Nurse 600
Just Culture: Theories and Concept to Implement a Change
To modify healthcare policies in a facility to a Just Culture environment, one must learned what “Just Culture” entails. By using economic, organizational change, and systems science theories and/or concepts a Just Culture program will be implemented into a facility by a leadership team. Just Culture
Mistakes and errors caused by medical providers happen in the healthcare field, resulting in punitive actions against the provider. As cited by Geffken-Eddy (2011) studies by the Institute of Medicine have shown that punishment will only lead to more medical errors or providers not reporting their wrong doings unless the risk of being caught is great. A new way to implement safer practices is to introduce a concept called “Just Culture” to a workplace. Just Culture consists of a work environment which healthcare providers are encouraged to provide essential safety-related information and report mistakes of their own or others (Geffken-Eddy, 2011). Having a Just Culture allows for open communication among healthcare workers to admit to their mistakes and using those mistakes as stepping stones to learn different means to prevent the error from occurring again. Economic
Economics theories can be broken down into a microeconomic theory, which focuses on the individuals in a group and the action of supply and demand, which drives the economy (Anderson, 2013). Scarcity becomes a driving force for consumers to act; for example, when a product is scarce, the demand becomes greater and product becomes costly affecting the consumer’s ability to obtain the product (Anderson, 2013). To relate the microeconomics theory to healthcare and implement Just Culture, one must view the healthcare providers’ services as valuable products that could potentially become scarce. Because healthcare is a product that needs to be readily accessible
and affordable to patients, one must keep healthcare supply abundant. Healthcare provider’s services and time can be kept in abundance by maintaining a Just Culture environment. By treating all workers fairly and encouraging a safe environment thru utilizing the mistakes made as learning concepts, the worker’s morale will improve and the work they provide will be of abundance (Geffken-Eddy, 2011). It is also essential to maintain services provided by healthcare providers abundant because if a company was to lose more providers, the existing workers will have to work more and harder to keep up with the demands from the consumers (patients). Patient safety may be affected by the increased workloads a healthcare provider accrues, hindering the effects of a Just Culture. By encouraging workers to engage in safer practices, not punishing them for mistakes, Just Culture will improve the overall work environment for workers; therefore, maintaining the services at an abundance. Organizational Change
Change Theory, introduced by Kurt Lewin, states that change in an institution is necessary but can only be achieved by the whole organization not just individuals. (Bishop, 2011,p.357). Lewin believed that change is a three-step process, which includes: unfreeze, change and refreeze (Connelly, n.d.). Implementing Just Culture into an existing work environment by utilizing those three steps will be beneficial. The first step, as described by Lewin, is to unfreeze, which involves leadership teams stating the reason for the change. The leadership team needs to teach the healthcare providers by providing statistics and information behind the reason of changing to Just Culture. Motivation for change needs to integrated in this first step. Secondly, once the workers accept the idea of a change, it is time to implement the changes. Lewin labels this part as the change or transition period. (Connelly, n.d). Steps toward Just Culture need to be started and workplace policies need to be changed to reflect Just Culture. When mistakes happen the leadership team must pull workers aside to find how the error occurred and discuss ways to prevent it from happening again without any punitive actions to the worker. Lastly, the refreeze step needs to be incorporated. Levin describes this step as maintaining stability in the new change (Connelly, n.d.). To maintain the new change to a Just Culture, management teams needs to continue safety improvements by utilizing worker’s
mistakes or errors as grounds for change within a system.
Systems
Applying a systems concept to Just Culture is possible by using the Theory of Goal Attainment. Imogene King developed Theory of Goal Attainment, which focuses the relationship between systems and the occurrences of processes and outcomes (goals) (“Goal attainment theory: key concepts”, n.d.). King incorporates three systems; personal, inter-personal and social in which all three will interact together. Personal system will be the healthcare worker; this person will gather information to explore further about themselves and their environment (Gonzalez, Moreno-Fergusson, Whetsell, p.424). Next is an interpersonal system, which involves groups of people. The interpersonal system can be viewed as the leadership team and the healthcare providers. Six concepts are integrated in the interpersonal system: communication, roles, stress, coping and transaction (“Goal attainment theory: key concepts”, n.d.). Focusing on communication, it is necessary for individuals to use communication “to make transactions, such as setting goals, choosing strategies for attaining the goals” (Gonzalez, Moreno-Fergusson, Whetsell, p.425). Just culture can be successfully implemented by having the leaders communicate clearly with the healthcare workers. Leaders also have the role of providing clear and concise rules in regards to the Just Culture model. Lastly, King described a social system, which is the interaction between everyone within an environment (“Goal attainment theory: key concepts”, n.d.). Having an environment that is geared toward safe, adequate patient care with the use of the leadership team will enable the workers to shift toward the Just Culture model.
References
Anderson, K. (2013). The Difference Between Macro and Microeconomics | Mint.com. Retrieved October 13, 2013, from https://www.mint.com/the-difference-between-macro-and-microeconomics/ Bishop, S. (2011). Theories of organizational behavior and leadership. In J. Butts & K. Rich (Eds.), Philosophies and theories for advanced nursing practice (pp. 347-362). Sudbury, MA: Jones & Bartlett Learning, LLC. Connelly, M. (n.d.). Kurt Lewin model of change. Retrieved October 12, 2013,
from http://www.change-management-coach.com/kurt_lewin.html Geffken-Eddy, D. (2011, October 11). Implementing a just culture on advance for nurses. Retrieved October 5, 2013, from http://nursing.advanceweb.com/Features/Articles/Implementing-a-Just-Culture.aspx Goal attainment theory: key concepts. (n.d.). Retrieved from http://imogenekingtheory.blogspot.com/p/key-concepts.html
Gonzales, Y., & Moreno-Fergusson, M., Whetsell, M., (2011). Models and theories focused on a systems approach. In J. Butts & K. Rich (Eds.), Philosophies and theories for advanced nursing practice (pp. 413-443). Sudbury, MA: Jones & Bartlett Learning, LLC.
