Improving safety by developing trust with a just culture
Intended for healthcare professionals

Improving safety by developing trust with a just culture

Deborah Small Chief nursing officer, Cleveland Clinic London, London, England
Robert M Small Applied economist, retired, London, England
Alice Green Nursing quality manager, Cleveland Clinic London, London, England

Why you should read this article:
  • To enhance your knowledge of the concept of just culture when measuring and assuring safety

  • To identify how to apply a just culture approach to your organisation

  • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers)

  • To contribute towards your professional development and local registration renewal requirements (non-UK readers)

This article presents a simple conceptual road map for implementing a just culture in healthcare settings. The concept of just culture was developed as one of five fundamental elements of a safety culture by psychology professor James Reason in 1997. A just culture requires an unbiased method of judging human error and is designed to develop organisational trust so that adverse medical events (errors) are reported and corrected before they combine with other errors to cause injury or death. To implement a just culture properly so as to increase organisational safety, practitioners must understand its role in enabling the error reporting needed to develop a safety culture. This article reviews these foundational concepts and explores the human causes of errors that a just culture addresses, the psychological importance of a just culture in enabling error reporting and how to implement a just culture in organisations.

Nursing Management. doi: 10.7748/nm.2021.e2030

Peer review

This article has been subject to external double-blind peer review and checked for plagiarism using automated software


Conflict of interest

None declared

Small D, Small RM, Green A (2021) Improving safety by developing trust with a just culture. Nursing Management. doi: 10.7748/nm.2021.e2030

Published online: 23 December 2021

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