@article{9370, author = {Maureen Connor and Deborah Duncombe and Emily Barclay and Sylvia Bartel and Charles Borden and Elizabeth Gross and Carol Miller and Patricia Reid Ponte}, 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.

CREATING THE PRINCIPLES OF A FAIR AND JUST CULTURE: 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.

INCORPORATING THE PRINCIPLES INTO PRACTICE: 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.

DISCUSSION: 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.

}, year = {2007}, journal = {Jt Comm J Qual Patient Saf}, volume = {33}, pages = {617-24}, month = {10/2007}, issn = {1553-7250}, language = {eng}, }