High Reliability and the Just Culture

Those who work in the safety space are very familiar with Just Culture.  Through a Just Culture, organizations can effectively navigate the tension between open reporting of the precursors to accidents and the very real need to hold individuals accountable for conduct that might lead to harm (consider what we might do with an intoxicated truck driver).

Many have heard of Dr. Lucian Leape’s testimony before the US Congress.  He reported that “the single greatest impediment to error prevention in the medical industry was that we punished people for making mistakes.”  It was Dr. Leape’s testimony, that in an industry that kills 440,000 lives each year in the US (the third leading cause of death after cancer and heart disease), that healthcare culture was one where a provider “would report only what they could not hide.”

The Just Culture has become an integral part of safety systems across high consequence industries, from aviation to healthcare, from railroads to zoos.  Through a Just Culture, managers can find an appropriate response to conduct involved in adverse events, thereby protecting system reliability by creating an open learning culture, while maintaining a high degree of personal accountability.