Mr. Isaacks' Insider: A Just Culture requires A Just Response

"Just Culture Requires Just Response"

Colleagues –

Most of us have done something in our youth to provoke a parent to exclaim, “that’s why we can’t have nice things!” I know I have ― and perhaps more than once, if you get my meaning. It’s no different with my children.

Shortly after moving into our new house, our girls were horsing around upstairs.

Following a loud bang, one of my daughters came down crying and told me there was something I needed to see.

After making sure no one was hurt, I learned that one of the girls had busted through the drywall in her bedroom. To be honest, the damage was extensive. However, my daughter’s remorse was so genuine that any thought I may have had to use that time-honored parental exclamation quickly faded.

• She didn’t need me to make her feel guilty.
• She didn’t need me to shame her.
• She didn’t need me to make a traumatic situation worse.

What she needed was a fair or “just” response.

In health care, a key component of high reliability is the development and practice of a “just culture.” Within this kind of culture, staff understand they should continuously analyze and report issues without fear of retaliation. A just culture doesn’t promote a blame-free environment. Instead, a team works to balance the cause of each error with an appropriate response that eliminates recurrence.

Establishing a just culture within an organization is accomplished through three important actions:

• Building awareness.
• Implementing supportive policies.
• Building just culture principles into the practices and processes of daily work.

These are not new concepts. However, a significant effort is required to hardwire such crucial principles into an organization’s culture.?

Looking back to the situation with my daughter, I basically had two options that day. I could have screamed at her, which would have made her feel worse than she already did. The other option was to accept that a mistake had occurred by understanding the accidental nature of the situation.

In a moment like this, a leader’s response will determine how an issue is reported in the future. A just response is an important building block of trust, safety, engagement and excellence. In my daughter’s case, I feel that my response was successful because it was fair and appropriate. It also set the tone for future interactions.

Likewise, I have experienced the power of just culture in my professional capacity.

Recently, while reviewing a daily summary of patient reports, I came to one that made me pause with concern. The report outlined an incident that affected patient care. However, as I continued reading, fear was replaced with admiration. The reporter had outlined a systematic approach to identifying the issue, conducted research that led to a solution and offered preventative measures that significantly reduced the chance of recurrence.

What impressed me most about the review was that it was made openly. The reporter used a name instead of remaining anonymous. Identifiable self-reporting is an important sign that just culture is blossoming within an organization. My just response to this report was vital for the sustainment of these important cultural steps and helped our team move forward instead of backward.

How can I respond justly?

• Be an active listener or observer. Leaders should actively hear and understand what took place and focus on the process instead of the person.
• Courage to use the just culture algorithm. The algorithm is a leader’s primary tool for understanding the actions of others and developing a just response. It allows the team to determine if an issue is the result of a failure within a system or the development of unhealthy practices.
• Close the loop. Nothing matters more to an employee than a leader who follows up with resolution. Closing the loop also reinforces the value of incident reporting.

Every just response adds to a just culture ― every time. A culture will become more just with each thoughtful and fair response. As leaders, we can either build trust or tear down the courage of our employees. I’m a builder.

If you have been working on your organization’s culture but have not seen positive results, remember that it’s the leader’s responsibility to grow and nurture excellence. That can only happen through repetitive, just responses to the important issues that you face each day.

I admit I don’t always get it right. For those times, humility is helpful. But when done correctly, I always see positive change within my team and my organization. Every victory reaffirms my commitment to a just culture. And with such a culture, we most certainly can have nice things.

DAVID ISAACKS, FACHE

Executive Health System Director

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