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El ABC de la Cultura Justa (The ABC of the Just Culture): The path to building a dependable organization

What Works & What Doesn't

The American British Cowdray Medical Center (ABC Medical Center), in Mexico City, has evolved throughout the years by consistently updating our vision but always with a focus on the patient as our reason to exist. Between 1999 and 2011, we fixed our vision on quality and patient safety and sought out those who could endorse us for what we achieved in this period: the national certifications and recertification of the General Health Council, the international Joint Commission Accreditation and the National Quality Prize.

The year 2010 was one of reflection and broadening our horizons to observe what was being done worldwide in relation to quality and patient care with a deep commitment to one of our most important organizational pillars: our people.

As an organization, we have analyzed our leadership, values and expectations of our work team in relation to the attention our patients are receiving, recognition of our people and our ethics code, among others. Though we have successfully maintained high-quality standards, we regularly ask ourselves: What is the next step to ensure that we continue to be the best option for our patients and physicians?

The answer we have found to allay our concerns has been to focus our efforts towards patient safety within the framework of a just culture. We intend to devise an ethical framework that will promote patient safety and achieve better patient care outcomes by focusing on our staff, our safety culture, institutional policies, safe practices and adequate incident reporting (see Figure 1). This is the starting point for our organizational culture transformation program.

Our program is called “The ABC of the Just Culture” because we seek to transform the culture of the American British Cowdray Medical Center to one in which errors are not personalized and processes can be analyzed and system flaws corrected to make the organization dependable.

We know that a ‘just culture’ can be achieved when we remind ourselves we are human and, consequently, fallible. A fundamental strategy to bring this cultural transformation about is to favor the organization from within by developing a learning environment.
We intend to:

  • Favor a non-punitive culture but not mistake it for a blame-free culture.
  • Promote the incident report of errors, near misses and sentinel events to learn from and enhance patient safety and care.
  • Reflect within the organization the leadership’s commitment to patient safety at all times.
  • Strengthen leadership, communication, recognition and team work between the different areas.
  • Implement the best practices in patient safety by educating, training and generating trust between staff.
  • Recruit, select and develop staff always bearing in mind the concept of safety.

We know the path is long, as it is for any organization undergoing a fundamental cultural transformation, but we are willing to invest the necessary time to instill this new culture.

What have we done?:

We started off by administering a Patient Safety Perception Survey to our staff to assess our baseline. We are now reviewing our policies and processes in accordance with the Just Culture Algorithm and our own patient safety policies, developing the implementation strategy and elaborating our education plan. 
But above all things, we are very enthusiastic and committed because, in the end, as a result of this transformation, we want our collaborators to feel free to report flaws and errors and communicate openly about incidents and sentinel events. We want people to learn from their errors to help design better and safer systems that assist our staff to make better and safer decisions. We will do this by supporting those who commit human error, coaching the at-risk behavior and punishing the reckless behavior (see Figure 2).

The Three Behaviors

* The Just Culture Algorithm, Version 3.1, Outcome Engineering, LLC. Curators of the Just Culture Community.

The American British Cowdray Medical Center recognizes and acknowledges that to err is human and we are keen to do what it takes to develop barriers that help minimize the errors by reporting, analyzing and modifying our system.

Alejandro Alfonso Diaz, Managing Director and CEO of ABC Medical Center in Mexico City, is an Eisenhower Fellow.

Issue 8 | Nominated Innovations