Ending Burnout Begins with Culture Change, Says ECRI Report
New research from ECRI, a global independent healthcare and patient safety nonprofit, and The Just Culture Company urges healthcare leaders to address punitive workplace cultures that undermine patient safety, erode trust, and drive burnout among healthcare workers. The findings are featured in a recently-published article, The Quiet Power of Accountability: 10 Leadership Steps to Transform Healthcare's Punitive Culture.
The article, coauthored by experts from ECRI and The Just Culture Company, analyzes two decades of data from AHRQ's Patient Safety Culture Survey. Authors also gathered thousands of data points from 12 industries over two years, measuring how punitive these industries are in response to errors made by their workforce, including healthcare, aviation, policing, emergency medical services (EMS), energy, construction, manufacturing, utilities, research laboratories, hospitality, and education (K-12 plus higher education).
Key findings include:
Police, aviation, and EMS are most punitive toward human error.
Education, research labs, and healthcare are the least punitive industries.
Despite modest gains, only 60% of healthcare workers today believe their organization responds non-punitively to error.
Although healthcare is less punitive than most other industries, the authors say healthcare has a long way to go to create cultures that prioritize patient safety, workforce wellness and reliable outcomes in care delivery.
"Too often, healthcare professionals are punished for being human. This drives fear, suppresses error reporting, and ultimately puts patients at risk," said Marcus Schabacker, MD, PhD, president and CEO of ECRI, who recently penned an op-ed on why punitive cultures are damaging to healthcare. "We must create environments where people can speak up, learn from mistakes, and feel supported while doing their jobs. The focus must shift from determining who is at fault when errors happen, to determining what went wrong, what we can learn, and how to improve the system overall."
"To produce better outcomes in healthcare, we need to design better systems around our team members and help them make better choices within those systems. We do this, in part, by learning from our mistakes," said David Marx, founder of the Just Culture Company. "Encouraging employees to self-report actions they did not intend is foundational to fully functional organizational systems of learning. We should judge the quality of a person's choices, not the triumph or tragedy those choices produce."
The study's authors are optimistic, adding that when a healthcare organization is committed to implementation of just culture concepts, they can see improvements in the rate of punitive responses to error as high as 35 percent in one year.
"The good news is that we know what works," said Barbara Olson, MS, RN, CPPS, coauthor and chief clinical officer of The Just Culture Company. "When leaders better understand human behavior and can differentiate human error and common workarounds—choices people often perceive as necessary or inconsequential—from culpable acts, they are able to foster a more just workplace and build trust and psychological safety for their staff."
The article outlines a ten-step approach to shifting organizational culture, including:
Evaluate actions based on an individual's intentions, not just outcomes.
End disciplinary actions for errors and at-risk behavior.
Design systems that support safe and effective choices.
Be fiercely intolerant of highly culpable behavior.
Reject the "no harm, no foul" philosophy.
Educate healthcare leaders and team members on the tenets of just culture.
Consider how "just culture" impacts far more than patient safety.
Educate professional boards, regulators, and the community.
Measure results and progress over time.
Lead with mercy, grace, and forgiveness.
