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Developing a Just Culture

By Barbara A. Brunt, for HealthLeaders Media  
   May 18, 2010

Regular monitoring and analysis of adverse events, open discussions of safety risks and barriers to safety, and ensuring that caregivers involved in adverse events receive attention that is just, respectful, compassionate, supportive, and timely are also addressed in the standards.

Rather than only react to the actual harm involved in a discovered event, an organization with a just culture assesses the daily risk inherent in its organization and works toward maximum reliability to prevent future adverse events, relentlessly improving both system design and the quality of collective behavioral choices. One of the defining qualities of a just culture is its commitment to values, including learning cultures, open and fair cultures, safe system design, and effective management of behavioral choices. A just culture fosters an environment in which employees hunger for knowledge and eagerly seek to understand risk at both individual and organizational levels (Griffith, 2009).

A just culture is one component of an accountable care organization (ACO). These organizations have a reporting, just, and flexible culture focused on improving safety and reliability through behavioral accountability and process design. Safety in ACOs is a core value. The focus is not on blame, but transparency. They provide high-value accountable healthcare delivery for patients, communities, and the providers they serve. We should all want to be part of an ACO.

American Nurses Association. (2010). Position statement on just culture. Accessed April 3, 2010, at
Griffith, K.S. (2009). "Column: The Growth of a Just Culture." The Joint Commission Perspectives on Patient Safety 9 (12): 8–9.
Leape, L.L. (2009). "Errors in medicine." Clinica Chimica Acta 404 (1): 2–5.
Schyve, D.M. (2009). "Leadership in healthcare organizations: A guide to Joint Commission leadership standards." Accessed April 22, 2010, at
Weick, K.E. & Sutcliffe, K.M. (2001). Managing the Unexpected: Assuring High Performance in an Age of Complexity. San Francisco: Jossey-Bass.

Barbara A. Brunt, MA, MN, RN-BC, is the director of nursing education and staff development at Summa Health System, a multihospital system in Akron, OH.

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