Creating a Just Culture: Nursing Best Practices

Safety and equity are considered integral components of quality healthcare. By prioritizing a just culture, nursing leadership can better target these key considerations for improving patient outcomes. But, what is just culture in healthcare? We’ll explore the meaning of just culture and discuss ways that you can integrate this principle within your organization.

What Is Just Culture in Healthcare?

While there is a broader just culture definition in healthcare, it does have a specific application to nursing. Just culture is a management principle focused on sharing and balancing nursing accountability with the organization’s responsibility for systemic flaws. Nurse leaders uphold this culture by ensuring that when errors occur, staff are treated in a fair and safe manner, free from retaliation.

Healthcare organizations are complex, and intricate processes can contribute to the occurrence of medical errors. This is why the individual clinician and the organization should share accountability. So, what is just culture in nursing specifically? It exists when nurses become empowered to report mistakes and system safety concerns because the culture they operate in focuses on correcting and preventing problems, instead of simply blaming and punishing individuals.

Building a Just Culture: Nursing Best Practices

There are many factors that go into building a just culture. Healthcare and nursing leadership can follow these five best practices to ensure that all staff are treated in a fair and safe manner.

1. Build Upon Existing Culture

When implementing a just culture, nursing leaders should try to maintain the foundations of their existing workplace culture. Foundational values like trust and communication underscore the just culture prioritization of respect and support. Reinvesting in these key aspects of your culture will allow new, innovative approaches to take root.

Tips:

• Consider hosting a nursing hackathon event where subject matter experts unite to tackle barriers to just culture in time-limited meetings. It’s like focusing a laser of expertise on specific problems to quickly generate workable solutions.
• Promote the formation of a nursing committee with the specific goal of improving and standardizing an organizational approach to instituting just culture.

2. Report and Respond to Errors

Open and honest reporting of errors is essential to maintaining just culture. Healthcare informatics rely on accurate, transparent reporting to reveal process failures that also bear responsibility for medical errors. Reviewing collected data not only helps target any needed education and training, but can also help to address systemic issues that contribute to negative outcomes.

Tips:

• Develop an efficient, standardized reporting system to collect information necessary for achieving an effective root cause analysis (RCA) investigation.
• Educate nursing staff on risky clinical behaviors such as corner cutting, falsifying documentation, and recklessness. Arming your staff with information about red flags for patient safety can help team members identify a problem and speak up when necessary.

3. Collaborate With Stakeholders

Every healthcare discipline that interacts with patients and senior management must be involved in creating a just culture. Nursing staff members are often instrumental in fostering multidisciplinary collaboration and leveraging the nursing chain of command to more effectively advocate for reform.

Tips:

• Mandate interdisciplinary collaboration engagement during formation and implementation of just culture. Interprofessional teams should be involved in RCA investigations and devising reformative policy changes, for example.
• Include consistent, dedicated agenda items within routine stakeholder meetings for addressing recent incident reports and RCA findings.

4. Create Policies and Procedures

In collaboration with the team, nurse managers develop and implement standardized processes to ensure the success of a just culture. Clear, intentional, and well-drafted policies and procedures are critical to helping your organization and staff make decisions, take appropriate action, and serve as the guideline for daily operations.

Tips:

• Ensure that practice standards and policies clearly define expected behaviors and preferred processes for when the unexpected occurs, especially following incidences as serious as a sentinel event.
• Clarify policies with definitions that explain the difference between human errors, at-risk behaviors, and reckless behaviors with corrective actions that are standardized and specific to the potential for harm they pose.

5. Train and Educate Staff

Ongoing education and training is essential for promoting just culture. Nursing educators and human resources (HR) staff are excellent sources for content suggestions and development.

Tips:

• Establish just culture expectations immediately via standardized onboarding materials and orientation programs.
• Set the foundation for a just culture by educating staff on its principles and why it’s vital. Schedule regular training sessions to highlight policy changes and updates as they occur and to debrief the takeaways from incident reporting.

Implementing Your Just Culture: Nursing Rollout Plan

The better prepared your team is, the smoother the implementation will be. The table below outlines an example of a rollout plan to help you get your just culture training program implemented.

Ready to Lead the Healthcare Culture Shift?

By championing just culture, nursing leaders can more effectively optimize patient outcomes. Harness this energy at your organization with IntelyCare’s consistently updated facility guides and best practice recommendations and realign your culture to match your evolving goals.

IntelyCare writer Diana Campion, MSN, APRN, ANP-C, contributed to the research and writing of this article.