Evaluation of the Impact of Revisiting Just Culture Within a Pharmacy Department in an Academic Medical Center



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Background: The Institute of Medicine’s report To Err is Human in 2000, served as a catalyst for the healthcare industry to make deliberate assurances that quality and safety are at the center of every patient care discussion. An essential component of a safety culture is a just culture which is often defined as an environment of shared accountability that recognizes the potential for human error and where individuals feel empowered to report errors or express concerns without fear of retribution or discipline. Since the creation and validation of the Just Culture Assessment Tool (JCAT) in 2013, the JCAT has been used with other survey tools to assess various aspects of culture in hospitals. However, a gap in literature exists evaluating the perception of a pharmacy department’s just culture. Given the major role pharmacy departments play in medication and patient safety, evaluation of interventions focused on improving just culture are needed. Methods: A quasi-experimental single-center study was performed to evaluate the perceived just culture of a pharmacy department. The study timeframe included a pre-intervention and a post-intervention survey period, from November 16th through November 30th, 2020 and March 26th to April 9th, 2021, respectively. The baseline JCAT identified an opportunity to improve departmental communication regarding safety event outcomes. A medication safety newsletter was distributed to the department which served as the intervention of this study. The primary objective was to assess change in perceived just culture after distribution of the medication safety newsletter, which was measured by change in percentage of negative responses (PNR) to the JCAT. A subgroup analysis was performed to see if employee role and demographics influenced the perceived just culture. Results: For the primary endpoint there was an unexpected statistically significant increase in overall JCAT PNR between the pre- and post-surveys (p=0.035). These results were likely due to confounders related to response rate rather than the intervention itself. There were statistically significant increases in PNR for the ‘Openness of Communication’ (p=0.009) and ‘Continuous Improvement’ (p=0.032) domains. Among reduction in ‘Feedback and Communication’ among Operations Pharmacists (p=0.003). Conclusion: Cultivating a just culture is developed over time and is a dynamic process that is influenced by many factors. Just culture process improvements are likely to impact more than one just culture domain thus utilizing a validated tool to measure changes at the domain level may be beneficial.



just culture, patient safety, just culture assessment tool, pharmacy