Netherlands Defence Academy, Hogeschoollaan 2, 4818, CR, Breda, The Netherlands.
Amsterdam UMC, Location VUmc, De Boelelaan 1089a, 1081, HV, Amsterdam, The Netherlands.
BMC Health Serv Res. 2022 Aug 13;22(1):1035. doi: 10.1186/s12913-022-08418-z.
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.
This study aims to explore requirements and challenges for fostering a just culture within healthcare organizations.
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.
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.
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.
公正文化被认为对于从错误中学习和促进患者安全至关重要。事件后公正文化的关键是关注学习而不是指责。现有的公正文化研究主要是理论性质的。
本研究旨在探讨在医疗保健组织中培养公正文化的要求和挑战。
我们研究了荷兰五家医疗保健组织中培养公正文化发展的举措。通过对利益相关者的访谈和组织内项目小组会议的观察收集数据。
根据医疗保健专业人员的说法，开放沟通特别重要，要注意对事件的不同看法。与开放沟通相关的一个挑战是如何处理个人责任和问责制。其次，为情绪留出空间被认为是至关重要的。情绪与事件的直接后果有关，但也与外部世界的反应有关，包括媒体和卫生督察员。
与情绪相关的一个挑战是如何在组织内外将对情绪的关注与对事实的关注结合起来。最后，医疗保健专业人员重视管理层的承诺和示范行为。作为管理者，这里的一个挑战是如何在保持距离的同时表现出承诺。另一个挑战是如何在公开性和相关方的隐私之间取得平衡，以及如何应对组织内其他层次和外部世界中不太微妙的观点。组织对所经历的紧张局势的反思可能有助于找到正确的平衡。
