Research interests and statement
The Relationship between Just Culture, trust, and patient safety
Medical error is now identified as the third leading cause of death in the United States. Error is often the fault of systems, processes, and various conditions not the individual who makes the error. Speaking up about errors is the cornerstone of the process by which we learn to avoid repeating them. Unfortunately, a major problem associated with this process is under-reporting. Studies and surveys have found that negative response from administrators and the potential for disciplinary action are primary barriers to speaking up about patient safety issues that are faced by nurses when they deliver care in an increasingly complex environment. Just Culture, an organization’s atmosphere of trust and fairness, has a direct impact on the likelihood that staff will report concerns. This culture is important because it helps to create a psychological safe haven that supports nurses’ ability to speak up.
My research and capstone study identified the difference in the perceptions of just culture between direct care nurses and nurse leaders in a large urban hospital. Healthcare leaders need to be aware of the just culture perceptions of their staff and develop strategies to improve fair outcomes especially regarding any type of incident investigation. Error reporters (most often nurses) must have complete confidence that they will not face retribution or retaliation as a result of disclosure because human error is inevitable. Leaders of organizations are responsible for the design of systems in which nurses provide care. They need to be confident that these systems support staff in their ability to provide care in a reliably safe process. When an error or incident occurs and is analyzed, outcome is attributed to either a system or individual. If the cause is the system then the leaders are accountable to correct it. My study utilized an assessment tool that identified gaps in just culture perception and uncovered incident investigation process that did not always value system redesign over individual accountability. It is likely that this analysis of investigations contribute to fears of discipline and retribution of direct care staff.
I envision future studies to assess trust and just culture perceptions by other members of the interdisciplinary team. These studies are key, as all care is provided by team members where interrelations are increasingly valued. Learning if there is a difference between team members perceptions of just culture is as equally important as between direct care staff and leaders.
Understanding whether the use of an algorithm will alter assignment of individual and system accountability following incident investigation is another significant study to build on. I have special interest in developing an objective tool utilizing just culture principles of behavioral choice to guide leaders during analysis. I hope to identify whether this can promote leaders and direct care staff perceptions of trust to be more closely aligned.
Finally, it is through including just culture concepts in healthcare leadership coursework that we can prepare future workers to create an atmosphere of trust and fairness for all staff in any organization.
Research related publications and presentations
This entry is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International license.
