1. Just Culture Collaborative
Jill Hanson and Stephanie Sobczak
Certified Just Culture™ Champions
WHA

3. Today’s Call Review the Just Culture Collaborative Plan
Culture of Safety Foundations
What is a “Just Culture”
Readiness Assessment
Resources
Next 30 days

4. Partnership for Patients
In addition to the ten core topics, WHA must offer collaborative specific to Culture Change:
Just Culture
Comprehensive Unit Based Safety Program
Leadership Engagement
*Transforming Care at the Beside will be offered under the Aligning Forces for Quality grant which continues until at least May 2013.

5. Why Just Culture?
From July 2011 WHA survey, 35 hospitals interested in Just Culture
Please describe which Safety Culture and/or Team Communication efforts would your hospital benefit from in the next 12 months? 
Comprehensive Unit Based Safety Program (CUSP) 28
44%
Transforming Care at the Bedside (TCAB) 22
35%
Team STEPPS 18
29%
Just Culture 35
56%
Bedside Report
Multidisciplinary Rounds 32
51%
Team / Safety Huddles
SBAR / DESC / IPASS the BATON 29
46%
Checklist adoption (surgical, med admin, hand-offs, etc)
Culture Mapping (a visual display of communication patterns among staff)
Other, please specify 5 8%
WHA Survey of QI Managers, July 2011

6. WHA’s Approach Two Certified Just Culture™ Champions
Benchmarked other successful collaborative work
Connected with other Just Culture ™ hospitals in Wisconsin
Learn what hospitals are currently doing for incident reporting (incl. RWHC’s Safety Zone)
Work with Outcome Engenuity staff , Fiona Lawton and David Marx as advisors to the project.

7. Poll Question #1
Please describe your hospital’s familiarity with Just Culture:
Our hospital has adopted Just Culture
Our hospital is in process of adopting Just Culture
Only individuals in our hospital know about or have worked in a Just Culture hospital
We understand the general concept behind Just Culture
Not very familiar – have heard of Just Culture

8. What is Just Culture?
Concept developed by David Marx (Outcome Engenuity), based on the work of James Reason and others. A systematic approach to understanding adverse events, consistently consoling or coaching employees and fairly applying discipline when indicated.

10. The Key to Becoming a Just Culture
Only part of it is the use of the Just Culture Algorithm
The Algorithm isn’t the meat of the Just Culture framework.
It’s an essential tool – but so much more should happen to support it’s wise use.

11. Poll Question #1 Answers
Please describe your hospital’s familiarity with Just Culture:
Our hospital has adopted Just Culture
Our hospital is in process of adopting Just Culture
Only individuals in our hospital know about or have worked in a Just Culture hospital
We understand the general concept behind Just Culture
Not very familiar – have heard of Just Culture

12. The Key to Becoming a Just Culture
You need to consider all of these elements in the context of your own organization.
That is what we will be doing over the next 12 months.

13. What’s the Problem? “The single greatest impediment to
error prevention in health care is
that we punish people for
making mistakes.”
Dr. Lucian Leape
Professor, Harvard School of Public Health
Testimony before Congress on Health Care Quality Improvement

16. The Silent Treatment study collected data from more than 6,500 nurses and nurse managers
from health systems around the United States during 2010.
All research participants were members of the American Association of Critical-Care Nurses (AACN) and/or the
Association of periOperative Registered Nurses (AORN).
The study used two research instruments: a Story Collector and a Traditional
Survey. The Story Collector generated rich, qualitative data; the Traditional Survey
produced purely quantitative data.

17. Dangerous Shortcuts
84 percent of respondents say that 10 percent or more of their colleagues take dangerous shortcuts and 26 percent say these shortcuts have actually harmed patients.
Source: The Silent Treatment study

18. Incompetence
82 percent of respondents say that 10 percent or more of their colleagues are missing basic skills and as a result, 19 percent say they have seen harm come to patients.
Source: The Silent Treatment study

19. Disrespect
85 percent of respondents say that 10 percent or more of the people they work with are disrespectful and this undermines the ability or willingness to share concerns and speak up about problems.
Source: The Silent Treatment study

20. What is happening in our hospital?
Makes You Wonder…..
What is happening in our hospital?

21. Measuring the Culture of Safety
AHRQ has made available the Hospital Survey on Patient Safety Culture (HSOPS) since 2004.
Comparative Data is available for 2007 – 2010.
The 2010 database has 885 hospitals and 338,607 staff responses.
On average, hospitals submitted 383 completed surveys for a response rate of 56%.
Wisconsin has 50 hospitals that have submitted data for at least two years in succession.
Stephanie

22. Poll Question #2
Does your hospital apply the AHRQ Hospital Survey of Patient Survey on a regular interval (every two years or less)?
Yes No
Have, but need to do it more frequently

23. Very Different from “Satisfaction”
Stephanie
(But much more difficult to “fix”)

25. AHRQ Item Level Data

26. AHRQ Item Level Data

27. AHRQ Item Level Data

28. AHRQ Item Level Data

29. Poll # 2 Answers
Does your hospital apply the AHRQ Hospital Survey of Patient Survey on a regular interval (every two years or less)?
Yes No
Have, but need to do it more frequently

30. Staff Safety Assessment
Just two (2) very important questions for any clinical unit:
Hospitals enrolled in WHA’s Partners for Patients initiatives have had teams using this assessment, or a variation of it.
If this applies to your hospital, speak with your teams about what they learned.
Disclaimer information here…

31. Adopting a Just Culture is:
Creating an open, fair and just culture
Creating a systematic, consistent, repeatable approach to incident review, coaching and discipline
Creating a learning culture
Designing safe systems
Managing behavioral choices

33. Human error At-risk behavior Reckless behavior
inadvertent action; inadvertently doing other that what should have been done; slip, lapse, mistake.
At-risk behavior
behavioral choice that increases risk where risk is not recognized or is mistakenly believed to be justified.
Reckless behavior
behavioral choice to consciously disregard a substantial and unjustifiable risk.

34. Adding Value to the Experience
Please consider:
Having adopted Just Culture and are experienced – please be willing to share stories of success and challenges.
Planning to adopt Just Culture and are just beginning – please ask questions.
Willing to share examples of wording in policies and procedures – before and after Just Culture adoption.
Consider sharing case examples for learning.

35. More Than An Algorithm!
Aligning policies; Learning how to set and achieve expectations; learning how to make value-supportive decisions
Designing safer systems
Managing behaviors (before needing to use the Algorithm)
Improving learning systems – both predictive and proactive (FMEA) AND reactive (RCA/Investigations)
Embed the justice framework in the organization
Follow up on Science of Safety Video

36. WHA’s Just Culture Collaborative Approach
Assessing Readiness
(Aug to Oct)
Implementation
(Nov to Jan)
Application
(Feb to Apr)
Case Studies
(May to Jul)
Getting Started with Just Culture
What is a Just Culture?
Implementation – Phase 1
Just Culture and the Disciplinary Process
Application – Event Investigation
Event Investigation
Case Studies on High Risk Scenarios
High Risk Clinical Processes
Assessing Readiness - Culture
Organizational Readiness Assessment
Implementation – Phase 2
The Just Culture Algorithm
Application – Coaching
Coaching At-Risk Behaviors
Case Studies on Daily Occurrences
Repetitive
At-Risk Behaviors
Assessing Readiness - Processes
Review Incident Reporting Process
Implementation –Phase 3
Training Managers & Staff
Application - Consoling
Consoling Employees
Case Studies on Non-Clinical Scenarios
Non-Clinical Scenarios

37. Constructing Your Team
Senior Leadership
Risk Management
Middle Manager(s)
Human Resources ??
Quality Improvement
Medical Staff?
Legal?
Trustees?
Front-Line Staff?
This is the minimum representation recommended.

38. Readiness
Just Culture can’t be implemented from the bottom or the middle.
Senior leadership must drive the change and be passionate about the reasons for change.
Don’t create another “flavor of the month” – this is too important.
Create tool for assessment

39. Tools to Assess Readiness
Part One: Organizational Assessment
A tool to review hospital organizational practices, policies and procedures and how closely they align with Just Culture attributes.
Part Two: Individual Assessment
A tool to assess leader’s and manager’s perception of organizational culture.

40. Organizational Culture Assessment
A 13 item questionnaire exploring:
Organizational policies
Adverse event investigation
Human resource approaches
Completed by the Patient Safety Officer

41. Individual Assessment
This 20 item questionnaire explores the following critical behavioral markers:
Coaching
Reporting
Responses to human error
Responses to reckless behavior
Severity bias
Transparency

42. Individual Assessment
Questionnaire is completed by 10 to 15 leaders within each organization
Organizational Leaders include the following:
Chief Nursing Officer
Medical Officers
Directors or managers of human resources, quality and risk management departments

43. Scoring the Assessments
Organizational Readiness Assessment – Scoring Guide
Weighted questions with a maximum of 22 total points
Individual Assessment of Organizational Culture
Questions based on five point Likert scale with a maximum of 40 total points per survey taken

44. Where to Find on the WHA Quality Center
Just Culture Page via:
Webinars Getting Started Webinar
References & Toolkits
Just Culture Organizational Readiness Assessment
Just Culture Organizational Readiness Assessment-Scoring Guide
Individual Assessment of Organizational Culture*
*Available on the WHA Quality Center for download or WHA can work with you to develop an on-line individual assessment questionnaire

45. Poll #3 Question
Based on today’s information, how likely is your hospital to continue participating in this collaborative?
Very Likely
Not sure yet
Not Likely
 Answers will be shared next month

46. The Next 30 Days Tools available on WHA Quality Center:
RECOMMENDED ACTION ITEMS
Determine membership and convene your Just Culture implementation team
Read and discuss the Silent Treatment article -OR-
Conduct a Staff Safety Assessment
Conduct Organizational Readiness Assessment
 Organizational Assessment for Team Discussion
 Individual Assessment
Review most recent AHRQ Survey Results
Tools available on WHA Quality Center:
Just Culture Resources
Recorded Webinars
Discussion Area

47. Thank You! Any Questions? Jill Hanson and Stephanie Sobczak
Certified Just Culture™ Champions
WHA