2.5.1 Getting the culture right Flashcards
What do the types of culture which collectively help us to achieve patient-centred, safe and effective care together with professional empowerment are interlinked and include?
They include a culture that is based upon the principles and values of fairness, quality, safety, transparency, learning and reporting.
What is a ‘just culture’?
Underpinning getting the culture right is a ‘ just culture’. This is a culture based upon fairness and is achieved when attitudes, behaviours and practices are fair.
What is a punitive culture based on?
A punitive culture is based upon assigning blame and punishment. It contributes to creating a culture of fear. People and organisations see what happens to others and if what they see is perceived to be draconian or unjust, this leads to fear, stifling reporting and stifling the raising of concerns. We lose the opportunity to learn, and patient safety is affected. A single instance of perceived punitive action can have a wide effect on how large groups of people choose to act.
Punitive culture: punisment –> Stifles reporting and learning –> Reduction in patient safety and quality of care
Would a no-blame culture be better than a punitive culture?
A no-blame culture may not be better than a punitive culture. It can breed complacency or nonchalance, which can also impact upon patient safety. At its worst, it can appear unacceptable to society overall due to the immunity from accountability, which can also be abused.
For example, there is a perception that, at times, diplomatic immunity can be unfair and abused.
No blame culture: blanket immunity –> Lack of accountability –> Not acceptable to society. Unfair
What is needed instead of blame culture or punitive care?
Instead, the ‘right culture’ or a ‘just culture’ is needed.
What is the ‘right culture’ or a ‘just culture’?
This is a culture based upon the principles of fairness, quality, transparency, reporting, learning and safety. A just culture promotes an open culture (transparency and discussion), a reporting culture (raising concerns), and a learning culture (learning from mistakes).
These cultures support each other to create a safety culture – balancing accountability and learning and leading to improved patient safety. It also creates a just and open working environment that is rewarding to work in, fosters professional empowerment and enhances the quality of service to patients and the patient experience.
Just culture: right culture –> Open culture: reporting culture; learning culture –> Safety and quality culture; balanced accountability and learning –> Fair working environment, improved patient experience, improved patient safety and quality of care.
Why do we need a just culture?
A just culture means:
Removing fears
Increasing sharing
Reporting of concerns
Being able to learn from mistakes or incidents
Being able to share lessons learnt (throughout the profession where appropriate)
Using this shared learning to reduce the likelihood of similar mistakes and incidents happening again.
This is a vital component contributing to better patient safety. When a mistake or incident occurs, we all want assurances that actions are being taken so that it will never happen again and that there will be fair accountability. It is not possible to stop errors occurring, however, a just culture will contribute to a system that improves continuously which should, in time, result in fewer errors.
How to achieve a just culture?
Achieving the right culture requires the embedding of just culture principles into attitudes, behaviours and practices, and the design of legislation, regulation, standards, policies and systems.
It requires commitment by all stakeholders to apply and ‘live’ the culture routinely, through all activities and all interfaces and for this to be habitual. It is a continuous and evolving movement and may take years to achieve, but one to which the RPS and others are committed.
Policies and procedures for a just and safe culture are simply words on paper if they are not ‘lived’ in actions and interactions. We all have responsibilities for living the culture and embedding the habit. Individuals and organisations can do this through strong leadership and educating people about a just and safe culture appreciating when it is in action through reflection, through benchmarking and through commitment of time.
