Patient safety – Just culture

The term ‘just culture’ describes a culture that does not focus on blaming staff when things go wrong, but one that successfully focuses on and learns from wider systemic issues.

There will be rare circumstances where individual healthcare staff member performance issues arise, and these should be addressed through the appropriate channels. However, as a whole healthcare staff endeavour to provide optimal care to their patients, and a culture that firstly focuses on blaming staff leads to a reluctance of staff to speak up when things do go wrong. Supporting staff to report issues without fear of retribution and accountability creates an environment focused on pro-actively identifying and addressing actual and potential patient safety concerns, leading to a safer health system for patients and increased psychological safety for staff.

The concept of just culture is explained in this video presented by Dr Matthew Thomas. Also watch this video that highlights the concept of the second victim in a patient safety event: the staff involved in the event.

Cultivating a reporting culture

A just culture enables the cultivation of a reporting culture focused on patient safety. Key components of a reporting culture are:

1. Establishing trust to improve reporting: leaders help to create an environment where it is psychologically safe to report. Psychological safety is very important in terms of ensuring people feel safe to speak up8 . Programs which acknowledge or give positive recognition for reporting (ie “Good Catch programs”) reinforce the trust being built.

2. Eliminate fear of negative consequences: Tied with the above establishing trust also means establishing that reporting will not have negative consequences to the clinician reporting or the clinicians involved.

3. Examine near misses: This assists in developing more mature processes to respond to poorly detected risks. It helps to provide information on potential system weaknesses in the environment.

Clinical Incident Management and Medical Indemnity

As per the CIM Guideline 2019, any staff member can identify that a clinical incident has occurred including both salaried and non-salaried visiting medical officers. Please note that the Department of Health's medical indemnity cover will not be jeopardised by statements made by a doctor in the course of notifying activities to their employer.

The contractual medical indemnity scheme is available to all medical practitioners working in the WA Public health system. Relevant documents regarding the medical indemnity scheme for both salaried and non-salaried medical practitioners are available.

More information

Patient Safety Surveillance Unit

Last reviewed: 08-04-2022
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Patient Safety Surveillance Unit