Introduction to Just Culture

Just culture is the concept of designing, implementing, and supporting a fair and just learning culture within an organization. Just culture entails managing behavioral choices and designing safer systems to prevent errors. A just culture model in health care creates a unique framework where administrators and employees both share in the responsibility of upholding safe practices where errors are minimized. In a just culture environment, shared responsibility is founded through trust, transparency, and open communication. Health care organizational commitment to a just culture acknowledges that health care providers operates in a complex and high risk environment and safe and reliable systems are essential to minimizing errors and adverse events. In a just culture environment individuals are empowered to report errors and take responsibility for their behaviors and actions. Administrative commitment to reliable and safe systems and provider’s accountability form the basis of the just culture model. The just culture model of health care leads to organizational improvements in safety and quality of care. 5, 47, 23

Just Culture

Managing Behavioral


Designing Safer

To Err is Human

The monumental report To Err Is Human: Building a Safer Health System from the Institute of Medicine brought to light staggering statistics on medical errors in this country. Preventable medical errors are responsible for conservatively between 44,000 and 98,000 deaths per year in United States. The study highlighted the need for implementation of safety and learning cultures in health care organizations to minimize errors, the need for a just culture.25

Just Culture

“It is through a Just Culture that we will begin to see, understand, and mitigate the risks within the healthcare system”

David Marx

Outcome Engineering

Stages of Just Culture - Where Are You?

Take the quiz to see which stage your organization is in!


Stage 1 - Organizational culture is based on rules and regulations


Stage 2 - Just culture becomes an organizational goal


Stage 3 - Organizational culture is seen as dynamic and continuously improving

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