HR Pulse - Winter 2007 - (Page 20) >> JUST CULTURE iors, and determining whether reassignment, termination or punitive action is warranted. An interactive version of the algorithm tool allows managers to provide a narrative description of an event, navigate through the series of algorithm questions and describe their plan of action. At the end of the online session, a PDF file is created containing all the information, including a “highlighted” copy of the algorithm showing the pathway to action. The file can then be printed and used in discussions with employees and, if necessary, as a part of their human resources file. The tool—included in the Just Culture Training for Healthcare Managers— also can be used by a regulator to evaluate the conduct of a licensed professional or by an organization to evaluate the conduct of a manager. The Obstacles Changing the definition of accountability when it comes to medical errors is no easy task, of course. Marx sees two primary obstacles to making healthcare cultures more just. First, healthcare organizations are not alone in their severity bias; the general public takes the same view. When a medical error results in severe harm or death and is made known, the outside world wants someone to “pay” for the mistake regardless of the quality of the choices that were made in providing patient care. Second, creating a true learning culture requires the participation of physicians, and getting them engaged in the process in a meaningful way can be an uphill battle. Since physicians generally are not employed by the healthcare organizations they serve, it is difficult to compel them to participate. And given the tort liability they face, greater openness and increased levels of reporting represent potential danger for them. Despite the challenges, Marx believes that the best way to improve patient outcomes is for healthcare employers and regulators to shift their focus away from blame and punishment and to embrace a different view of accountability. He says he hears from people all the time about how well the Just Culture Model works, even with eight-year-olds. “It’s not about the broken window. It’s about the choice you made in playing ball in the front yard. The stakes we’re talking about are much higher, but the message is the same.” n Anne Coulter is a freelance writer who lives in Evanston, Ill. Learn more about her at www.bigleap.com. 20 HR Pulse Winter 2007 349330_Critical.indd 1 9/29/07 5:57:45 PM http://www.bigleap.com http://www.criticalresource.net
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