Transcript What is “just culture”?

Just Culture: The Necessary
Environment for Safe Practice
Sally Watkins, PhD, RN
Assistant Executive Director
Nursing Practice, Education, and Research
Washington State Nurses Association
Objectives
What is a just culture?
What steps can you take to embed a
just culture in your work environment?
What is WSNA doing to help establish
such a culture of safety in the
workplace?
It is from the mission of caring
for people in times of their
greatest vulnerability and need
that health care workers find
meaning in their work, as well
as their experience of joy.
Lucian Leape Institute
Yet, many suffer emotional &
physical harm while providing
care:
Bullied
Harassed
Demeaned
Ignored
Physically assaulted
Physically injured
Workplace safety is inextricably
linked to patient safety.
Unless caregivers are given the
protection, respect, and support
they need, they are more likely
to make errors, fail to follow
safe practices, and not work
well in teams.
Physicians Insurance A Mutual Company
.
Care is complex…mistakes
are inevitable…
So…what’s the “old” culture?
Name, blame, shame
Fear – of retaliation, of termination
Culture of silence
Loss of licensure/ability to work
Lack of administrative accountability
for system issues
Other?
Characteristics of a Just Culture
Atmosphere of trust & respect
Teamwork: “Have each other’s backs”
Encouragement for disclosure
Learning environment
Accountability for behaviors but not
system failures
Recognition that humans do make
mistakes; non-punitive response
Leadership competency alignment
A just culture accepts nobody’s
account as “true” or “right” and
others wrong…Instead it
accepts the value of multiple
perspectives, and uses them to
encourage both accountability
and learning.
Sidney Dekker
Differentiate:
Human error
At risk behavior/negligence
Reckless conduct
Intentional rule violation
» Disciplinary Systems Theory
David Marx, JD
What steps can you take to
embed a just culture in your
work environment?
Personal Leadership
Mindfulness
Creativity
Encouraging consciousness
Suspend judgment
Engage ambiguity
Invite reflection
Acknowledge “something’s up”
Clinical Forethought
Anticipating and preventing potential
problems
“Future Think” – forethought about
specific diagnoses
Anticipation of crises, risks, and
vulnerabilities
Seeing the “unexpected”
Benner, Hooper-Kyriakidis, and Stannard
QSEN Competencies
Quality Improvement
Safety
Teamwork and Collaboration
Patient-centered Care
Evidence-based Practice
Informatics
KNOWLEDGE SKILLS ATTITUDES
Nurses routinely skip breaks &
meal periods to provide patient
care
Ann Rogers, PhD, RN, FAAN
Self-scheduling controls
Take your breaks
Nourish your body
Power naps
Look at number of hours, shifts, days
in a row
Take your vacations
Fatigue is a source of error
Decreased alertness
Decreased vigilance
Decreased
concentration
Decreased judgment
Depressed mood
Impaired performance
Increased anxiety
Assess your fatigue risk
Epworth Sleepiness Scale (ESS)
The Pittsburgh Sleep Quality Index
(PSQI)
www.wsna.org – Practice - Fatigue
EPWORTH SLEEPINESS SCALE
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
Sitting and reading
Watching television
Sitting inactive in a public place (e.g. a theater or meeting)
As a passenger in a car for an hour without a break
Lying down to rest in the afternoon when circumstances permit
Sitting and talking to someone
Sitting quietly after a lunch without alcohol
In a car, while stopped for a few minutes in the traffic
Johns, M.W. (1991). A new method for measuring daytime sleepiness: The Epworth sleepiness
scale. Sleep, 14, 540-545.
Workplace engagement
Do you know your department’s quality
indicators and result trends?
Do you participate in debriefings?
Disclosure processes?
Do you attend staff meetings? Are you on
a committee?
DON’T GOSSIP - “Nothing about me
without me” philosophy re: colleagues
Provide “second victim” support
Report near misses, unsafe staffing
What else can YOU do? (WWFD)
:
Moral Courage!
Speak of up for safety using ARCC:
Ask a question
Make a Request
Voice a Concern (“I have a concern…”)
If no success, use Chain of Command
ARCC from Craig Clapper, HPI)
WSNA’s activities to promote
just culture
Proposed legislation
Continuing education
Resources
Coalition partnerships
The incentive of having a just
culture is to feel free to
concentrate on doing a quality
job rather than on limiting
personal liability, to feel involved
and empowered to contribute to
safety improvements by flagging
weak spots, errors and failures.
Sidney Dekker
To find joy & meaning in your
daily work, you must be able to
answer “YES” each day:
Am I treated with dignity & respect by
everyone?
Do I have what I need so I can make
a contribution that gives meaning to
my life?
Am I recognized and thanked for what
I do?
References
ANA Position Statement “Just Culture” 2010
Barnsteiner, J. (September 30, 2011) Teaching the Culture of Safety. OJIN:
The Online Journal of Issues in Nursing. Vol 16, No 3, Manuscript 5.
Benner, P, Hooper-Kyriakidis, P & Stannard, D (2011) Clinical wisdom and
interventions in acute and critical care. A thinking-in-action approach (2nd
ed.) NY, NY: Springer Publishing Company.
Dekker, Sidney. (2012) Just Culture. Ashgate Publishing Company
Johns, M.W. (1991). A new method for measuring daytime sleepiness: The
Epworth sleepiness scale. Sleep, 14, 540-545.
Lucian Leape Institute. (2013) Through the eyes of the workforce: Creating
joy, meaning, and safer health care. National Patient Safety Foundation:
www.npsf.org
NCSBN Regulatory Action Pathway. From NCQAC March 2013 Agenda.
Schaetti BF, Ramsey SJ, & Watanabe GC. (2008) Personal Leadership.
Seattle, WA: Flying Kite Publications
The Incident Decision Tree: Guidelines for Action Following Patient Safety
Incidents http:www.ahrq.gov/downloads/pub/advances/vol4/Meadows.pdf