HCA 675 What are the differences you see between a culture of accountability, where people are held accountable for the mistakes they make, and the Just Culture approach, where mistakes are not punished, but seen as methods of learning?

HCA 675 What are the differences you see between a culture of accountability, where people are held accountable for the mistakes they make, and the Just Culture approach, where mistakes are not punished, but seen as methods of learning?

HCA 675 What are the differences you see between a culture of accountability, where people are held accountable for the mistakes they make, and the Just Culture approach, where mistakes are not punished, but seen as methods of learning?

Topic 4 DQ 1

The approach of Just Culture in an organization includes “Adopting one model of shared accountability, learning from mistakes vs. blaming individuals, managing behavioral choices (human error, at-risk behavior, reckless behavior), designing safety into all clinical systems and processes, Commitment of organization/leadership to shared goals” (Allyn, 2019, key components of just culture). With this type of culture there is an increase in the number of reporting issues which leads to increased safety, as one is not punished, but looked at as an opportunity for learning to occur (Allyn, 2019). This type of culture allows people to speak up without fear of being reprimanded. When people feel safe to report issues without being reprimanded, they tend not to cover up or hide details associated with error (Allyn, 2019). For some, learning and change may not occur without consequences.

We have adopted the just culture approach in my organization. Since the implementation of the just culture approach, we have seen a huge increase in reporting which has allowed us to provide further education or perhaps a change in the process. Prior to this is was an “us against them” mentality, staff against management, where people would not report, cover-up for other staff when issues occurred. However, this never allowed management to correct the issues through education and process changes. I will also add, it did take some time to make the transition, but as people in the organization began to see that issues brought up were looked at as an opportunity to improve versus punitive, reporting increased so that positive changes through education and process could be made.

The culture of accountability holds people accountable for their actions and mistakes. Culture of accountability can

HCA 675 What are the differences you see between a culture of accountability,
HCA 675 What are the differences you see between a culture of accountability,

have a positive impact through the production of “organizational success, human fulfillment and the creation of real value” (Partners in Leadership, 2010). “When healthcare organizations hold themselves and their employees accountable, they can learn from mistakes and continuously improve operations. A culture of accountability in healthcare improves doctor-patient trust, reduces the misuse of resources, and helps organizations provide better quality care” (PowerDMS, 2018). However, with the culture of accountability people may not bring forth issues for fear of punishment or the punishment of a co-worker. When issues are not brought forth, they cannot be resolved. The fault may not lie on the person who is assumed to have made the mistake, it may be a process issue or a combination of events that lead to the issue/incident.

 

References

Allyn, J. (2019). Just culture: balancing accountability with quality and safety. Retrieved from https://www.rsna.org/en/news/2019/February/Just-Culture-Background

Partners in Leadership. (2010). A culture of accountability. Retrieved from https://www.partnersinleadership.com/insights-publications/a-culture-of-accountability/

PowerDMS. (2018). Creating a culture of accountability in healthcare. Retrieved from https://www.powerdms.com/blog/creating-culture-accountability-healthcare/

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Hi Jodie, thank you for making an informative contribution to the present discussion. Indeed, a just culture ensures the elimination of victimization of individuals in an organization as shared accountability is facilitated. Moreover, the presence of a just culture facilitates the recognition of the fact that individual practitioners cannot become accountable to system failings that are beyond their control. Moreover, such a culture similarly recognizes that various active or individual errors represent predictable interactions between human operators as well as their environment’s system (Boysen, 2013). On the other hand, the culture of accountability ensures that a person becomes liable to any mistake that they commit. This ensures that healthcare practitioners become very keen, which minimizes the presence of aberrations. Thus, a culture of accountability ensures the presence of reduced mistakes in the delivery of care, which makes the whole process safer as opposed to the just culture.

References

Boysen, P. G. (2013). Just culture: a foundation for balanced accountability and patient safety. Ochsner Journal, 13(3), 400-406.

The culture of accountability has definite pros in cons within healthcare. The reason that numerous healthcare organizations implement a culture of accountability within their organization is because a lack of accountability in healthcare can cause significant problems to the organization. Lack of accountability can impact quality of care, ruin an organization’s reputation, and ultimately increase the risk of possible lawsuits (Gasior, 2018). Each of these can greatly impact the organization and should not be held lightly. With lack of accountability in a healthcare organization, it has been found that nearly 210,000 hospital patients die each year from hospital-related infections or mistakes made my medical personnel (Gasior, 2018). Aspects such as this could be avoided if staff followed proper policies and procedures. Ethics and accountability should be an aspect that is implemented within a healthcare organization’s culture. On the other hand, providers can get punished when they are held accountable for their actions, which may make for a provider to decide to not be honest when they make a mistake. Another aspect that can occur when a healthcare provider is held accountable for every action is they may feel that they can take all measures to provide the best treatment possible.

A Just Culture approach differs slightly from a culture of accountability because it understands that balance is a necessity. A Just Culture understands that human error and/or technical error is evitable, especially within a healthcare setting. With a Just Culture there is a need for open and honest reporting (Boysen, 2013). In a Just Culture, it is understood that an individual may be at fault, but the system is at fault to a certain extent as well. The Just Culture believes that punishing people without changing the system will only perpetuate the problem instead of solving the problem at hand (Boysen, 2013). The positive aspect of using this approach is because it allows for an open, honest environment that allows for people to be people. On the other hand, there can be repercussions because people may be more careless if they do not believe that there will be any type of punishment for their actions.

 

References

Boysen, P. (2013). Just culture: balancing safety and accountability. Choice Reviews Online50(06), 50-3197-50-3197. https://doi.org/10.5860/choice.50-3197

Gasior, M. (2018, March 1). Creating a Culture of Accountability in Healthcare. PowerDMS. https://www.powerdms.com/blog/creating-culture-accountability-healthcare/

 

Responses,

Julianne, thank you for making an informative post on the substantive issues of this week’s discussion. Indeed, the presence of a just culture and culture of accountability possess both advantages and disadvantages. The just culture ensures that health care workers learn from their mistakes in order to become better in future. However, this predispose the patients to safety issues as most of the undertakings in health care are sensitive. On the other hand, the culture of accountability ensures that individuals always work to give their best. As a result, medical errors of omission or commission have been managed where this culture exists (Boysen, 2013). Nevertheless, its existence puts healthcare workers under pressure since they will always worry about the consequences of making mistakes. Therefore, I agree with your assertions that both cultures have pros and cons.

References

Boysen, P. (2013). Just culture: balancing safety and accountability. Choice Reviews Online50(06), 50-3197-50-3197. https://doi.org/10.5860/choice.50-3197