JUST

CULTURE IN

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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 WORKBegin 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), 55-59. 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.