Defining reckless behavior hard with just culture
The difficult part of adopting a "just culture" philosophy may be defining exactly what constitutes reckless and willful behavior, says Grena Porto, RN, ARM, DFASHRM, a health care risk manager and principal with QRS Healthcare Consulting in Hockessin, DE, and past president of the American Society for Healthcare Risk Management.
Porto acknowledges that risk managers who embrace a nonpunitive approach can face dilemmas when an employee seems to be willfully and wantonly defying safety procedures, but she says it can be difficult to reach that conclusion with confidence. Porto gives the example of a night shift nurse who repeatedly fails to call physicians with important questions or patient updates, despite being warned to do so and with no apparent reason not to. Under a just culture, that behavior might be deemed willful and reckless, justifying discipline.
"But if you keep digging, you might find out that she didn't call because physicians consistently yell at nurses for waking them at night," Porto says. "The nurse didn't want to cite that as the reason because she might appear weak or not a team player," she explains. "So, what at first seemed like a willful and reckless behavior actually has a systems cause, and you're not achieving anything by punishing the nurse," Porto says.
She doesn't disagree, necessarily, with the just culture advocates who say there will be some situations in which the employee acts recklessly, with full awareness of the potential danger to the patient, with no systems component. But Porto contends that those situations are so rare that they don't justify abandoning the nonpunitive approach.
She's concerned that the just culture approach uses the term "willful" a little too liberally. "That's where this philosophy can fall apart," Porto says. "Just because someone does something willfully doesn't mean there isn't more to the story, more to the explanation about why the person willfully chose to do something that violates the rules."
Source
For more information on possible difficulties with the just culture approach, contact:
- Grena Porto, QRS Healthcare Consulting, 7454 Lancaster Pike, No. 301, Hockessin, DE 19707. Telephone: (302) 235-2363.
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