Brian Radbill, MD, FACP, Chief Medical Officer, Mount Sinai Morningside, talks with Kim Keller and other staff about ways to develop a culture of safety.

Establishing a culture in which employees feel comfortable reporting safety events is one of the keys to achieving “zero harm” in health care because it allows hospitals to identify vulnerabilities in their care delivery systems.

Recently, a safety event in Tennessee that resulted in a nurse being convicted of criminally negligent homicide gained national attention for its criminalization of medical error. The verdict is expected to have a chilling effect on safety event reporting in hospitals across the nation that will ultimately make our health systems less safe.

Now is a crucial time for health care leaders to support front-line staff by promoting and properly implementing a system called Just Culture.

Brian Radbill, MD

Just Culture is a fair and just system of accountability that supports an organization’s values and reflects what we know about system design—systems are not perfect, and people make mistakes—when determining how we respond to a safety event. On the journey to “high reliability,” it is crucial that health care organizations develop a culture of safety and learning that respects and supports front-line staff.

Just Culture refers to a system used in a number of industries that is based on the principle that mistakes are generally the product of faulty organizational cultures, rather than the fault of one or more employees. The goal is to create an organization in which people report errors to help the organization learn from mistakes.

Historically, and even today, there is a perception that health care organizations remain overly punitive when responding to a safety event. Mount Sinai heard this from their own staff in the system-wide staff survey, Your Voice Counts.

Just Culture is not about creating a blame-free environment. It is about finding a fair balance where accountability is shared between the individual and the organization. The organization is responsible for designing and implementing safe systems and responding to safety events in a just manner. Individuals are accountable for the quality of their choices and for reporting errors or otherwise identifying system vulnerabilities.

Despite widespread recognition of the value of Just Culture, managers and leaders within health care often lack the necessary training to effectively and consistently respond to safety events in a manner consistent with Just Culture. In addition, most front-line staff have not been formally trained about Just Culture and are unaware of what it means to them.

To address these knowledge gaps and respond to concerns raised in the Your Voice Counts survey, leadership across the Mount Sinai Health System began working with David Marx, a pioneer in safety across several industries who is widely recognized as the “Father of Just Culture.” As part of that collaboration, Mount Sinai received training and educational materials to allow us to develop our own Just Culture “train-the-trainer” program. Originally intended as an in-person program, a virtual Just Culture training program was developed in response to the COVID-19 pandemic that allows participants to actively learn and engage with facilitators.

Recently, we began the first of several planned Just Culture Training for Managers programs within the Mount Sinai Health System. In order to make the program entertaining and leverage its online platform, the concept of the program is that participants are members of an at-home viewing audience watching a fictional morning talk show complete with hosts, guests, and even “commercial breaks.” Designated facilitators guide participants through a series of learning exercises in small breakout groups, culminating in their use of the Just Culture Company’s Just Culture Algorithm™ to work through two practice safety event cases.

In addition, after they have completed the half-day training, participants are instructed on how to educate staff about Just Culture within their unit or department. To strengthen the adoption of Just Culture, participants are invited to participate in monthly Zoom “lunch-and-learns” during which experts within the Health System discuss how to apply Just Culture in numerous industries.

Now more than ever, health systems need to work with front-line providers to create a culture of safety through a system of shared accountability. Just Culture training provides department heads, managers, nurse mangers, and other leaders with the tools to properly respond to a safety event to make our system of health care delivery safer. Through this training and associated education plan, the Mount Sinai Health System is committed to sustaining a workplace that ensures staff are treated fairly and patient safety remains at the center of everything we do.

For more information on Just Culture training at Mount Sinai, contact Shabona Akter, shabona.akter@mountsinai.org.

Brian Radbill, MD, Chief Medical Officer at Mount Sinai Morningside, is also a nephrologist who specializes in the treatment of chronic kidney disease. He earned his MD degree at Hahnemann University School of Medicine and trained as a resident and a fellow at the Icahn School of Medicine at Mount Sinai.