The Relationship Between Just Culture, Trust, and Patient Safety

2.50
Hdl Handle:
http://hdl.handle.net/10755/623944
Category:
Full-text
Format:
Text-based Document
Type:
DNP Capstone Project
Level of Evidence:
Other
Research Approach:
Quantitative Research
Title:
The Relationship Between Just Culture, Trust, and Patient Safety
Author(s):
Paradiso, Linda Ann; Sweeney, Nancy
Lead Author STTI Affiliation:
Epsilon Chi
Author Details:
Linda Ann Paradiso DNP, RN, NPP, NEA-BC; Nancy Sweeney PhD, APRN, BC
Abstract:

OBJECTIVES: This study explored the difference in the perception of trust between nurse leaders and direct care nurses in a Just Culture, and the impact this may have on patient safety related to voluntary reporting of patient care issues.

BACKGROUND: Medical errors are the third leading cause of death in the United States, and nurses can have a significant impact in reducing those deaths.  Hospitals are imperfect systems where nurses have competing demands, where they are forced to improvise and develop work arounds.  This autonomy creates illusions that systems are effective.  Direct care nurses possess the unique ability to identify errors due to their proximity to the patient.  The primary barrier to reporting errors is the negative organizational response and the risk of discipline. Just Culture is an environment where organizations are accountable for the systems they design, and foster an analysis of the incident, not the individual.  If nurses perceive their treatment is not just, they may drive valuable safety-related information underground.  Organizations must strive to understand the nature and scope of errors, actively redesign faulty systems, and value voluntary error reporting.  

METHODS:  An anonymous survey was conducted in a large, urban teaching hospital to determine the relationship of trust and Just Culture.  All direct care nurses and nurse leaders (1580 participants) were recruited. 

RESULTS: This study revealed that there was a statistically significant difference between the direct care nurses’ and nurse leaders’ perceptions of trust and Just Culture within the organization.  The majority of direct care nurses did not perceive that they will be given a fair and objective follow up process, or that the hospital will investigate the event fairly.  When involved in an incident, direct care nurses perceived that they would be blamed, and feared disciplinary action.

CONCLUSIONS: The findings offer practical implications to developing a trusting and Just Culture. An understanding of strengths and weaknesses  can assist nurse leaders to ensure a fair and balanced approach to incident investigation.  A Just Culture is not a blame-free culture, but a balanced accountability. Leaders need to look beyond the error, to the systems in which direct care nurses work, and the behavioral choices they make within these systems. When attitudes and behaviors are aligned, then the approach to performance improvement becomes the standard work of all staff.  

Keywords:
Trust; Just Culture; Speaking up; Psychological Safety; Performance Improvement; Patient Safety Culture; leadership; Nursing
CINAHL Headings:
Organizational Culture; Patient Safety; Trust; Health Care Errors; Nurse Attitudes; Perception; Perception--Evaluation; Voluntary Reporting; Quality of Health Care
Repository Posting Date:
22-Mar-2018
Date of Publication:
22-Mar-2018
Note:
This work has been approved through a peer-review process prior to its posting in the Virginia Henderson Global Nursing e-Repository.
Grantor:
Old Dominion University
Degree:
DNP
Degree Year:
2017

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typeDNP Capstone Projecten
dc.evidence.levelOtheren
dc.research.approachQuantitative Researchen
dc.titleThe Relationship Between Just Culture, Trust, and Patient Safetyen_US
dc.contributor.authorParadiso, Linda Annen
dc.contributor.authorSweeney, Nancyen
dc.contributor.departmentEpsilon Chien
dc.author.detailsLinda Ann Paradiso DNP, RN, NPP, NEA-BC; Nancy Sweeney PhD, APRN, BCen
dc.identifier.urihttp://hdl.handle.net/10755/623944-
dc.description.abstract<p><span style="text-decoration: underline;">OBJECTIVES:</span> This study explored the difference in the perception of trust between nurse leaders and direct care nurses in a Just Culture, and the impact this may have on patient safety related to voluntary reporting of patient care issues.</p> <p><span style="text-decoration: underline;">BACKGROUND:</span> Medical errors are the third leading cause of death in the United States, and nurses can have a significant impact in reducing those deaths.  Hospitals are imperfect systems where nurses have competing demands, where they are forced to improvise and develop work arounds.  This autonomy creates illusions that systems are effective.  Direct care nurses possess the unique ability to identify errors due to their proximity to the patient.  The primary barrier to reporting errors is the negative organizational response and the risk of discipline. Just Culture is an environment where organizations are accountable for the systems they design, and foster an analysis of the incident, not the individual.  If nurses perceive their treatment is not just, they may drive valuable safety-related information underground.  Organizations must strive to understand the nature and scope of errors, actively redesign faulty systems, and value voluntary error reporting.  </p> <p><span style="text-decoration: underline;">METHODS:</span>  An anonymous survey was conducted in a large, urban teaching hospital to determine the relationship of trust and Just Culture.  All direct care nurses and nurse leaders (1580 participants) were recruited. </p> <p><span style="text-decoration: underline;">RESULTS:</span> This study revealed that there was a statistically significant difference between the direct care nurses’ and nurse leaders’ perceptions of trust and Just Culture within the organization.  The majority of direct care nurses did not perceive that they will be given a fair and objective follow up process, or that the hospital will investigate the event fairly.  When involved in an incident, direct care nurses perceived that they would be blamed, and feared disciplinary action.</p> <p><span style="text-decoration: underline;">CONCLUSIONS:</span> The findings offer practical implications to developing a trusting and Just Culture. An understanding of strengths and weaknesses  can assist nurse leaders to ensure a fair and balanced approach to incident investigation.  A Just Culture is not a blame-free culture, but a balanced accountability. Leaders need to look beyond the error, to the systems in which direct care nurses work, and the behavioral choices they make within these systems. When attitudes and behaviors are aligned, then the approach to performance improvement becomes the standard work of all staff.  </p>en
dc.subjectTrusten
dc.subjectJust Cultureen
dc.subjectSpeaking upen
dc.subjectPsychological Safetyen
dc.subjectPerformance Improvementen
dc.subjectPatient Safety Cultureen
dc.subjectleadershipen
dc.subjectNursingen
dc.subject.cinahlOrganizational Cultureen
dc.subject.cinahlPatient Safetyen
dc.subject.cinahlTrusten
dc.subject.cinahlHealth Care Errorsen
dc.subject.cinahlNurse Attitudesen
dc.subject.cinahlPerceptionen
dc.subject.cinahlPerception--Evaluationen
dc.subject.cinahlVoluntary Reportingen
dc.subject.cinahlQuality of Health Careen
dc.date.available2018-03-22T19:13:43Z-
dc.date.issued2018-03-22-
dc.date.accessioned2018-03-22T19:13:43Z-
dc.description.noteThis work has been approved through a peer-review process prior to its posting in the Virginia Henderson Global Nursing e-Repository.-
thesis.degree.grantorOld Dominion Universityen
thesis.degree.levelDNPen
thesis.degree.year2017-
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