High reliability — or the sustained performance of high levels of safety — is a relatively new concept in health care. Other high-risk industries, such as the nuclear power and commercial aircraft industries, have exemplary safety records. What we have learned from these organizations is that they display key common features: leadership commitment, high reliability, a culture of safety and organizationwide use of process-improvement tools.
Attaining a culture of safety is essential to establishing and maintaining high reliability in health care. The bedrock needed to support that culture is trust. Trust that management will review reported medical errors and manage behavioral choices fairly and consistently, with a focus on improving hospital procedures. By aligning faith in safe system design and fair and consistent management of behavioral choices, health care systems become safer for
UF Health participates annually in the Agency for Healthcare Research and Quality’s Culture of Safety survey to measure our culture improvements over time and to benchmark against other teaching hospitals. Since 2008,
UF Health has made continual improvement in staff perceptions of patient safety. To further advance our culture of safety toward achieving national recognition as a leader in health care safety, UF Health is initiating training for hospital managers and physician clinical leaders.
The Just Culture model assumes that by nature everyone is capable of doing three types of actions that can lead to harm, and that each action should be managed differently. The model requires managers to examine the facts of each event without allowing the severity of the outcome to influence their decision to address the situation and those involved. In a Just Culture system, human errors, such as a mistake, are always consoled and improvements are made to error-proof the system. At-risk behavior, or choosing not to follow safety rules because the risks of harm seemed low, is always coached and the system is changed to make it easier to do the right thing. Reckless behavior, a conscious decision to breach a rule without regard for the potential outcome, is rare. In a Just Culture, reckless behavior receives corrective action.
Staff members who choose not to follow safety rules after being coached also will receive corrective action.
Many of our managers naturally follow Just Culture concepts. Now the Just Culture framework provides a uniform roadmap for all managers to follow when investigating events. By creating a consistently fair and just environment, staff members learn to trust that their event reporting leads to earnest investigations into faulty health care systems. Staff members will become even more engaged in process improvement efforts and have a greater confidence that patient safety is improving across the organization.