Restorative Just Culture in Practice

Dekker, Sidney; Rafferty, Joseph; Oates, Amanda

doi:10.4324/9781003162582

Cited by 14 publications

(4 citation statements)

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“…Of these three, one used Reason’s definition 5 and two used variations of Dekker’s restorative approach. 15 Notably, the two consultants who were employed as RCA Leads were unfamiliar with the term.…”

Section: Resultsmentioning

confidence: 99%

“…The NHS renewed its focus on establishing a Just Culture through the Just Culture Guide 13 and Being Fair Report. 14 These publications reference two theories: Reason’s Safety Culture 5 which highlights the importance of analysing and addressing both organisational and individual factors that contribute to an incident; and Dekker’s Restorative Just Culture 15 which focuses on repairing relationships and meeting the needs of affected parties. The NHS’ use of these two distinct theories in its main guides has the potential to generate confusion regarding what is meant by the term Just Culture.…”

Section: Introductionmentioning

confidence: 99%

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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

2023

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

2023

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“…Sadness that we weren’t able to meet much earlier and sadness that on the long journey since Joshua died, somehow humanity and compassion were sucked out of the process. (Dekker et al , p. 71) 15 …”

Section: Introductionmentioning

confidence: 99%

Support for healthcare workers and patients after medical error through mutual healing: another step towards patient safety

et al. 2022

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BackgroundMedical errors, especially those resulting in patient harm, have a negative psychological impact on patients and healthcare workers (HCWs). Healing may be promoted if both parties are able to work together and explore the effect and outcome of the event from each of their perspectives. There is little existing research in this area, even though this has the potential to improve patient safety and wellness for both HCWs and patients.MethodsUsing a patient-oriented research approach with constructive grounded theory methodology, we examined the potential for patients and HCWs to heal together after harm from a medical error. Individual interviews were conducted and transcribed verbatim. We conducted concurrent data collection and analysis according to grounded theory principles. With our findings, we created a framework and visual breakdown of the communication process between patients and HCWs.ResultsOur findings suggest that, after a medical error causing harm, both patients and HCWs have feelings of empathy and respect towards each other that often goes unrecognised. Barriers to communication for patients were related to their perception that HCWs did not care about them, showed no remorse or did not admit to the error. For HCWs, communication barriers were related to feelings of blame or shame, and fear of professional and legal consequences. Patients reported needing open and transparent communications to help them heal, and HCWs required leadership and peer support, including training and space to talk about the event(s).DiscussionOur resulting framework suggests that if there was an opportunity for an open and purposeful conversation early or before increased emotional suffering, there might be an opportunity to bridge the barriers, and help patients and HCWs heal together. This, in turn, contributes to improved health quality and patient safety.

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“…However its application without parallel efforts to repair trust and relationships can perpetuate a deeper, more insidious threat to the institution's safety foundation. 8 While Just Culture focuses on learning from a specific patient safety incident, there is also a need to consider how the framework, processes associated with safety investigations, and structures to support safety work are received by those affected by harm, including patients, family members, and healthcare staff. It is clear that the harm from the event itself is compounded by additional harm due to an organization's lack of response and exclusion of those impacted.…”

mentioning

confidence: 99%

Achieving a restorative Just Culture through the patient safety incident response framework

Lounsbury,

Sujan

2023

Journal of Patient Safety and Risk Management

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Despite years of calls for adoption of a Just Culture, it is evident that taking this concept from paper to practice has been slower than expected. Many have cited the subpar application of the Just Culture framework and, recently, questions have been raised regarding how the Just Culture framework is perceived by those impacted by harm, including patients, family members, and staff. Though this framework is one tool that can be used to guide inquiry after harm events, its use, independent of active efforts toward restoration of relationships with patients, families, and staff, could compromise engagement and therefore learning. A lack of focus on restoring the trust of those affected by harm in parallel with the event investigation introduces a risk of further compounding the harm for all involved. Those involved in safety work at NHS England have recognized the need to apply a systems mindset within a concerted effort toward more compassionate engagement for optimal learning and improvement. In response, they have included compassionate engagement and involvement of those affected by patient safety incidents as a foundational pillar in the NHS England Patient Safety Incident Response Framework.

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Restorative Just Culture in Practice

Cited by 14 publications

References 0 publications

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

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

Support for healthcare workers and patients after medical error through mutual healing: another step towards patient safety

Achieving a restorative Just Culture through the patient safety incident response framework

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