3 types of misbehavior determine when to punish
Under a just culture, employee misbehavior can be categorized in these three general ways, says Geri Amori, PhD, ARM, FASHRM, a consultant with The Risk Management & Patient Safety Institute (RM&PSI) in Lansing, MI:
• Human error. This misbehavior is a mistake, plain and simple. The employee meant well and did not realize he or she was doing anything wrong. The response to this kind of error might be improvements in processes and procedures, more training, better design, or changes in the work environment.
• At-risk behavior. This behavior is habits developed over time that lead to unintentional risk taking. An example would the staff member who skips double-checking high-risk medications so much that he doesn't even realize he is skipping that safety step anymore. Not double-checking becomes his norm (normalization of deviance).
The appropriate response to at-risk behavior includes removing incentives such as the employee being overworked or without proper tools. The manager might also create incentives for healthy behaviors.
• Reckless behavior. This behavior occurs when an employee takes intentional risks by overriding safety mechanisms or ignoring standards and knows the outcome can be dangerous. It is not a simple mistake because the employee consciously knows he or she is taking a risk.
This behavior justifies disciplinary behavior under a just culture. In addition to examining factors such as illness or medication use by the employee, it also may be appropriate to consider other factors such as whether the person already received retraining on this issue, lied about the event or tried to cover it up, lacks remorse, or does not appear willing to learn from the error. The employee's previous involvement with errors, or lack thereof, also should be considered.
Sources
For more information on adopting a just-culture approach to patient safety improvement, contact:
- Geri Amori and Margaret Curtin, The Risk Management and Patient Safety Institute, 6215 W. Saint Joseph Highway, Lansing, MI 48917. Telephone: (517) 703-8464.
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