Culture drives quality—if an organization does not have a culture in which they hold themselves and others accountable, it is probable that it will not achieve and sustain high-level quality outcomes. Patient safety is defined as freedom from accidental injury; you have seen how medical errors are harmful, and that there are second victims that suffer as well. Remember quality can be defined as “the cumulative impact of all that happens to a patient while in an organization’s care” (Porter, 2012, p. 193). A Just Culture gives organizations a template to uniformly address the shortcomings or errors of those who fail. It addresses failures in four different areas, which include 1) human errors and mistakes, meaning unintentional harm; 2) carelessness or at-risk behavior—or not paying attention that results in an error; 3) recklessness or a flagrant disregard for norms where an error occurs unintentionally, but because of recklessness; and 4) those who just do not pay attention and have no regard for authority. In this Discussion, you will identify a model that a health care organization might use to improve their culture of quality and describe whether the ethical theory of Just Culture would improve the quality and why. To prepare: Review  Learning Resources on culture and patient safety. Post  a cohesive response to the following: Post a model you have selected that health care organizations might use to improve the culture of quality. Describe whether the ethical theory of Just Culture would improve the quality of a health care organization and how. Support your response by identifying and explaining key points and/or examples presented in the Learning Resources. Resources: Joshi, M. S., Ransom, E. R., Nash, D. B., & Ransom, S. B. (Eds.). (2014). The healthcare quality book: Vision, strategy, and tools (3rd ed.). Chicago, IL: Health Administration Press. Chapter 8, “The Culture Connection: Hardwiring Consistent Quality Delivery” (pp. 193–206) Chapter 11, “Patient Safety and Medical Errors” (pp. 269–294) Chapter 12, “Creating a Culture of Safety and High Reliability” (pp. 297–324) Detsky, A. S., Baerlocher, M. O., & Wu, A. W. (2013). Admitting mistakes: Ethics says yes, instinct says no. Canadian Medical Association Journal, 185 (5), 448. Note: Retrieved from the Walden Library databases. MacLeod, L. (2014). “Second Victim” casualties and how physician leaders can help. Physician Executive, 40 (1), 8–12. Note: Retrieved from the Walden Library databases. Nelson, W. A. (2013). Addressing the second victims of medical error. Healthcare Executive, 28 (2), 56–59. Note: Retrieved from the Walden Library databases. Stempniak, M. (2014). The other victim. When a patient is harmed, staff often suffer in silence. Hospitals & Health Networks, 88 (7), 18. Note: Retrieved from the Walden Library databases. Centers for Disease Control and Prevention. (2016). Chronic disease prevention and health promotion: Statisti ...

1. Culture drives quality—if an organization does not have a
culture in which they hold themselves and others accountable, it
is probable that it will not achieve and sustain high-level
quality outcomes. Patient safety is defined as freedom from
accidental injury; you have seen how medical errors are
harmful, and that there are second victims that suffer as well.
Remember quality can be defined as “the cumulative impact of
all that happens to a patient while in an organization’s care”
(Porter, 2012, p. 193).
A Just Culture gives organizations a template to uniformly
address the shortcomings or errors of those who fail. It
addresses failures in four different areas, which include 1)
human errors and mistakes, meaning unintentional harm; 2)
carelessness or at-risk behavior—or not paying attention that
results in an error; 3) recklessness or a flagrant disregard for
norms where an error occurs unintentionally, but because of
recklessness; and 4) those who just do not pay attention and
have no regard for authority.
In this Discussion, you will identify a model that a health care
organization might use to improve their culture of quality and
describe whether the ethical theory of Just Culture would
improve the quality and why.
To prepare:
Review
Learning Resources on culture and patient safety.
Post
a cohesive response to the following:

2. Post a model you have selected that health care organizations
might use to improve the culture of quality. Describe whether
the ethical theory of Just Culture would improve the quality of a
health care organization and how.
Support your response by identifying and explaining key points
and/or examples presented in the Learning Resources.
Resources:
Joshi, M. S., Ransom, E. R., Nash, D. B., & Ransom, S. B.
(Eds.). (2014).
The healthcare quality book: Vision, strategy, and tools
(3rd ed.). Chicago, IL: Health Administration Press.
Chapter 8, “The Culture Connection: Hardwiring Consistent
Quality Delivery” (pp. 193–206)
Chapter 11, “Patient Safety and Medical Errors” (pp. 269–294)
Chapter 12, “Creating a Culture of Safety and High Reliability”
(pp. 297–324)
Detsky, A. S., Baerlocher, M. O., & Wu, A. W. (2013).
Admitting mistakes: Ethics says yes, instinct says no.
Canadian Medical Association Journal, 185
(5), 448.
Note:
Retrieved from the Walden Library databases.

3. MacLeod, L. (2014). “Second Victim” casualties and how
physician leaders can help.
Physician Executive, 40
(1), 8–12.
Note:
Retrieved from the Walden Library databases.
Nelson, W. A. (2013). Addressing the second victims of medical
error.
Healthcare Executive, 28
(2), 56–59.
Note:
Retrieved from the Walden Library databases.
Stempniak, M. (2014). The other victim. When a patient is
harmed, staff often suffer in silence.
Hospitals & Health Networks, 88
(7), 18.
Note:
Retrieved from the Walden Library databases.
Centers for Disease Control and Prevention. (2016).
Chronic disease prevention and health promotion: Statistics and
tracking
. Retrieved from
http://www.cdc.gov/chronicdisease/stats/index.htm
Hospital Consumer Assessment of Healthcare Providers and
Systems. (n.d.).

4. CAHPS hospital survey
. Retrieved from http://www.hcahpsonline.org/home.aspx
Healthy People 2020. (2016a).
2020 topics and objectives: Objectives A–Z
. Retrieved from http://www.healthypeople.gov/2020/topics-
objectives
Healthy People 2020. (2016b).
Access to health services
. Retrieved from http://www.healthypeople.gov/2020/topics-
objectives/topic/Access-to-Health-Services
Healthy People 2020. (2016c).
How to use DATA 2020
. Retrieved from http://www.healthypeople.gov/2020/How -to-
Use-DATA2020