HR Pulse - Winter 2007 - (Page 18) >> JUST CULTURE limit. At-risk behavior is when someone knowingly goes 10 mph over the speed limit. And reckless behavior is when someone is zooming down the highway at 100 mph,” he says. “The concept works really well for the parent who is about to hand over the car keys to a 16-year-old. Tell the teenager to recognize that he’s fallible, but let him know that he can reduce his risk through the quality of choices he makes.” Human resources professionals respond well to the Just Culture Model because by nature they’re usually more inclined than risk managers or line managers to turn to coaching as a way to change behavior, according to Marx. “It just puts a framework to what they would do anyway in terms of applying fairness and consistency,” he says. He is quick to point out, however, that coaching does not work when it comes to human errors because those behaviors are inadvertent. In addition to being strict, hospital policies also generally have a severity bias. Marx says this outcomes-based thinking must change. “We have to take our eyes off the severity of the outcome,” he explains. “If I chose to drive drunk, I have to be held accountable for that choice regardless if I cause harm.” The Algorithm When an employee’s actions do not live up to an organization’s values—either because of a mistake, “near miss” or pattern of risky behavior—what is the appropriate reaction? Many managers are automatically inclined to take a punitive route, but that may not always be the best solution. The Just Culture Algorithm is a structured process designed to help managers assess situations where an employee has breached one of three types of responsibilities: • Duty to avoid causing unjustifiable risk or harm • Duty to follow a procedural rule • Duty to produce an outcome. By going through a series of steps, a manager can identify whether the employee’s action was a result of human error, at-risk behavior or reckless behavior. Once the nature of the action is defined, the manager can then use the algorithm to determine what step(s) the organization should take, which may include one or more of the following: • Support the employee’s behavior • Console the employee • Coach the employee • Conduct a human error investigation • Conduct an at-risk behavior investigation • Consider punitive action • Accept the outcome. The goal is to determine how, if at all, to modify both the system and the employee’s performance to avoid future errors and improve patient outcomes. The algorithm also helps managers assess situations where employees are either committing repetitive human errors or demonstrating repetitive at-risk behav10/27/06 9:57:20 AM 18 HR Pulse Winter 2007 305023_fina.indd 1 http://www.michaelcfina.com
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