Just Culture hardest elements discussion guide

Choose the two elements in the concept ” Just Culture” that are most difficult to achieve and provide one strategy for each that will make them achievable NUR630GCU NUR630 2020 March Week 8 Discussion (+dq2) Latest DQ2 The concept of a “Just Culture” has a number of key elements. Choose the two elements that you feel are the most difficult to achieve and provide one strategy for each that will make them achievable. A just culture balances the need for an open and honest reporting environment with the end of a quality learning environment and culture. While the organization has a duty and responsibility to employees (and ultimately to patients), all employees are held responsible for the quality of their choices. Just culture requires a change in focus from errors and outcomes to system design and management of the behavioral choices of all employees.2 Consider the following situations: •  Two nurses select the (same) wrong vial of intravenous medication from the dispensing system. One nurse administers the drug, causing cardiac arrest. The other nurse realizes the switch when drawing the solution from the vial into the syringe at the bedside. How do we approach the nurses and investigate the situation? •  The attending physician tells a resident physician to obtain a specific blood test. The resident forgets. Fearing the wrath of the supervising physician, the resident reports that the result is normal. How do we deal with this breach? •  A surgical team does not perform a surgical time out on the grounds that no adverse events have occurred in the past. How do we handle this violation? •  The night nurse supervisor reports to a medical director that the lead respiratory therapist was in the hospital at 4:00 am with alcohol on his breath. At a later date, the physician confronts the employee who vehemently denies alcohol abuse. Should the matter be dropped? In only one of these scenarios does an adverse event occur, yet a just culture, with its insistence on a value-based culture and shared accountability, demands that all of these situations be addressed. However, individual practitioners should not be held accountable for mistakes made in a system they cannot control.3 In the first example, further investigation showed that the 2 vials of entirely different medications looked alike in shape, size, color, and print. This accident waiting to happen did happen to the first nurse and her patient. Human error was involved, but this nurse should be consoled and supported rather than punished. The resident physician falsified patient data, which cannot be condoned and must be addressed. Honest disclosure without fear of retribution is an important characteristic of a just culture. The surgical team cannot function outside of the value-based principles designed by the organization. Although this surgical team has never been involved in an adverse event, one may occur in the future. As for the respiratory therapist, in a just culture we are concerned for the safety of our patients and we are concerned for and care about each other. Further nonpunitive investigation is necessary. Choose the two elements in the concept ” Just Culture” that are most difficult to achieve and provide one strategy for each that will make them achievable NUR630 These examples address an aspect of just culture that goes beyond ensuring that employees feel free to report errors. Highly reliable organizations and industries foster mindfulness in their workers. Weick and Sutcliffe4 describe mindfulness in terms of 5 components: 1 A constant concern about the possibility of failure 2 Deference to expertise regardless of rank or status 3 Ability to adapt when the unexpected occurs 4 Ability to concentrate on a task while having a sense of the big picture 5 Ability to alter and flatten the hierarchy to fit a specific situation Mindfulness throughout an organization considers, but moves beyond, events and occurrences. Everyone in the organization is continually learning, adjusting, and redesigning systems for safety and managing behavioral choices.