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How effectively has a Just Culture been adopted? A qualitative study to analyse the attitudes and behaviours of clinicians and managers to clinical incident management within an NHS Hospital Trust and identify enablers and barriers to achieving a Just Culture
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Tasker, Adam, Jones, Julia and Brake, Simon (2023) How effectively has a Just Culture been adopted? A qualitative study to analyse the attitudes and behaviours of clinicians and managers to clinical incident management within an NHS Hospital Trust and identify enablers and barriers to achieving a Just Culture. BMJ Open Quality, 12 (1). e002049. doi:10.1136/bmjoq-2022-002049 ISSN 2399-6641.
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Official URL: http://dx.doi.org/10.1136/bmjoq-2022-002049
Abstract
Objectives Just Culture aims to improve patient safety by examining the organisational and individual factors that contribute to adverse events, enabling corrective action so that errors are not repeated. This qualitative study aims to: (1) analyse whether the attitudes and behaviours of clinicians and managers are aligned with a Just Culture; (2) identify barriers and enablers to an organisation adopting a Just Culture.
Methodology This qualitative study used interviews and observation of Trust meetings to elicit the attitudes and behaviours of staff. Semistructured interviews were conducted with 13 doctors of all grades, 5 medical students and 2 managers. Five meetings that reviewed clinical incidents and mortality were observed. This was done in a single Hospital Trust in the Midlands, England. Data were thematically analysed using directed and inductive approaches.
Results There is evidence of a fair incident management process within the Trust; however, there was no agreed vision of a Just Culture and the majority of the staff were unfamiliar with the term. Negative perspectives relating to clinical incidents and their management persist among staff with many having insecurities regarding being the subject of an investigation and doubts about whether they drive improvement.
Conclusion This paper examines the significance of these findings and provides recommendations which may have application within other healthcare organisations. Major recommendations include (1) Just Culture: define an agreed vision of what Just Culture means to the Trust; (2) investigations: introduce incident management familiarisation training; (3) Learning Culture: increase face-to-face communication of outcomes of investigations and incident review; (4) investigators: establish an incident investigation team to improve the timeliness and consistency of investigations and the communication and implementation of outcomes.
Item Type: | Journal Article | ||||||
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Subjects: | B Philosophy. Psychology. Religion > BJ Ethics R Medicine > RA Public aspects of medicine |
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||
Library of Congress Subject Headings (LCSH): | Medical personnel -- Attitudes, Professional ethics, Cultural competence, Communication in medicine, National health services administration -- Great Britain, Organizational change -- Research | ||||||
Journal or Publication Title: | BMJ Open Quality | ||||||
Publisher: | BMJ Publishing Group | ||||||
ISSN: | 2399-6641 | ||||||
Official Date: | 27 January 2023 | ||||||
Dates: |
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Volume: | 12 | ||||||
Number: | 1 | ||||||
Number of Pages: | 7 | ||||||
Article Number: | e002049 | ||||||
DOI: | 10.1136/bmjoq-2022-002049 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||
Date of first compliant deposit: | 7 March 2023 | ||||||
Date of first compliant Open Access: | 8 March 2023 | ||||||
RIOXX Funder/Project Grant: |
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