Use the quick links below to find the resources and information you need to implement and maintain Safety IQ in your pharmacy.
Just and Safety Culture
A just and safety culture is the shared belief and the practice of healthcare providers that prioritizes safety when providing care to patients and a system that treats people fairly when something goes wrong.
Unfortunately, a ‘blame-and-shame’ approach to mistake-making prevails across healthcare professions. Because individuals are often blamed for the shortcomings of the system in which they work everyday, stigma and fear prevent open communication about mistakes, root-causes remain invisible, and future patients may be harmed by a preventable recurrence.
According to the US Institute of Medicine, “the biggest challenge to moving toward a safer health system is changing the culture from one of blaming individuals for errors to one in which errors are treated not as personal failures, but as opportunities to improve the system and prevent harm.”
For community pharmacies, a just and safety culture optimizes learning from medication incidents and near-miss events to prevent future errors and improve patient safety. Medication incidents and near-miss events are discussed openly, and learnings are shared with the pharmacy team to prevent recurrence. Medication incidents are rarely caused by a single event or the actions of a single person. Analysis of medication incidents and near-miss events often reveal a system failure or environmental factors that must be changed to prevent medication incidents.
Resources you can use to support just and safety culture include:
- Community Pharmacy Safety Culture Toolkit (CPhM):
- Culture Change Toolbox (BC Patient Safety and Quality Council):
- Health Quality Council of Alberta Just Culture Website:
A just and safety culture is not consequence-free. While your pharmacy shouldn’t punish staff for errors that happen due to a systemic issue, your staff are accountable for following protocols, procedures, and practice directions. It’s important for your pharmacy to ensure that behavioural and work expectations are clear and that staff have the resources, education, and processes and procedures to work safely and within regulatory requirements.
It is important to have an accountability framework in place that ensures that leadership responds to medication incidents in a way that is expected, practiced, and applied uniformly across the entire workforce.
A Framework for Safe, Reliable, and Effective Care combine two of the best known accountability algorithms from David Marx and James Reason and CPhM has adapted this version to pharmacy practice in Manitoba. Download the algorithm from the following link:
Leaders and pharmacy team members should also be familiar with their obligations under provincial and federal legislation including, but not limited to the following:
- The Pharmaceutical Act and Regulations
- Code of Ethics
- The Apology Act
- The Personal Health and Information Act
The CPhM Guide to Pharmacy Practice outlines the legislation, standards of practice, practice directions, and Code of Ethics that pharmacists must uphold.
|Characteristics of Blame-and-Shame vs. Just-and-Safety Culture|
|Blame-and-Shame Culture||Just-and-Safety Culture|
|Preoccupation with individual performance and the belief that with the hard work and focus of individuals, things will naturally improve.||Preoccupation with safety and people have current knowledge about the factors that determine the safety of the system.|
|Open communication about incidents and near misses is discouraged directly and indirectly. Individuals are made to feel incompetent if they are involved in an incident. Reporting is absent, not used effectively, or is used to focus on individual performance.||Incidents and near misses reported without fear of blame and learning is shared across the team. Every team member feels confident discussing incidents and near misses and asking questions.|
|Punishment is trusted as an effective way to motivate carefulness.||Trust that the organization will deal people fairly when something goes wrong is predominant.|
|Persists with potentially faulty systems and practices in place; stop-gaps such as ‘work arounds’ are used by individuals to avoid errors.||System and teams adapt to changing pressures and demands.|