The moderating role of just culture between nursing practice environment and oncology nurses' silent behaviors toward patient safety: A multicentered study

BACKGROUND

Patient safety is a critical part of healthcare delivery that must be prioritized to guarantee optimal patient outcomes. Oncology nursing is a specialized area of nursing that demands great focus on patient safety because of the high-risk nature of this patient group. Nurses play an important role in ensuring that patients receive safe and effective care. However, the nursing practice environment can have a substantial impact on how nurses respond to patient safety problems. A just culture can promote open communication and identify potential safety issues, whereas a culture of silence can have a negative impact on patient outcomes.

OBJECTIVE

Firstly, assess the relationship between the nursing practice environment and oncology nurses' silent behavior towards patient safety. Secondly, the interaction effect of just culture as a moderator in this relationship.

METHOD

A cross-sectional, correctional research design was employed. Data was collected from 303 nurses working at the oncology departments of five hospitals in Egypt using three questionnaires. Data was analyzed using SPSS-PROCESS Macro (v4.2).

RESULTS

There was a moderate, negative, and significant correlation between the nurse practice environment and silent behavior of nurses towards patient safety. The interaction effect of just culture with nurse practice environment strengthens this relationship, thus enhancing errors reporting.

CONCLUSIONS

This study emphasized on the importance of creating a just culture that facilitates open communication and eliminating the potential hazards result from nurses' silence. Thus, oncology nurses must be encouraged to report issues related to patient safety.

Insights on just culture from seafarers and shipping companies in Indonesia: An exploratory study

BACKGROUND

Just culture aspires to prompt organizational learning from enhanced feedback by frontline operators. Just culture requires mechanisms to eliminate fear and sanction but not accountability when reporting safety-related issues. Adopted in sectors such as aviation, just culture remains an underdeveloped field in the maritime sector.

OBJECTIVE

This study explores how some pre-requisites for a just culture (i.e., ease of reporting, motivation to report, and trust) are perceived and potentially implemented by seafarers' and shipping company safety representatives in Indonesia.

METHODS

Semi-structured interviews were used to collect qualitative data in an exploratory study involving eleven active seafarers and four safety managers from shipping companies in Indonesia.

RESULTS

The conditions for ease of reporting seem present, at least on paper. Shipping companies receive one to two near-miss reports per month. However, incidents seem to be underreported. It appears that companies are unsuccessful in establishing the motivation and trust necessary to enhance safety event reporting.

CONCLUSION

The study suggests that the concept of a just culture is not well understood among certain Indonesian shipping companies. The main barriers to implementing a just culture relate to hierarchical structures in the industry, frequent crew changes, blame culture, and lack of anonymous reporting for safety concerns.

Just Culture: How Do We Address Risky and Unprofessional Behaviors that Lead to Errors?

Unprofessional behavior in the procedural arena is associated with worse patient outcomes. This is thought to be due to breakdowns in communication structures and team dynamics. Behavioral issues are often uncovered during the investigation of serious event reports. Understanding differences in behavior deviations enables leadership to best address each type with an appropriate response. This allows institutions to address reckless behavior and unprofessionalism, while concomitantly creating a culture that fosters trust to promote self-reporting and sharing of information. These are characteristics of high-reliability organizations that produce sustained excellence in patient outcomes.

Patient Safety and Clinician Well-Being

Clinician well-being and patient safety are intricately linked. We propose that organizational factors (ie, elements of the perioperative work environment and culture) affect both, as opposed to a bidirectional causal relationship. Threats to patient safety and clinician well-being include clinician mental health issues, negative work environments, poor teamwork and communication, and staffing shortages. Opportunities to mitigate these threats include the normalization of mental health care, peer support, psychological safety, just culture, teamwork and communication training, and creative staffing approaches.

Assessment of nurse's perceived just culture: a cross-sectional study

BACKGROUND

The non-punitive approach to error investigation in most safety culture surveys have been relatively low. Most of the current patient safety culture measurement tools also lack the ability to directly gauge concepts important to a just culture (i.e. perceptions of fairness and trust). The purpose of this study is to assess nurses' perceptions of the six just culture dimensions using the validated Just Culture Assessment Tool (JCAT).

METHODS

This descriptive, cross-sectional study was conducted between November and December 2020. Data from 212 staff nurses in a large referral hospital in Qatar were collected. A validated, self-reported survey called the JCAT was used to assess the perception of the just culture dimensions including feedback and communication, openness of communication, balance, quality of event reporting process, continuous improvement, and trust.

RESULTS

The study revealed that the overall positive perception score of just culture was (75.44%). The strength areas of the just culture were "continuous improvement" dimension (88.44%), "quality of events reporting process" (86.04%), followed by "feedback and communication" (80.19%), and "openness of communication" (77.55%) The dimensions such as "trust" (68.30%) and "balance" (52.55%) had a lower positive perception rates.

CONCLUSION

A strong and effective just culture is a cornerstone of any organization, particularly when it comes to ensuring safety. It places paramount importance on encouraging voluntary error reporting and establishing a robust feedback system to address safety-related events promptly. It also recognizes that errors present valuable opportunities for continuous improvement. Just culture is more than just a no-blame practice. By prioritizing accountability and responsibility among front-line workers, a just culture fosters a sense of ownership and a commitment to improve safety, rather than assigning blame.

Fostering a just culture in healthcare organizations: experiences in practice

Background

A just culture is regarded as vital for learning from errors and fostering patient safety. Key to a just culture after incidents is a focus on learning rather than blaming. Existing research on just culture is mostly theoretical in nature.

Aim

This study aims to explore requirements and challenges for fostering a just culture within healthcare organizations.

Methods

We examined initiatives to foster the development of a just culture in five healthcare organizations in the Netherlands. Data were collected through interviews with stakeholders and observations of project group meetings in the organizations.

Results

According to healthcare professionals, open communication is particularly important, paying attention to different perspectives on an incident. A challenge related to open communication is how to address individual responsibility and accountability. Next, room for emotions is regarded as crucial. Emotions are related to the direct consequences of incidents, but also to the response of the outside world, including the media and the health inspectorate.

Conclusions

A challenge in relation to emotions is how to combine attention for emotions with focusing on facts, both within and outside the organization. Finally, healthcare professionals attach importance to commitment and exemplary behavior of management. A challenge as a manager here is how to keep distance while also showing commitment. Another challenge is how to combine openness with privacy of the parties involved, and how to deal with less nuanced views in other layers of the organization and in the outside world. Organizing reflection on the experienced tensions may help to find the right balance.

Peer review and its ethical implications

Peer review is an essential tool for institutions and providers to meet the modern goals of safety and quality in health care. It is a mechanism that leads to a just culture within a health care institution whereby errors and complications are considered products of the system rather than isolated actions by an individual. The benefits and potential drawbacks of peer review are outlined in this review with a special emphasis on the interface between peer review and principles of medical ethics. It is argued that peer review, in the ideal setting, is founded upon the principles of beneficence and justice, and to varying levels on non-maleficence and autonomy.

Perspective: in pursuit of a learning culture

Transitioning from peer review to peer learning is an important step forward in developing a learning culture. Additional measures are going to be required to meet this goal. Ideas toward establishing a learning culture are detailed in this perspective.

Communicating Patient Quality and Safety in Your Hospital

Discussing medical quality starts with defining quality. Human health care publications identify safety, timeliness, efficiency, effectiveness, equity, and patient centeredness as important components of medical quality. Safety is foremost as medical errors are a leading cause of patient death. Studies examining patient outcomes have found that culture is critical. Cultures that emphasize communication, open discussion, and continuous improvement lead to improved patient survival and decreased medical errors. Leadership, training, staff meetings, and processes for gathering input all contribute to a culture of safety. Discussing medical errors with clients is difficult but can be made more manageable with a 6-step process.

Just Culture: Practical Implementation for Radiologist Peer Review

Peer review is a cornerstone of quality improvement programs and serves to support the peer learning process. Peer review in radiology incorporates the review of diagnostic imaging interpretation, interventional procedures, communication, and the evaluation of untoward patient events. A just culture is an environment in which errors and near-miss events are evaluated in a deliberately nonpunitive framework, avoiding a culture of blame and responsibility and focusing instead on error prevention and fostering a culture of continuous quality improvement. Adoption of a just culture requires careful attention to detail and relies on continuous coaching of individuals and teams to ensure future systems improvements and a culture of safety. The authors describe the practical implementation of a just culture framework for peer review in an academic radiology department and highlight its application to interpretive, noninterpretive, and procedural domains through case examples.

Association between safety leading indicators and safety climate levels

OBJECTIVES

The aim of this study was to evaluate the association of leading indicators for occupational health and safety, particularly safety inspections and non-compliances, with safety climate levels.

METHODS

Nordic Occupational Safety Climate Assessment Questionnaire was employed to evaluate safety climate in cross-sectional design. The geographically diverse population of the inspection body made it possible to conduct the survey across 10 provinces in Iran. 89 completed questionnaires were obtained with a response rate of 47%. Except for management safety justice, the internal consistency of other six dimensions was found to be acceptable (α≥0.7).

RESULTS

Mean scores of dimensions ranged from 3.50 in trust in the efficacy of safety systems (SD=0.38) to 2.98 in workers' safety priority and risk non-acceptance (SD=0.47). Tukey HSD tests indicated a statistically significant difference of mean scores among groups undergoing different number of safety inspections and those receiving different number of non-compliances (p<0.05), with no significant differences based on safety training man-hours and sessions (p>0.05). Spearman's rank-order correlation showed no relationship between work experience and number of non-compliances (correlation coefficient=-0.04, p>0.05) and between safety training man-hours and number of non-compliances (correlation coefficient=-0.15, p>0.05).

CONCLUSIONS

Our results indicate that safety climate levels are influenced by number of safety inspections and the resultant non-compliances.

PRACTICAL APPLICATIONS

Findings suggest that safety non-compliances detected as a result of conducting safety inspections could be used to monitor the safety climate state. Establishing plans to conduct scheduled safety inspections and recording findings in the form of safety non-compliance and monitoring their trend could be used to monitor levels of safety climate.

General Concepts of Patient Safety for the Oral and Maxillofacial Surgeon

Whether managing patients in private offices or as part of a care team at hospitals, oral and maxillofacial surgeons owe it to patients to understand medical error and take action to reduce its frequency and adverse effects. This article reviews general concepts of patient safety, including high-reliability organization, crew resource management, simulation training, root cause analysis, and just culture.

Ethics in Publishing: Complexity Science and Human Factors Offer Insights to Develop a Just Culture

While ethics in publishing has been increasingly debated, there seems to be a lack of a theoretical framework for making sense of existing rules of behavior as well as for designing, managing and enforcing such rules. This letter argues that systems-oriented disciplines, such as complexity science and human factors, offer insights into new ways of dealing with ethics in publishing. Some examples of insights are presented. Also, a call is made for empirical studies that unveil the context and details of both retracted papers and the process of writing and publishing academic papers. This is expected to shed light on the complexity of the publication system as well as to support the development of a just culture, in which all participants are accountable.