Just culture

In healthcare, a truly just culture must be fair for patients and for health staff — both are equally important. Having a just and learning culture is a vital part of patient safety; it helps prevent things going wrong, as well as ensuring that people are treated honestly and fairly if they do.

Staff who work in a just culture are more likely to do their job well and achieve good outcomes for patients. Patients and those close to them fare better after incidents in organisations where there is a just culture and are less likely to complain or take legal action after an incident.

National policies set the tone for culture in healthcare and can either help or seriously hinder attempts to achieve a just culture.

Healthcare policies should be risk-assessed for whether they are conducive to the agreed definition of just culture before they are put forward.

When things do go wrong and cause harm, it is very rare that this is because individuals deliberately depart from good practice or act maliciously. However, if that were the case, the individuals need to be held to account.

Individual members of staff should never be singled out or made scapegoats for something going wrong which is due to system failure.

Experiencing avoidable harm in healthcare often has a devastating effect on peoples’ lives. How an organisation responds to patients and those close to them after such incidents can itself cause serious harm if done poorly.

Patients are entitled to know what has happened in their healthcare. There must be full openness and transparency, and the patient and those close to them must be given the chance to be involved in investigations if they want to be.

The duty of candour must be fully complied with, but with compassion. Fear of consequences such as litigation or complaints is no excuse for not being open and honest with patients.

Staff involved in an incident which causes avoidable harm can themselves be traumatised by it. They should also be treated fairly and with compassion, with suitable support provided.

Senior management are responsible for creating and maintaining the right culture in their organisation. Organisations should be held to account if they do not nurture a just culture or do not demonstrate that they learn and take necessary action over failures in patient safety.

Staff should be listened to, supported, and helped to learn and improve (if necessary), rather than blamed or punished.

In rare cases of intentional unsafe practice or incompetence that are proven, individuals do need to be held to account. Blame should not be avoided at all costs.

Failure, either by organisations or individuals, to comply with the duty of candour which applies to them is unacceptable and should always have serious repercussions.

Patients and those close to them have a perfectly reasonable right to raise concerns or complaints about medical harm, or to seek compensation and accountability through taking legal action if they need to. They should not be stigmatised for doing so and their healthcare needs should never be compromised as a result.