How effectively has a Just Culture been adopted? A qualitative study to analyse the attitudes and behaviours of clinicians and managers to clinical incident management within an NHS Hospital Trust and identify enablers and barriers to achieving a Just Culture

Abstract

ObjectivesJust Culture aims to improve patient safety by examining the organisational and individual factors that contribute to adverse events, enabling corrective action so that errors are not repeated. This qualitative study aims to: (1) analyse whether the attitudes and behaviours of clinicians and managers are aligned with a Just Culture; (2) identify barriers and enablers to an organisation adopting a Just Culture.MethodologyThis qualitative study used interviews and observation of Trust meetings to elicit the attitudes and behaviours of staff. Semistructured interviews were conducted with 13 doctors of all grades, 5 medical students and 2 managers. Five meetings that reviewed clinical incidents and mortality were observed. This was done in a single Hospital Trust in the Midlands, England. Data were thematically analysed using directed and inductive approaches.ResultsThere is evidence of a fair incident management process within the Trust; however, there was no agreed vision of a Just Culture and the majority of the staff were unfamiliar with the term. Negative perspectives relating to clinical incidents and their management persist among staff with many having insecurities regarding being the subject of an investigation and doubts about whether they drive improvement.ConclusionThis paper examines the significance of these findings and provides recommendations which may have application within other healthcare organisations. Major recommendations include (1) Just Culture: define an agreed vision of what Just Culture means to the Trust; (2) investigations: introduce incident management familiarisation training; (3) Learning Culture: increase face-to-face communication of outcomes of investigations and incident review; (4) investigators: establish an incident investigation team to improve the timeliness and consistency of investigations and the communication and implementation of outcomes.

Navigating uncertainty and complexity: Understanding healthcare professionals in addressing patient safety challenges

“…Following a severe adverse event involving a patient, healthcare providers need support to prevent further negative consequences for other patients [8], as their reasoning and clinical approach may alter and they may resort to defensive practices, potentially putting other patients at risk. Therefore, patient safety benefits from healthcare centers designing safety policies that include support programs for second victims and promote the principles of just culture [9].…”

Ethical challenges experienced by veterinary practitioners in relation to adverse events: Insights from a qualitative study

“…Creating a just culture is complex partly because of a lack of consensus definition or understanding of how it may be achieved 88 . Indeed, a recent study promoting learning from adverse events within an NHS Trust recommends precisely defining what a just culture means to staff, improving familiarity and transparency regarding how adverse events will be reviewed and responded to by the organisation, and enhancing learning through improved communication about adverse event review outcomes and the formation of adverse event investigation teams 89 …”

“…88 Indeed, a recent study promoting learning from adverse events within an NHS Trust recommends precisely defining what a just culture means to staff, improving familiarity and transparency regarding how adverse events will be reviewed and responded to by the organisation, and enhancing learning through improved communication about adverse event review outcomes and the formation of adverse event investigation teams. 89 Advocates of just culture approaches suggest that understanding and supporting the needs of practitioners who are emotionally or professionally affected by adverse events (i.e., second victims) 90 is essential if they are to be learned from. 91 In human healthcare, structured support for second victims 92 is based on an understanding of factors that predispose and contribute to distress as well as symptoms exhibited in the aftermath.…”

Fostering path to a just culture in healthcare organizations: Influential factors and challenges

“…The employed research methodologies predominantly follow a qualitative approach, characterized by the utilization of data collection methods such as interviews, focus groups, and observational techniques (Tasker et al, 2023;van Baarle et al, 2022b;Weenink et al, 2022) and a quantitative study using a cross-sectional approach (Kim & Yu, 2021;Yoon & Lee, 2022). The participants in the included studies are hospital nurses (Kim & Yu, 2021;Yoon & Lee, 2022), healthcare providers (Tasker et al, 2023;Weenink et al, 2022), and healthcare organizations (van Baarle et al, 2022b Fostering a just culture within healthcare involves several key components as highlighted in the study. Firstly, nurses working in general hospitals should actively seek to expand their understanding of what constitutes a fair culture.…”

“…These factors directly and indirectly influence the reporting of patient safety events by healthcare professionals, particularly military nurses, as emphasized in recent research. In essence, creating awareness and fostering empowerment are fundamental steps in building a just culture that prioritizes patient safety and quality care within healthcare organizations (Kim & Yu, 2021;Tasker et al, 2023;Yoon & Lee, 2022).…”