Creating a fair and just culture: one institution's pat toward organizational change

Jt Comm J Qual Patient Saf. 2007 Oct;33(10):617-24. doi: 10.1016/s1553-7250(07)33071-7.


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.

MeSH terms

  • Cancer Care Facilities / organization & administration*
  • Cancer Care Facilities / standards
  • Guidelines as Topic
  • Humans
  • Inservice Training
  • Massachusetts
  • Organizational Case Studies
  • Organizational Culture*
  • Organizational Innovation
  • Safety Management / organization & administration*
  • Social Justice
  • Staff Development