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Just culture

"Safer patients — every patient, every time"

A just culture of safety — what is it?

Patient safety word collage
  • "Safer patients — every patient, every time."
  • recognizes adverse events (accidents in Québec) can occur
  • takes steps to avoid or reduce risks
  • deals effectively with harm when it occurs
  • is a supportive learning environment that implements improvements leading to safer patient care
  • facilitates fairness for both patients and healthcare providers
The culture of an organization is often described as "the way we do things around here." In recent years, it is recognized that a just culture of patient safety is essential if physicians and other healthcare workers are to provide safer care.

Think about it

How would you describe the culture of your medical school, or any hospitals or community practices you have been in?

A just culture of safety recognizes that, while mistakes do happen and outcomes are not always ideal, all healthcare providers work together and share knowledge. It also recognizes that appropriate policies and procedures aimed at safer care are in place. Individuals are encouraged to critically assess everyday situations for their potential risk.

As learners, medical students may feel it is inappropriate to comment on risky situations they observe. In a culture of safety everyone is encouraged to note potentially unsafe situations and to recommend improvements.

A challenge to a just culture of safety stems from hierarchical structures in hospitals and medical schools that may inhibit individuals from making this kind of contribution. This can be worsened when people in positions of authority — or even those without authority — trivialize either the problems or the value of the contribution made by other team members. A just culture respects everyone who has questions or concerns about potential risks.

In a just culture, the interests of both patients and providers are protected when an adverse event occurs. Such events are analyzed to support and educate administrators, healthcare providers, and patients to prevent similar events in the future. The professional accountability of healthcare providers is determined fairly.

Many different approaches aim to advance an understanding of how to make care safer; increasingly, these are evidence based.