The Just Culture Model on Patient Safety - Research Paper Example

? The Just Culture Model on Patient Safety Introduction The alternative to a punitive system is the application of the just culture model. This is a model that has been widely applied in the aviation industry. The model seeks to encourage an environment where individuals report their mistakes so that solutions of the errors are understood so that the underlying issues are fixed. The mode teaches us to shift attention from judging others retrospectively. It is focused on the degree of the outcome to the evaluation of real time behavior choices in an organized and rational manner. The approaches of models that focus on the punishing of the individuals, instead of focusing on changing the system, provide a strong incentive to the people to report only those errors that they absolutely cannot get away with. This is called the punitive approach model. It shuts off the necessary information required to identify the fault in the system and create safer systems. In such a system people do not learn from their mistakes. Discussion of need/purpose for A Just Culture Model for Patient Safety To improve the quality of overall health care system, there is a need to improve on the culture of safety within the health care. This is an essential component when it comes to reducing errors. A just culture can thus be said to be one that is supportive of shared accountability. It holds the organization responsible for systems that it has chosen to design and for how they choose to respond to the behavior of staff in a just and fair manner (Manasse et al, 2005). For their part, the staff are the ones who are accountable for the quality of the choices that they make and for the reporting of the errors they make and the vulnerabilities of the system. This paper aims at discussing the concept of the just model and its application in the health system cultures (Manasse et al, 2005). The market recognition program has five concepts that were developed by the American Nurses credentialing center. This program reflects the focus of the healthcare system on the achievement of superior performance as shown in their outcomes. These components stress the fact that the outcomes of infrastructure developed for excellence are highly essential to a culture that promotes excellence and innovation, of which a prime component is safety. These components include, Empirical Outcomes, Transformational Leadership, Exemplary Professional Practice Empowerment, Innovations and Improvements, New Knowledge and Structural Just Culture (Manasse et al, 2005). “Just Culture” is not discussed in this context; however, it is in tandem with the case model. In reference to transformational leadership, it fronts for advocacy as an attribute of patients as well as leaders in nursing. In terms of Professional Engagement, imminent evidence in this case is that which would promote organizational leadership as part of nursing (Technology, 2012). Objective(s) The major focus of just culture is to increase the safety of patients; this is done through effective reporting, modification of the system, accountability and remediation. The objectives of the just culture are to increase the number of medical personnel, who report information regarding medical malpractice, increase remediation that is sponsored by the employer to incorporate the culture in the review of complaints regarding malpractice, create a patient safety database for the whole state, assist in the development of the national safety database and increase use of practice intervention and improvement program, which is an alternative to the discipline program (Reiling, 2007). The main objective of the just culture is to establish a mindset that is organization-wide which will positively influence the workplace environment and the work outcome in many ways. This concept promotes culture where mistakes and errors in the workplace do not result in automatic punishment but a process from which the source of the error can be established. The objective of this culture is promoting an environment where unintentional errors result in counseling and education around the error. This will decrease the chances of a similar error taking place (Zuzelo, 2010). The increasing of error reporting will lead to revisions in the health care delivery systems. It will create a safer environment for patients and for individuals to receive services. This gives the nurses, doctors and other medical personnel a sense of belonging in the process (Zuzelo, 2010). The objective of the culture is to improve the work environment. This will be done as nurses and the other workers deliver services in a safer and better functioning system. The culture in the workplace will be one that encourages safety and quality over immediate blame and punishment (Zuzelo 2010). Description of the Just Culture Model for Patient Safety The just culture correlates well with the nurses’ critical thinking skills and their process when they are trying to identify the root causes of errors. The nursing and other medical occupations rely heavily on the ability of the personnel to assess a situation, diagnose the problem and come up with a plan that can help in improving the situation or avoiding the problem. This is a model that is naturally fit for the nursing environment. For the student and staff nurses, this concept of a just culture gives them an opportunity of feeling more at ease when they are reporting errors and problems. It also promotes a sense of accountability for the improvement of the system (Technology, 2012). The just culture represents an opportunity for the nurses and educators. This is the opportunity to help in the improvement of the care delivery for individuals and patients and the environment for those that work in those environments. Disruptive and intimidating behaviors can promote medical errors since they contribute to poor satisfaction for the customers and hinder the prevention of adverse outcomes. The cost of care increases, which results in qualified administrators, clinicians and managers looking for new positions in organizations that promote the just culture model (Technology, 2012). Teamwork and collaboration and communication at work place are the determinants for the quality of the services offered to patients. To ensure the quality of the services offered and to promote the safety culture a health organization must address the issue of the behaviors that threaten the performance of the healthcare organization. A care organization should also promote the no-tolerance approach to such behaviors and include a professional code of conduct (Reiling, 2007). Use of Available Evidence This is the first position that ANA has taken on the just culture concept. NA, through the national center for quality nursing, has for long been working with incentives for patient safety, which includes the national database that holds nursing quality indicators. They handle the care campaigns, safe staffing and saving lives campaign among others to promote the just culture. In the year 2000, the House of Delegates adopted the report on building a safe system for health care for informed patients (Reiling, 2007). In the year 1997, Reason John wrote that the just culture concept creates a trust atmosphere in a work place. This encourages and rewards people for the provision of essential information that regards the safety of this model and also explicitly articulates the constituents of acceptable and unacceptable behavior in the workplace. He goes on to say that this concept forms the middle component between a safety culture and patient safety. He argues that the concept of discipline should be tied to the individual behaviors and the risks that their behavior presents more than the real outcome of the problem (Reiling, 2007). The model addresses two questions: the first is the role of punitive sanction in maintaining the safety in the health care systems and the second is whether the application of the threat of punitive sanction, when used as the remedy for human error, hurts or helps our system in its safety efforts (Reiling, 2007). The model is based on recognition of the fact that humans are forever destined to make mistakes and the result of this is that there is no system that can be developed to be error free and perfect in the results. Given this, the adverse events and human error should only be considered as outcomes to be measured and monitored. In doing this the goal is error reduction instead of error concealment and the improvement of the system design (Manasse et al, 2005). In addition to this, the just culture model groups the classes of human behavior into three, and these three create predictability in the occurrence of errors. The first of the three is a simple human error. This is inadvertently doing otherwise than what is required to be done. The second is risk-behavior, which occurs when a choice in behavior is made and increases the risk where the risk has not yet been identified or it is mistakenly believed to have been justified. The third of the three is reckless behavior. This is action taken in conscious disregard for an unjustifiable and substantial risk (Manasse et al, 2005). Outcome Many lessons are learnt from the just culture model. Many errors are caused by activities that rely on the weak aspects of cognition. These are the attention span and short-term memory. The just culture enables workers to avoid their reliance on vigilance and memory and to employ the use of checklists and protocol, standardize and simplify use of constraints and the forcing of functions (Dekker, 2007). This culture has enabled organizations to spot trying to change the condition of humans but to change the conditions under which the workers work. This is easy to implement using the just culture model (Byers & White, 2004). The concept of a “just culture” has enabled workers in the heath care institutions to: 1. Create a fair, open and just culture to promote a learning environment. Organizations must stop the use of overly-punitive reaction to errors and events. The organizations must instead recognize their own fallibility that can only bring more errors and this will be drifting away from what has been learnt. 2. Creation of a learning culture- this is the foundation of the safety of patients. It is a culture that seeks knowledge and in the case of the safety of patients, it promotes risks at the organizational and individual levels. These risks can be seen in the events and near misses, or by the mere observing of the systems design of the work place and individual behaviors and those in the neighborhood. 3. The design of safer systems. The system of the workplace is the factor that has the greatest impact on patient safety. Organizations must ensure that they adopt systems that anticipate the possibility of human error and their capture before they become highly critical and permit for recovers when the errors reach the patient. 4. Management of behavioral choices- this is the second cornerstone in the safety of patients. We must anticipate that as humans we are prone to make mistakes. It is through how we manage behavioral choices that we allow ourselves to achieve the safety desired outcome. Impact by CNS and/or CNS Student The employment of this model of just culture in our health care systems will affect clinical nurse specialist students in a way consistent with how they are expected to behave in their workplace. The behavior of these students must be one that reflects the concept of a just culture. The students will face a huge change when they are incorporated into the health care systems. They will be expected to adjust themselves from the culture that they were used to in college to the just culture that is encouraged and promoted in the working environment (Byers & White, 2004) Normally incidents are kept under wraps and are mostly not reported to the management or to those who are in charge. Just culture encourages the reporting of such matters so that a remedy to the underlying problem is found before the situation worsens (Dekker, 2007). Aspects of Spheres of Influence and Synergy Model Exemplified The CNS system has three domains of practice; this is known as the three spheres of influence. They are the nursing personnel, patient and the health care system. The three spheres overlap each other and are interrelated. Each sphere, however, posseses a focus that is distinct and the primary goal of all the spheres are for the continuous improvement of the outcomes of the patients and the nursing care (Dekker, 2007). Within the CNS spheres of practice, there was the identification of seven core competencies (Byers & White 2004); 1. Direct clinical practice 2. Expert coaching 3. Collaboration 4. Consultation 5. Research 6. Professional leadership in the clinical environment 7. Ethnical decision making. Conclusion The just culture model is one that is helping employees in health care organization be more effective in what they do. The healthcare system will then have a reduced casualty rate as the employees will be keen on reporting errors and mistakes that have occurred in the process of practice. This can then be assessed and a satisfactory solution to the evolving problem found before the situation develops to a critical level. This is the concept that has proven most fit to be employed in out health care organizations and will ensure that there is improved safety in the system and better customer service and satisfaction with the services offered. References Byers J. F, White S. V. (2004). Patient safett: Pprinciples and practice. New York: Springer. Dekker S. (2007). Just culture : Balancing safety and accountability. Aldershot: Ashgate. Manasse H. R, Thompson K. K, Pharmacists A. S. (2005). Medication safety : A guide for health care facilities. Bethesda: American Society of Health-System Pharmacists. Reiling J. (2007). Safe by design : Designing safety in health care facilities, processes and culture. Oakbrook Terrace: Joint Commission Resources. Technology. (2012). Health IT and patient safety : Building safer systems for better care. Washington: National Academies Press. Zuzelo P. R. (2010.). The clinical nurse specialist handbook. Sudbury: Jones and Bartlett Publishers. Read More