University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Thomas Colletti



Objective: The purpose of this article is to review whether implementing a culture of safety to address system issues, rather than the standard culture of blame, leads to a safer environment for staff and patients.

Method: A PubMed literature search was conducted with search terms just culture OR culture of safety AND healthcare. The search was limited to the past five years with free full-text articles from the United States. The search resulted in 55 articles to be reviewed. Of the reviewed articles, the 6 most relevant were selected.

Results: Literature suggests that implementation of a culture of safety, by increasing psychological safety, decreasing power distance, and evaluating near misses and adverse events, through the principles of a just culture, creates a safer environment for patients and staff, improves employee engagement, increases event reporting of near-miss and adverse events, promotes continuous learning, and improves patient outcomes.

Conclusion: If the healthcare industry is to become highly reliable, a culture of safety must be embraced. Organizations have to increase psychological safety while decreasing power distance to promote staff comfort with escalating near-miss and adverse events. These events require a rigorous evaluation and should be addressed by implementing the just culture principle of accepting human error, coaching at-risk behavior, and accountability for culpable events. Focusing on the system flaws will lead to a culture of trust, improve event reporting, and the ability of the organization to continuously learn and improve. These benefits will also drive the organization toward becoming a high-reliability organization.

Keywords: Just culture, Psychological safety, Culture of safety.


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