Just Culture Model of Accountability

A few years ago when I entered pharmacy management, the hospital I worked for promoted the “Just Culture” philosophy. Managers were educated on it, and we were all given a copy of the Just Culture Algorithm v3.2. I kept it close and found it to be very helpful to review prior to meeting with an employee when coaching or when discipline looked like it may be needed. It helped me remain unbiased and consistent in my dealings with staff. Working in the medication safety arena, the algorithm was also useful when working with nursing managers and making recommendations on how they might want to consider proceeding with their staff in the event of an error.

The Just Culture Company is designed to implement organizational improvements and change the culture by placing less focus on error and outcomes and more on risk, system design and the management of behavioral choices. There are three main behaviors to consider with an error:

  1. human error
  2. at-risk behavior
  3. reckless behavior

The manager’s response to the event must consider these underlying behaviors rather than the severity (or lack of) of the outcome. In terms of system designs, an organization must look for ways to implement processes and procedures which will facilitate good decisions and support the employee in getting the job done safely and correctly. An organization must be cautious not to assign blame when the system is to blame. On the flip side, although we are all human and, as a result, are prone to human error, an organization must hold staff accountable for their choices at times.

If you are not familiar with the Just Culture philosophy, and have never seen their algorithm, I would encourage you to look into it. From my experience, the closer an organization follows these principles, the safer the employees feel admitting mistakes resulting in a more honest and open culture ultimately resulting in a safer place for our patients.

Terri Vidals
Terri Vidals

Terri has been a pharmacist for over 30 years and is a drug diversion mitigation and monitoring subject matter expert. Her years of experience in various roles within hospital pharmacy have given her real-world insight into risk, compliance, and regulatory requirements, as well as best practices for medication and patient safety.

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