Healthcare & Hospital Management

Biography

Biography: Linda Paradiso

Abstract

Medical errors are the third leading cause of death in the United States, and nurses can have a significant impact in reducing those deaths. Hospitals are imperfect systems where nurses have competing demands, and are forced to improvise, and develop work-around. This autonomy creates illusions that systems are effective. Errors rarely occur in a vacuum, but are a sequence of events with multiple opportunities to correct the error. Nurses possess the unique ability to identify errors due to their proximity to the patient. The primary barrier to reporting errors is the negative response and risk of discipline. In an environment of trust a safe haven can be developed that supports speaking out. Just Culture is an environment where organizations are accountable for the systems they design, fostering analysis of the incident, not the individual. Organizations must strive to understand the nature and scope of errors actively redesign faulty systems, and value voluntary error reporting. Organizations often determine response to an error by its severity. In a Just Culture all errors hold equal importance. Nurses must receive fair treatment when reporting safety near misses and incidents. If nurses perceive their treatment is not just, they may drive valuable safety-related information underground. The adoption of Just Culture principles is most effective when embraced by all members of the organization. An anonymous survey was conducted in a large, urban teaching hospital to determine the relationship of trust and Just Culture. The findings offer practical implications to developing a trusting and Just Culture, and a balanced approach to incident investigation. When behaviors and attitudes are aligned, then the approach to performance improvement becomes the standard work of all staff. Leaders need to be aware of the perception of trust in the organization to foster Just Culture principles and move to becoming a reliable organization.