Creating a fair and just culture: one institution's pat toward organizational change.
BACKGROUND
Health care organizations have begun to move toward a nonpunitive, or "blame-free," process when analyzing medical errors and near misses. The Dana-Farber Cancer Institute's (Boston) "Principles of a Fair and Just Culture," define for staff and managers behavioral expectations when an error occurs.
The principles focus not just on patient safety but on a culture of safety and transparency in all the organization's functional areas, including nonclinical departments such as information services, administration, and research.
Introducing the principles is a gradual process, one that requires continual education and discussion among staff at all levels and a commitment to examining and changing many of the systems, policies, and procedures that guide the organization's work. A survey conducted in January 2007 revealed that the clinical areas had sustained higher-than-average scores and that the nonclinical areas showed improvement.


CONCLUSIONS
Changing a long-standing culture of blame, control, and disrespect to one that embraces principles of fairness and justice and standards of respectful behavior is a major undertaking. Educating and involving clinical and administrative leaders, who work directly with staff and play a pivotal role in translating the principles into practice, is especially important.
Connor
Maureen
M
Dana Farber Cancer Institute, Boston, USA. maureen_connor@dfci.harvard.edu
Duncombe
Deborah
D
Barclay
Emily
E
Bartel
Sylvia
S
Borden
Charles
C
Gross
Elizabeth
E
Miller
Carol
C
Ponte
Patricia Reid
PR
D002173:Cancer Care Facilities / Q000458:organization & administration* / Q000592:standards; D017408:Guidelines as Topic; D006801:Humans; D007318:Inservice Training; D008404:Massachusetts; D019982:Organizational Case Studies; D015279:Organizational Culture; D009936:Organizational Innovation; D017751:Safety Management / Q000458:organization & administration*; D012935:Social Justice; D013192:Staff Development