The concept of a fair and just culture refers to the way an organization handles safety issues. Humans are fallible; they make mistakes. In a just culture, ‘hazardous’ human behavior such as staff errors, near–misses and risky actions are identified and discussed openly in hopes of finding ways to improve processes and systems—not to identify and punish the individual.
—Pepe & Caltado, 2011

This Discussion examines the opportunities of managers in working with groups to promote change that facilitates the delivery of safe, high–quality care.

To Prepare

• Review the information on just culture presented in the Learning Resources.
• For this discussion, you will use the Regulatory Decision Pathway found in Russell, K. A. & Radtke, B. K. (2014).
• Examine an adverse event at the unit level in your organization or one with which you are familiar and apply the Regulatory Decision Pathway.
• Compare the findings of the Regulatory Decision Pathway to what actually happened at the unit in your organization. Was the event deemed: bad intent, reckless, at risk, or human error? According to the pathway, do you now think it was the correct action?
• Think about how a nurse leader–manager may use just culture as a framework to create or maintain a focus on accountability and outcomes throughout a group. What actions could be taken if a systems–related error was made or if an error resulted from risky behavior?
• How might role conflict and/or ambiguity have contributed to the situation?

Learning Resources

Note: To access this weeks’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Dekker, S. & Nyce, J. (2013). Just culture: “Evidence, power and algorithms. Journal of Hospital Administration, 2(3), 73–78. Retrieved from http://sidneydekker.com/wp–content/uploads/2013/01…

Lockhart, L. (2015). Does your organization have a just culture?, Retrieved from http://www.NursingMadeIncrediblyEasy.com DOI–10.1097/01.NME.0000457286.16594.92

Document: Russell, K. A. & Radtke, B. K. (2014). An evidence–based tool for regulatory decision–making: regulatory decision pathway. Journal of Nursing Regulation, 5(2), 5–9. (PDF)
Copyright 2014 by Elsevier Science & Technology Journals. Used with permission of Elsevier Science & Technology Journals via the Copyright Clearance Center.

Outcome Engenuity (2016). Outcome Engenuity. Retrieved from https://www.outcome–eng.com/

Pepe, J., & Cataldo, P. J. (2011). Manage risk, build a just culture. Health Progress. Retrieved from http://www.outcome–eng.com/wp–content/uploads/2012…

Spreitzer, G., & Porath, C. (2012). Creating sustainable performance. Harvard Business Review, 90(1/2), 92–99.
Retrieved from the Walden Library databases.

Document: Tips on Distinguishing Peer Reviewed Articles (PDF)

Document: Outline for Strategic Plan for Change (Word document)

Optional Resources
West, E., Holmes, J., Zidek, C., & Edwards, T., (2013). Intraprofessional collaboration through an unfolding case and the just culture model. Journal of Nursing Education 52(8), 470–74. doi:10.3928/01484834–20130719–04
Retrieved from the Walden Library databases.
MedStar Health. (2014). What does it mean to adopt a fair and just culture in healthcare? Retrieved from