Glossary

J

Just Culture
The phrase "just culture" was popularized in the patient safety lexicon by a report that outlined principles for achieving a culture in which frontline personnel feel comfortable disclosing errors—including their own—while maintaining professional accountability. The examples in the report relate to transfusion safety, but the principles clearly generalize across domains within health care organizations.

Traditionally, health care's culture has held individuals accountable for all errors or mishaps that befall patients under their care. By contrast, a just culture recognizes that individual practitioners should not be held accountable for system failings over which they have no control. A just culture also recognizes many individual or "active" errors represent predictable interactions between human operators and the systems in which they work. However, in contrast to a culture that touts "no blame" as its governing principle, a just culture does not tolerate conscious disregard of clear risks to patients or gross misconduct (e.g., falsifying a record, performing professional duties while intoxicated).

In summary, a just culture recognizes that competent professionals make mistakes and acknowledges that even competent professionals will develop unhealthy norms (shortcuts, "routine rule violations"), but has zero tolerance for reckless behavior.
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