What is Just culture?

“We can’t change the human condition, but we can change the conditions under which humans act.” James Reason¹

What is Just culture

Safety awareness is on the increase at healthcare organizations across the country.  Along with this awareness is an important opportunity to report both medical and medication errors.  Increased reporting allows healthcare organizations as well as Patient Safety Organizations to better understand systems and human actions that contribute to error.   The biggest factor preventing the reporting of medication error is fear; particularly the fear of losing professional licensure, reputation and employment status. 

In order to overcome this fear, an organization must shift from a widely held cultural practice of shame-and-blame to a non-punitive Just culture.  This new culture acknowledges that human and system errors exist alongside each other.  Just culture recognizes that even the most experienced, competent and caring healthcare workers are not exempt from human error.  The modern patient safety movement has taken a ‘system focus’ requiring safety researchers to better understand the role systems, workflow, workload, workplace environment and process play as causes or contributing  factors of error.  Just Culture strongly encourages reporting of medication error where health workers are never punished for reporting.   

While the blameless / non-punitive aspects of Just Culture have been addressed, it is important to note that the developer of Just Culture (David Marx) acknowledges the need for accountability within a culture.  Marx distinguishes three distinct behaviors within a Just Culture as follows:






Human Error

Safety Actions are consistent

Safety ‘work-around’ behavior is uncommon

Staff follows all Safety  Policies and Procedures


Learning environment

Incident / errors reported regularly

Management encourages Safety Behaviors and error reporting

“At Risk”

Safety Actions vary based upon work conditions

Safety ‘work-around’ behavior is common.

Adherence to Safety Policies and Procedures  is inconsistent

Creates unsafe conditions.  

Behavior may be viewed as acceptable or unacceptable depending upon local safety culture and attitudes.

Incident / error reports sporadic


Conscious violation of safety system

Decision Support System alerts disregarded

Non-Adherence to Safety Policies and Procedures 

No regard for patient safety and welfare

Behavior seen by coworkers and management as unacceptable and dangerous with serious consequences

Attempt to hide errors

Incident / errors go unreported


Safety Awareness begins with you and your work team every day!  Recognize that medication errors can happen to even the most experienced healthcare workers.  If your Safety Actions are consistent and you follow all Safety Policy, Procedures and Processes, there is significant opportunity to reduce medical and medication error and prevent patient harm.  Consider reporting error without fear of punishment. This will help the entire organization learn.  Why not create a Just Culture starting today?


1.       Reason J.  Human error: models and management.  BMJ 2000; 320:768-70. 


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