In any given workplace, there is a basic agreement upon hiring employees: they will perform job duties to the best of their abilities in exchange for fair pay.  However, there’s a lot more to daily operations than simply leaving employees to their own devices and expecting everything to run smoothly.  This is why organizations require management, leadership, clear policies and procedures, and oversight to ensure compliance, productivity, and a safe and efficient work environment.

In the EMS industry, in particular, there’s a lot of pressure on employees to perform without fail.  After all, lives hang in the balance, and even a small error could have tremendous consequences.  That said, employee performance is not the only factor in play.

There has long been a practice of holding employees accountable for any errors that might occur; but this isn’t really fair, because these workers must do the best they can within a system; and with the tools they’re given.  If the system or the tools are inadequate, employees cannot be held accountable.  In other words, they cannot be expected to succeed forever in a system where they’re set up for failure.

The idea of just culture is one that can benefit employees and employers alike, providing a pathway to open communications that helps employees feel safe reporting accidents or errors and also facilitates collaborative solutions to prevent future incidents and solve existing problems that may have contributed to errors in the first place.  How can you create a just culture in your workplace and how will it benefit your employees and your organization?

Why is Just Culture Necessary?

Within the healthcare industry, there’s a tendency to blame errors on employees.  If items on an EMS checklist are missed, creating a life-threatening situation in the process, an employee might be fired, for example.  The employee could be blamed even if he/she was scheduled for back-to-back shifts or not given adequate time to complete the checklist, for example.

However, this strategy ignores the fact that employees don’t always have control over the circumstances in which they’re asked to perform, nor does it account for systematic problems that virtually set employees up to fail.  This, in turn, puts a lot of unnecessary pressure on employees, and with the threat of firing hovering overhead like the sword of Damocles, they may be understandably hesitant to speak up, or voice concerns about hazards.

This obviously isn’t what you want.  Employees in the trenches are the first and best source of information about the efficacy of day-to-day operations, as well as potentially hazardous and costly problems.  You want to create a culture where employees are encouraged to point out safety concerns and report honest mistakes, so you can gain insights that help you to minimize risk factors and prevent harm and expense that could be easily avoided with proper knowledge.

What is Just Culture?

While there are certainly instances when employees must be held accountable for gross negligence or willful misconduct, EMS organizations also need to exercise some restraint when it comes to penalizing employees for honest errors over which they have little or no control.

Say, for example, that you’re experiencing problems with checklists not being completed, leading to essential items missing from EMS vehicles, potentially creating life-threatening conditions because workers don’t have the right tools for the job.  While you could penalize employees for such infractions, you might want to first find out why checklists aren’t being completed.

Perhaps employees aren’t given enough time to thoroughly check everything before they’re sent out for a shift.  Maybe the checklist itself is incomplete, or employees are having trouble accessing needed checklists.  Employee negligence or laziness could be to blame, but until you get to the bottom of the problem, it’s a good idea to give employees the benefit of the doubt.

The ultimate goal is to create a culture in which employees feel comfortable coming forward with safety concerns, or volunteering information about innocent mistakes.  If they fear reprisal, all that will happen is that you won’t know mistakes are being made.  When employees are empowered to speak up and offer feedback, you have a much better chance to address issues that could lead to compliance failures and even accidents over time.

Implementing Just Culture within Your Organization

Changing your culture won’t happen overnight.  It takes time to develop trust between employees and management and it starts with listening to employees, considering their feedback, and taking action to address their concerns.  Anonymous surveys could be a good place to start.  From there, you could assign teams to come up with potential solutions to systematic concerns, empowering them to take ownership of problem-solving that benefits every employee and the organization as a whole.

When employees feel they’re being heard and see that their expertise and efforts create positive change, they’ll be far more likely to speak up in the future and collaborate with management.  This can help to boost morale and decrease stress in a very demanding profession.

If you have questions about this article or want to see how Ninth Brain can help with the Just Culture of your program, email