Creating a Fair and Just Culture: One Institution's Path 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. 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.