If we truly believe in a just culture and the benefits this can bring for patient safety, it has to give equal importance to being fair to patients and families as well as to staff.
We are taught that to create this culture, when things have gone wrong, we need to focus on three questions (Dekker 2017): Who is hurt? What are their needs? And whose responsibility is it to meet those needs?
In the aftermath of a patient safety event resulting in serious patient harm or death, the response of the organisation to the patient or family is crucial. Yet too often, rather than the restorative approach Dekker calls for, harmed patients and bereaved families experience a response that in many cases significantly exacerbates their grief, trauma and distress.
The needs of harmed patients and families are for acknowledgement, apology, honest and full explanation, genuine reflection and also accountability.
Ensuring that staff involved in patient safety events are treated consistently and fairly is crucial to creating a just culture in healthcare, but there must also be a clearer framework of accountability that unpins the reasonable actions all healthcare providers should undertake to ensure their systems, processes and culture support their staff to deliver safe care.
Most importantly of all, the healthcare system needs to ensure that harmed patients and their families are properly cared for with compassion and empathy and not subject to further harm caused by the organisational and system response.
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