Assembling a Team for a Just Culture Workplace
At its core, the notion of “just culture” in a workplace or organization is fairly simple. The idea is that every part of your organizational culture encourages open reporting of adverse events and risky situations and holds people and groups accountable in a just (and often non-punitive) manner. But that fairly straightforward model requires the upending of whole systems, policies and procedures while inculcating a fundamentally new understanding of human behavior.
Hospitals and other organizations often find themselves enlisting formal training to make this transition. For years, the South Carolina Hospital Association has worked with David Marx and The Just Culture Company (formerly Outcome Engenuity) to provide our members with discounted rates for a suite of courses designed to train, build and sustain accountability in the workplace.
That partnership has allowed Just Culture to take hold in a number of South Carolina health systems. MUSC Health, in particular, was a prominent early adopter, leading to Just Culture champions like Danielle Scheuer, MD, MSCR, who currently serves as Chief Quality Officer at the health system.
Based on her experience, she stresses that, for Just Culture to really take hold, organizations need to truly reimagine their workplace accountability practices and embrace a framework to support consistent management of operational systems and behaviors.
“It really can’t be about the error, a ‘no harm, no foul’ mindset,” explains Danielle Scheuer. “It’s about the decision-making process, about making the [Just Culture] algorithm an integral part of your reporting system.”
Not only that, but Scheuer stresses that the training and expertise can’t merely be limited to human resources or patient safety team members—a core group of support is needed to make sure that the culture encompasses the entire organization.
“You really need to have HR, legal, risk, quality, compliance, CMO, COO, CEO, etc—everyone needs to buy in to the approach and commit to changing policy and processes,” she contends. A piecemeal approach is destined to fail without your entire leadership team on-board.
All organizations will start from different situations—MUSC Health had the advantage of a mature reporting system and a built-in learning culture to integrate Just Culture into—but the key is to recognize that Just Culture will always be an ongoing process.
“We think of implementing a new system and then going into maintenance mode, but it’s bigger than that. It’s really a whole philosophy,” says Scheuer. “It’s really never finished.”
Another champion of Just Culture-as-philosophy is Tom Crawford, PhD, MBA, FACHE, who serves as the System Chief Operating Officer and an Assistant Professor at MUSC Health. Crawford sees the model as the only way forward for the healthcare industry, and he makes its teaching an integral part of the MHA program at MUSC.
“After I went through [my own] Just Culture training, I realized I had opportunity to educate all of these graduate students, right out of the gate, to use the Just Culture algorithms and be consistent in the way they looked at situations and scenarios,” he explains. “Leaders have to be accountable for their systems, to believe that good systems, polices and processes produce good outcomes and bad systems produce bad outcomes.”
“I believe this is the only way to improve our health system writ large.”
For Crawford, the bidirectional accountability, where employees and managers recognize their shared responsibility for Just Culture, is key.
“I was visiting a big medical center to talk about Just Culture, and I knew really quickly that it wouldn’t work here because the leadership wasn’t nodding their heads [at this point],” he recalls. “You can tell when leadership is really interested in training and embedding the processes and when they are not.”
Both Crawford and Scheuer agree that a comprehensive, enterprise-wide commitment needs to be made for Just Culture to take hold in an organization.
“Getting that senior-level commitment is critical,” says Scheuer. “It would really behoove [an interested individual] to talk to their leadership about Just Culture first, to bring the information they learn to them and build on that education to get that full commitment.”