Defense Date
4-16-2024
Graduation Date
Spring 5-10-2024
Submission Type
Dissertation/Thesis
Degree Name
Doctor of Nursing Practice (DNP)
Department
Doctor of Nursing Practice (DNP) Program
School
School of Nursing
Faculty Mentor
Catherine Johnson
Committee Member
Jacalyn A. Liebowitz
Keywords
Just Culture, Fallibility, Human Error, Drift, At-Risk Behavior, Reckless Behavior, Knowledge Behavior, Purpose Behavior, Outcome Bias, Severity Bias, Systems Design
Abstract
Objectives
The purpose of this study was to assess employee perceptions of a healthcare organization’s existing climate of psychological safety regarding reporting patient care errors or near-miss events. Based on data obtained from the use of a valid and reliable survey tool, a plan was developed for the introduction and implementation of Just Culture throughout a large multi-hospital healthcare system.
Methods
Employee perceptions of the organization’s culture and current barriers to improving patient safety were identified by administering the JCAT survey to a population of 25,893 frontline staff, middle leaders, and senior leaders (clinical and non-clinical) at 26 separate hospitals prior to implementation. A total of 10,021 respondents (38.7 rate of return) expressed the extent to which each agreed or disagreed with 27 descriptive statements arranged within six broad dimensions. Thereafter, an enterprise-wide implementation of Just Culture began by providing extensive training to leaders in the system and more abbreviated training to the employees.
Results
Descriptive statistical tests and calculations were completed, and the Cronbach’s alpha values were above α = 0.7 for all except one of the constructs mapped to the six primary JCAT dimensions. Data revealed the presence of a punitive culture in response to human error, and a reluctance to voluntarily report adverse events. More than 2,000 leaders completed in-person Just Culture training, and over 27,000 employees completed the training online during the 16-month project.
Conclusions
Prior to commencing this quality improvement project, leaders within the healthcare system had relatively little awareness of the science of human factors. Raising their awareness of human fallibility, human behavioral choices, and why re-designing systems is most often the solution to future error prevention has been transformational. Growing relational trust between leaders and frontline nurses and caregivers was identified as a critical element in the creation of psychological safety, ultimately enhancing the patient safety culture.
Language
English
Recommended Citation
Stuart, Lawson, "Enhancing the Culture of Safety Among Hospital Personnel by Implementing a Just Culture Program: A Quality Improvement Project" (2024). Doctor of Nursing Practice (DNP) Manuscripts. 51.
https://dsc.duq.edu/dnp/51