title: Creating a fair and just culture: one institution's pat toward organizational change.
abstract: 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.
authors.affiliation: Dana Farber Cancer Institute, Boston, USA. maureen_connor@dfci.harvard.edu
authors.forename: Maureen
authors.initials: M
authors.lastname: Connor
authors.forename: Deborah
authors.initials: D
authors.lastname: Duncombe
authors.forename: Emily
authors.initials: E
authors.lastname: Barclay
authors.forename: Sylvia
authors.initials: S
authors.lastname: Bartel
authors.forename: Charles
authors.initials: C
authors.lastname: Borden
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Gross
authors.forename: Carol
authors.initials: C
authors.lastname: Miller
authors.forename: Patricia Reid
authors.initials: PR
authors.lastname: Ponte
mesh_terms: 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