Improving Organizational Culture to Support Patient Safety

By Dr. Tom Lloyd, LLM, MB ChB, MD, MRCS, MFFLM
Director, Saegis Safety Institute



While there has been a great deal written about organizational culture recently, it is still difficult to define and a complex concept for leaders to tackle. Yet there is evidence that it is a critical issue that must be addressed to improve patient safety.

A flawed organizational culture in a healthcare context adversely affects teamwork and communication, and consequently increases risk and impacts safety. The Joint Commission has estimated 80% of serious medical errors involved miscommunication between caregivers during transfer of care.

A hospital culture felt to be unsupportive, unfair and blame-focused will often engender disruptive behaviour, which is also known to have a negative impact on patient safety as it leads to ineffective care and poorer clinical outcomes.

A Learning Environment

Conversely, substantial improvement to hospital culture can successfully improve organizational outcomes and patient safety. The challenge for institutional leaders is how to bring it about. It has been reported that to achieve cultural improvement, organizations need to foster a learning environment wherein assessment of errors and incidents is consistent, transparent and not just punitive. This requires sustained and visible support by management for teams, as well as promotion of psychological security and the ability to safely speak up when individuals feel something is wrong.

The concept of installing a “just culture” has for many years, in a number of industries, been seen as an effective way to meet this need. It combines law, human factor science and system design, and focuses on shared accountability between team members and leaders, while also taking into account the interplay between behavioural choice and system design.

Instilling a Just Culture

One approach to instilling a more just culture is through an investment in training. For example, one program, Just Culture Certification by Minneapolis-based solutions firm Outcome Engenuity, has been very successful worldwide in turning around flawed cultures in high-risk, safety-driven industries, such as aviation and manufacturing as well as healthcare. The program aims to lead organizations away from judging events on the severity of the outcome to understanding the root causes and learning from the error. Through a mix of online learning and in person course work, it is intended to provide knowledge and tools for leaders and teams to establish a more open and fair culture. One key tool of the program is the Just Culture AlgorithmTM, a decision-making tool for managers to determine consistent, appropriate and constructive responses to an incident or error.

In Canada, the just culture concept appears to be gaining traction, and training is now more accessible due to a recent partnership between Outcome Engenuity and Saegis, a subsidiary of the Canadian Medical Protective Association (CMPA). Through this collaboration, Saegis now offers a range of Just Culture courses and programs onsite at hospitals across Canada.

Investing in Organizational Change

While programs like Just Culture are available to help hospitals engender positive change in their organizational cultures, the challenge for institutional leaders is to determine if they are an investment priority given the scarcities of time and budgets. Ideally, though, as more Canadian hospitals see tangible, positive results from programs like Just Culture, investing in them will become an easier decision for healthcare leaders across Canada.

Joint Commission Center for Transforming Healthcare Releases Targeted Solutions Tool for Hand-Off Communications, Joint Commission Perspectives®, August 2012, Volume 32, Issue 8, Copyright 2012 Joint Commission on Accreditation of Healthcare Organizations

Joint Commission Perspectives on Patient Safety, Managing Disruptive Behaviour, January 2009.

Retrieved June 2013 from: Mannion R, Smith J. BMJ Quall Saf 2017;0:1-3