Just Culture: Developing a frame of reference on ‘Just Culture’ for the Dutch inspectorate of health and youth

Runtime: 2017 - 2019
Client: ZonMw

Project description

The role of the healthcare inspectorate is to improve patient safety and quality of care. Awareness is growing that behavior change, required for patient safety and quality of care is not solely covered by external control or codes of conduct, but depends on internal motivation and willingness to learn.

In the literature, the concept of ‘Just Culture’ has been presented in this context (1, 2). A Just Culture is a culture of trust in which professionals feel free to be transparent about insecurity and fallibility. An important aspect is fairness towards persons involved in situations with unwanted outcomes and a willingness to learn from these occurrences. A culture of openness and cooperation can provide room for improving patient safety and quality of care. Patients and clients benefit from healthcare providers who recognize, discuss and repair unsafe situations in healthcare.

The Dutch Health and Youth Care Inspectorate (‘Inspectorate’) wishes to examine the potential of a Just Culture approach for its own practice of improving quality of care through supervision. In this project, we aim to co-produce a Just Culture frame of reference for supervision.  To this end, we closely collaborate with the Inspectorate and various healthcare organizations. Central questions are: How can a Just Culture be recognized and assessed? Which instruments for regulation fit in with a Just Culture? What kind of interventions of the inspectorate can reinforce a Just Culture?

Prof. Dr. Roland Bal, Dr. I. Wallenburg, Prof. Dr. G.A.W.Widdershoven (VUmc), L.A. Hartman (MA) (VUmc), Dr. E van Baarle (VUmc)

The research takes on a practice approach, comprising observations, interviews and focus groups. We study initiatives to develop a Just Culture in healthcare organizations (case studies in 2 general hospitals and 2 mental care hospitals) and how in the Inspectorate seeks to incorporate such approach in its supervisory work – elucidating opportunities and possible frictions, both within healthcare organizations and the Inspectorate, as well as in the interaction between them.

1. Dekker S. Just Culture: Balancing Safety and Accountability: Ashgate; 2012.
2. Khatri N, Brown GD, Hicks LL. From a blame culture to a just culture in health care. Health Care Management Review. 2009;34(4):312-22.