1. Maryann Alexander, PhD, RN
A Regulatory Model/Decision Tree for Collaboration and Practice Accountability
Maryann Alexander, PhD, RN
Nancy Spector, PhD, RN
Maureen Cahill, MS, RN
Kathy Russell, JD, RN

2. The Just Culture Model (simplified)
Reckless
Behavior
Conscious Disregard of Substantial and Unjustifiable Risk
Manage through:
Remedial action
Punitive action
At-Risk
A Choice: Risk Believed Insignificant or Justified
Removing incentives for at-risk behaviors
Creating incentives for healthy behaviors
Increasing situational awareness
Human
Error
Product of Our Current
System Design and Behavioral Choices
Manage through changes in:
Choices
Processes
Procedures
Training
Design
Environment
Console
Coach
Punish 2

3. The Just Culture Model A Single Event Repetitive Events
Repetitive errors – yes, there is a process
Repetitive at-risk behaviors – yes, there is a process
Both may lead to disciplinary action… 3

4. Just Culture
Examines the fallibility of the system as well as inevitable human error and flawed behavioral choices
System
Human Error
Flawed decisions

5. Regulation Public Protection
Holding systems and individuals accountable for their actions
Safer care for Patients

6. Regulatory Model
Encourage reporting of errors so that systems, processes and behaviors can be improved
Collaborative/Partnership (Facility and BON and Nurse and Facility)
Centers around the patient
Focus is on ethical behavior
Encourages remediation
Employs discipline where needed

7. Accountability of Nurse
Recognize Contributions of System Errors
Patient Outcome Not Primary to BON Decision
Boards and Employers Collaborate
Use Reliable Tools to Evaluate Behaviors and Systems

8. Regulatory Decision Model

11. Next Steps Volunteers Try out the decision tree
Send us your feedback/comments
Feedback from Outcomengenuity
Develop a resource kit
Pilot the model/algorithm once completed

12. Our Goal
Help BONs make consistent decisions that protect the public and lead to safer systems and competent practitioners.