Title: Building a Just Culture in Healthcare: a HSE Dialogue
Venue: Croke Park Conference Centre, Dublin
Date: 23rd May, 2023
Foreword, Mr Bernard Gloster, CEO
I welcome you to a very important conference, Building a Just Culture in Healthcare: a HSE Dialogue. The HSE is committed to working together to create a compassionate, just, fair and open culture. In a Just Culture the focus is on system learning where staff feel empowered and confident to speak up and raise concerns, highlight risks and propose improvements to enhance patient safety and staff wellbeing.
It is important to acknowledge that we have started our journey of embedding and supporting Just Culture throughout the organisation. However, there is still more work to do as the most recent HSE Staff Survey highlighted that 46% of respondents did not feel that they were treated fairly following a patient safety incident. This is something we want to explore further. Improving and enhancing our culture is an important area of our work for me.
I urge all attending to reflect on the learning from both a national and an international perspective and to think about what we can all do together when we return to our teams and services to progress the implementation of a Just Culture.
I would like to thank all authors and participants for their contributions to this important day.
Bernard Gloster, CEO, HSE
Overview
One of the six principles of the HSE Incident Management Framework is that incident management is just and fair. A just and fair approach ensures that staff are confident in reporting an incident and that the review process will not seek to assign blame but rather to understand any weaknesses in the systems of care/ work that contributed to the incident occurring. Supporting staff to be open about incidents allows valuable lessons to be learnt from such events and helps prevent them in the future to improve patient safety.
A Just Culture in an organisation emphasises this underlying principle. It applies a values based supportive model of shared accountability and proposes that an organisation accepts appropriate responsibility and accountability for system learning and that individual practitioners should not be held accountable for system failings. However, a Just Culture also holds staff to account for acts of deliberate harm and complete disregard of policies and procedures without due consideration of the potential harm to patients. This is equally important for patient safety.
A just culture approach is key in gaining a shared understanding of how safety is achieved within any complex organisation.
Conference Programme
Please click to access: Conference programme, speaker biographies and finalists' posters
Presentations from the Conference
Additional supporting information
- Building a Just Culture in Healthcare: a HSE Dialogue - Discussion Paper
- Sam Cromie & Franziska Bott, Just culture's ''line in the sand" is a shifting one; an empirical investigation of culpability determination, Safety Science, 86, 2016, p258-272.
- O’Donovan, R., Ward, M.E., De Brún, A., & McAuliffe, E. (2018) Safety culture in healthcare teams: a narrative review of the literature. Journal of Nursing Management 2018 Dec 17.
- Just Culture - NHS Mersey Care Documentary This film documents the amazing transformation in one organisation —Mersey Care, an NHS mental health trust in the UK. Only a few years ago, blame was common and trust was scarce. Dismissals were frequent: caregivers were suspended without a clear idea of what they might have done wrong. Mersey Care’s journey toward a just and learning culture has repaired and reinvigorated relationships between staff, leaders and service users. It has enhanced people’s engagement, joint ownership and sense of responsibility. It has taken the organisation to a place where hurt doesn’t get met with more hurt, but with healing.
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