Portal de Periódicos da CAPES

How to create a just work culture

2022; Elsevier BV; Volume: 28; Issue: 3 Linguagem: Inglês

10.1016/j.ptdy.2022.02.013

2773-0735

Johanna Taylor Katroscik,

Patient Safety and Medication Errors

In December 2021, the APhA Board of Trustees issued a statement addressing the intense burnout that pharmacists and other pharmacy team members are currently experiencing. The statement addressed some of the major root causes of the challenges facing the profession including understaffed pharmacies, unrealistic performance metrics, and a disjointed payment system. As the profession continues to navigate these difficult times, how can it start to make steps toward progress, even if they are small ones? Looking back to the early to mid-2000s, the idea of just culture was brought to the spotlight in health care settings. “Just culture” is essentially the idea that there is a shared accountability in safety outcomes; that is, in most cases the cause of a safety event cannot necessarily be solely blamed on one individual. It is a system in which reporting errors is both encouraged and important. Blame is not placed on a specific person, but is used to learn what the root cause of the error was and to improve safety outcomes. According to the just culture model, there are three expected behaviors: human error, at-risk behavior, and reckless behavior. Human error is defined as an inadvertent mistake; for example, running a stop sign without even realizing it. At-risk behavior is defined as a behavior that increases risk and could either be a risk that is not recognized or one that is somehow justified (e.g., a pharmacist working 8 hours straight without taking a break missing a drug interaction or placing a medication for one patient into a bag for another patient). Reckless behavior is defined as making a conscious choice to do something that is known to be wrong or harmful, like running a stop sign on purpose because you’re in a hurry and think no one will notice. Each of these could potentially cause harm, but how they are addressed in a just culture approach is different. In the example of running a stop sign, a just culture approach might be to ask if the stop sign was visible or if it was somehow blocked by a tree or bush. When thinking about a pharmacist making an error, the just culture approach would be to look at the reason the pharmacist did not take a break—were there metrics that they couldn’t meet, were they not supported by their employer, etc. A solution would be to look at the process and whether a better support system could be built into the work environment so that the pharmacist could take breaks to give their body and mind the necessary breaks to be able to perform their job. For running a stop sign, the action would be disciplinary because the person who performed the action purposely did not take potential safety consequences into account. Pharmacists are used to advocating for their patients but are not always great at advocating for themselves. As the profession continues to be pushed to its edge, pharmacists must learn how to be self-advocates and be empowered to take care of themselves so they can take care of their patients. Taking time to eat and taking restroom breaks can be small steps in the right direction. Talking with leadership and working to incorporate a just culture into pharmacies could be a slightly bigger step. Presenting a solution gives leadership and management an actionable item with which they can move forward. According to an American Society of Health-System Pharmacists Medication Safety Policy Position, pharmacists should be encouraged to “exert leadership in establishing a just culture in their workplaces and a nonpunitive systems approach to addressing medication errors while supporting a nonthreatening reporting environment to encourage pharmacy staff and others to report actual and potential medication errors in a timely manner.” By starting and establishing just culture practices in pharmacy settings (hospital, community, etc.), pharmacies, pharmacists, and pharmacy technicians can work together to create joint accountability that moves the profession forward.