Just Culture Book Club Week 1 Blog Post – Preface and Cases

This week we read the Preface, Case Study and Chapter 1 of Sidney Dekker's Just Culture: Restoring Trust and Accountability in Your Organization. In these chapters, Dekker introduces the concept of restorative justice and presents two cases that highlight what happens when things go wrong and a restorative Just Culture is not in place.

When posting your thoughts on the Preface and two cases, consider the following questions:

  • What are the arguments against a systems approach to harm reduction in healthcare? How do we balance individual accountability vs. system accountability? What are the advantages of a Just Culture?
  • Consider the example given in the book of preventing wrong site surgery. What should a hospital do when policies and procedures are in place to prevent serious safety events (e.g. signing the site and confirming with the patient prior to surgery), but harm still occurs?
  • How is the focus on active errors (individual accountability) different in retributive vs. restorative justice?
  • What are your thoughts on the case “Under the Gun”? Were the review of the case and subsequent actions taken in line with a Just Culture? If not, what would be a more just (or restorative) response to this unexpected event?
  • What are your thoughts on the case “When Does a Mistake Stop Being Honest”? What similarities do you see between this case and the practice of medicine? Are there similar pitfalls? What is the responsibility of an individual to correct or speak up for system failures before they cause harm?

Feel free to expand beyond these questions and offer your own! The next post will focus on Chapter 1: Retributive and Restorative Just Cultures.

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