
Top Stories 
Published On June 10, 2015
POLICY
Defined: Just Culture
A new organizational approach views medical errors in a whole new light.
just culture n: An approach to assigning responsibility for medical errors. It considers the actions of individuals as well as the systems in which they operate.
Doctors and nurses make mistakes, and those mistakes can have heartbreaking consequences. When lives are lost, fingers will point, historically in the direction of the health care workers themselves. But the real object of blame is often more complicated, something underlined in a landmark Institute of Medicine report (To Err Is Human, 1999), which argued that faulty organizational processes may be as much or more to blame than a lone clinician.
The term “just culture” describes an organization that understands this bigger picture and works to place blame fairly. In the wake of an error, a just culture would first look at the participant’s intentions. Was it the result of a mindless lapse, like grabbing the wrong vial? Or was this a deliberate choice to violate hospital protocol? Misjudging a risk might fall somewhere in the middle. Attention then turns to the hospital’s system for protecting against such errors. Did the doctor or nurse have adequate training? Had fail-safe procedures been put in place?
This more “just” understanding of an error can make sure that corrective actions are directed effectively. The principles have been used in aviation, the military and other industries in which human error is likely to have major consequences—and where it’s critically important to keep errors from happening again.
Dispatches

Medicine and the Makers Roderic Pettigrew is training a new hybrid specialty—half physician, half engineer.

Sins of the Past The California Death Certificate Project is finding the physicians associated with opioid overdoses. Is it justice or a witch hunt?

Prohibition at 100 The 18th Amendment launched the most sweeping health experiment in U.S. history. Physicians—then and now—have debated its complex legacy.

Where Have All the Microbes Gone? Internist and researcher Martin Blaser believes that disturbances in the gut may underlie several modern maladies.

Podcast: Can AI Save Us from Despair? Psychiatry is finding its footing with machine intelligence. New tools may dramatically help those who need it the most.

A New Iron Age As more bacteria gain resistance to standard treatments, is the answer a return to therapeutic metals?

The Pharmacist Will See You Now As the role of the pharmacist changes, one program explores how it can help people with heart disease and other conditions.
