so that managers and staff may openly talk about the risk, investigate the causes of error and at-risk
behaviors, and together design improved systems and manage behavioral choices that will produce
better organizational outcomes. In short, the organization will commit to view errors and at-risk behaviors
as learning opportunities, to be co-managed by managers and staff.
Accountability (Code of Conduct)
Given these aforementioned objectives, the substantive portion of our Code of Conduct policy states that
employees are required to follow company policies, to make behavioral choices that are supportive of all
organizational values, and to avoid causing unjustified risk or harm to self or others.
Where working under a duty to produce an outcome, an employee will be held accountable as directed by
the Code of Conduct policy. The Code of Conduct policy puts the employee on notice of their duty and
prescribes acceptable outcomes attached to each duty (e.g., time and attendance, dress code,
harassment).
Where working under a duty to follow a procedural rule within a system, an employee will be subject to
disciplinary action when he/she has recklessly disregarded the risks associated with non-compliance.
At all times, an employee will be subject to the duty to avoid causing harm to themselves, to fellow
employees, patients, visitors, and to the organization. Under this duty, employees will be open to
disciplinary action when an employee has acted with reckless disregard toward harm to self or others.
In addition to these actions stemming from single events, when it is found that an employee has
committed a series of human errors or at-risk behaviors whose cause does not originate within the work
system, that employee will be subject to disciplinary action when it has been found that non-punitive
remedial action (e.g., education, coaching) is not effective in changing behavior.
Decision-making in accordance with these provisions will use an objective standard, except where the
employee may show subjectively that they had a good faith basis for believing that a particular breach
was justified. Actions taken along with these provisions will be guided by the Just Culture Algorithm.
Just Culture Committees
Just Culture Steering Committee
The Just Culture Steering Committee is responsible for providing oversight and recommendations on Just
Culture integration within HOSPITAL-owned or affiliated organizations. Specific recommendations will
focus on providing direction on Just Culture implementation, budget considerations, training implications,
and ultimately the successful sustainability of Just Culture within each HOSPITAL-owned or affiliated
organization.
Just Culture Operations Committee
A tactical committee that will help ensure successful implementation of Just Culture by following the
recommendations of the Just Culture Steering Committee.