Just Culture in Nursing

on the dot Culture in NursingJUST finale An Approach that is Right and in force(p) for the Philippine Nursing SystemBernardo Oliber Alconis Arde Jr., RN, MANNursing has always been regarded as a humanistic science since it has evolved from experience to science. Anchored by altruistic motives, nurses perform nursing c ar to patients with tact and prudence otherwise patients caoutchouc is jeopardized. Hence, it is safe to say that nursing should be a perfect mark an arena where mistake is never an option.While in that location are great efforts by the nursing community to pursue perfection by its evidence-based approach, the fact lifelessness stand that humans are faint. And by human nature, even if nurses make the best choices of care for their patients, other factors aside from these choices may still make them undefendable to committing breaks. If nurses infallibility can never be attained, how then can it be managed?Traditionally, wellnesscares nicety has held individu als accountable for all errors or mishaps that befall patients under their care. When errors occur, the fast solution is to blame an individual for the error. Blaming individuals creates a culture of fear, discourages open reporting and discussion of errors, and does little to restrain future errors or improve the safety of the health care system (NCBON, 2011). According to Leape (2000), as cited by American Nurses Association (2010) these approaches that focus on punishing individuals instead of changing systems provide strong incentives for race to report only those errors they can non hide. Thus, a punitive approach shuts off the information that is needed to identify faulty systems and create safer ones. In a punitive system, no one learns from their mistakes. Many observers attribute underreporting to the punitive (name and blame) approach that many healthcare organizations have taken with regard to safety incidents. By inculcating a sense of fear, the punitive approach disc ourages reporting and, in doing so, prevents organizational learning and improvement (Barach Small, 2000 Blegen et al., 2004 Kadzielski Martin, 2002 Kingston, Evans, Smith, Berry, 2004 Manasse, Eturnbull, Diamond, 2002 Wakefield et al., 2001, 1999).As an alternative to this traditional system, application of a model which is wide used in aviation industry known as the Just Culture Model seeks to create an environment that encourages individuals to report mistakes so that the precursors to errors can be better understood in order to fix the system issues (ANA, 2010). Just Culture, as defined in aviation industry, is a culture in which apparent movement line operators are not punished for actions, omissions or decisions taken by them that are commensurate with the experience and training, but where gross negligence, wilful violations and destructive acts are not tolerated (Eurocontrol, 2014). Reason (n.d), as quoted by Skybrary (n.d) statute titleed that it is an atmosphere of t rust in which people are encouraged, even rewarded for proving essential safety-related information but in which they are also clear about where the line must be drawn between acceptable and unacceptable behaviour.In 1997, as mentioned by ANA (2010), fanny Reason wrote that a Just Culture creates an atmosphere of trust, encouraging and rewarding people for providing essential safety-related information. A Just Culture is also clear about what constitutes acceptable and unacceptable behavior. Therefore a Just Culture is the middle component between patient safety and a safety culture (Reason, 1997). However, the term Just Culture was first used in a 2001 report by David Marx (Marx, 2001), a report which popularized the term in the patient safety lexicon (Agency for Healthcare Research and Quality, n.d.). Further he argues that discipline needs to be tied to the behavior of individuals and the potential risks their behavior presents more than the actual outcome of their actions (Marx , 2001).In the health care arena, Medscape (n.d) emphasized that Just Culture recognizes that human error and faulty systems can cause a mistake and encourages an investigation of what led to the error instead of an immediate rush to blame a person. A just culture, expert say, is a non-punitive environment in which individuals can report errors or crocked calls without fear of reprimand, rebuke, or reprisal (Blegen et al., 2004 Karadeniz Cakmakci, 2002 Kingston et al., 2004 Pizzi, Goldfarb, Nash, 2001 Wakefield et al., 1999 Wild Bradley, 2005). The pattern of a fair and just culture refers to the way an organization handles safety issues. Humans are fallible they make mistakes. In a just culture, hazardous human behavior such as staff errors, near-misses and risky actions are identified and discussed openly in hopes of finding ways to improve processes and systems not to identify and punish the individual (Pepe Cataldo, 2011).In the Philippines, where nurses face a lot of wor kplace-related issues such as understaffing, undue remuneration, and contrasted employers to name a few, they become more vulnerable to making mistakes. With so much pressure at hand due to how these errors are addressed currently plus the fact that nurses are more often unappreciated, they may burnout putting the delivery of care at stake. This existing practice is opposed by the model of Just Culture, where according to Pepe and Cataldo (2011), is a model that distinguishes among human error, at-risk behavior, reckless behavior, malicious willful violations and the corresponding levels of accountability.Moreover, just culture is not a blame-free approach. It is a dodge that gets into the root of the problem, whether it is a worker wilfully contributing to the error or the system providing inadequate support to the workers need. Furthermore, it is a system of justice that involves both investigatory action and disciplinary action. Hence, a just culture stands between a blaming or punitive culture, on the one hand, and a no-blame or anything-goes culture, on the other. This view reflects the connotation of balance typically associated with the terms just or fair. (Weiner, Hobgood Lewis, 2007). It balances the need to learn from mistakes and the need to take disciplinary action where appropriate.In a setting where just culture is implemented, encouragement of error disclosure is emphasized through open communication. As stated in Skybrary (2014) the personnel is clear, that in the interest of safety, the organisation wants to know, at all times, about unsafe events, unsafe situations that have presented themselves or could arise. They are keen to step forward and speak up when they perceive a situation as dangerous, think of a procedure as risky, or any other issue in their daily tasks that they infer as potentially harmful and are yet without good remedy. This system makes sure the staffs are motivated to report and the trend must be maintained. Moreover , whenever there are reports, the organization assures that they are acknowledged, discussed properly and provided with appropriate feedbacks.When errors occur, the person who committed the error is not blamed instantly. He or she is not punished now but rather a safety investigation is initiated to determine the proper disciplinary action. The organisation investigates why this error was made and what can be through to avoid them or to mitigate the effects for future operations. The workforce is protected as best as possible from negative consequences resulting from human error or subsequent investigations and in principle the organisation will defend and support people should external prosecutions or litigations target them. The organisation attempts to repair the situation as best as possible and restore the operations to normal. The organisation provides compensation for those that have experienced personal loss or damage. The organisation tries hard to prevent that same event from happening again. A case is not closed by condemning or finding the guilty one, but by discovering the underlie problems in the system, by rectifying this and by repairing the damages done (Skybrary, 2014).When the problem is discovered, rectified and repaired, the organisation then communicates the situation with confidentiality to all the members of the group. This dissemination intends not to humiliate psyche but rather provides a learning platform for everyone. In just culture, the error that has happened was seen not as something to be fixed but rather an hazard of learning and ironing the system. It creates an environment of introspection while errors are discussed and collectively outlines improved policies, protocols and/or guidelines. It also shapes a venue for the enrichment of managerial competencies.Hence, it is an implicit claim of just culture that it is inevitable for practitioners to commit mistakes that even the most experienced individual is capable of makin g mistakes. It is also implied in just culture that penalty is not an assurance that workers will not be making mistakes and that perfecting a performance is impossible and can never be sustained.ANA (2010), in their position report card about this concept officially endorse the Just Culture concept as a strategy to reduce errors and promote patient safety in health care. In their efforts to endorse this non-punitive approach, they promote and disseminate information about the Just Culture concept in ANA publications, through constituent member associations, and ANA connected organizations. Hence, the feasibility of incorporating this approach in the present system in the Philippines must also be taken into consideration.However, the adopting organization must develop its own strategies in implementing just culture. It is because no single method fits all in applying the just culture. This concept, when used as an approach in improving the quality of care, must be contextualized depending on the acceptance and capability of the institution to implement this model. Once this approach is incorporated in the system, ANA (2010) encourages continued research into the effectiveness of the Just Culture concept in improving patient safety and employee performance outcomes. To this end, Just Culture might just be the absolute answer to the faulty system not only of nursing but might as well the entire Philippine Healthcare system.ReferencesErickson, A. K. (2012, November 1). Step forward Hospital journey to Just Culture. pharmacist.com. 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