Just Culture has gained significant attention in the healthcare industry, but when I talk about it in our EMT and paramedic course it seems that the concept has a way to go. Too many of our peers do not feel comfortable making a mistake and owning it without punishment up to and including suspension or termination. And let’s be honest, emergency medical services (EMS) has earned that resistance. For those of us that have been around for a few years we have seen our peers targeted, some may have deserved it, but others simply made a mistake. And of course, we do not help the integration of Just Culture, how many of us have seen people labeled by their peers and never let them forget the mistake that was made. Whispering behind the person’s back and making sure the new guy hears all about the mistake someone made years ago. This makes providers even more hesitant when it comes to reporting an error.
Just Culture, when working as intended, encourages individuals that work in high-stakes, dynamic industries, to take accountability when we know we have made a mistake. And we do so, employers should respond to your integrity with respect and coaching. There will of course be an investigation when it is called for, the facts need to be gathered as litigation may be in the organization’s future, but we also want to use this as part of the continuous quality improvement (CQI) process. Are there others within the organization that are making the same mistake? Maybe this issue is really related to a piece of equipment we are using within the EMS system as a whole. And if it is, we need to not only identify it, but also let the other organizations within the system know about the issue before something detrimental happens.
But do not expect Just Culture to save you when you are continuously making mistakes. There are only so many times that an organization is going to coach and educate you. For example, I used to work for a private entity. There was a paramedic that was in my new hire orientation. She did not pass her initial internship. She did not pass that second internship at a lower certification. But she was allowed to continue her employment and move into the 911 system working at the lower skillset. After several months she was allowed to attempt another paramedic internship. We were very short staffed, and everyone knew she would pass when she was placed with a specific Field Training Officer (FTO), and she did.
Over the next couple of years, it was not secret that she had made several mistakes, I mentioned earlier, people in EMS love to talk and the industry is essentially one big quilting circle. Some mistakes were bigger than others. After a couple of years, I was promoted into the clinical department and put in charge of investigations. While organizing the office I took over I found file after file with her name on it in all sorts of different drawers spread throughout the office. By the time I was done I had a stack of files for this person that was about 3” thick. It wasn’t very long before she made another mistake, this one involving narcotics, and before the investigation was officially opened the medical director said that he wasn’t sure he wanted her working under his license anymore. We conducted a thorough and fair investigation, and upon concluding the investigation the medical director said she was done. He was no longer willing to let her work under his medical license, we processed a revocation of clinical privileges, and she was terminated. But this was an extreme case that demonstrated a pattern of behavior.
By in large, Just Culture works, and we need it. Our industry is suffering from a severe shortage. We no longer have lines of people waiting to get hired. We cannot throw providers away for making a genuine mistake. We need to encourage organizations to truly adopt the concept and not waiver from it regardless of how big the mistake was. Any punitive damages awarded by the legal system is not going to be reduced because you terminated the person that made the mistake.
If you want to learn more about Just Culture, join us in either BLS L2 or the ALS L24 course!
