Risk Considerations: Promoting a Culture of Safety

In a chiropractic culture in which “blame and shame” are the default responses when patient harm events happen, providers may try to conceal their errors rather than report them.[i] As a result, chiropractic practices might be unable to accurately identify and address system failures that can compromise patient safety.

During his testimony before the United States Congress in 1997, Dr. Lucian Leape, who is regarded as the father of the modern patient safety movement, pointed out the dangers of a punitive environment, stating that “The single greatest impediment to error prevention is that we punish people for making mistakes.” [ii]

The focus on patient safety in healthcare has significantly increased since the Institute of Medicine’s groundbreaking report To Err is Human was published in 2000. This report was a wakeup call to the healthcare industry regarding the patient safety crisis in the United States, where it was estimated that between 44,000 and 98,000 people die each year from preventable medical errors.[iii]

Patient safety leaders have found that errors are very rarely due to carelessness or misconduct, but rather system failures and unintentional human missteps.

Although error reporting may be low in a punitive environment, changing the culture can increase staff member’s willingness to report. [iv]

To encourage error reporting, chiropractic practices must embed “just culture” concepts – such as transparency and accountability – into their organizational culture. Although intentional rule violations and reckless conduct require disciplinary action, honest mistakes should be viewed as learning opportunities.[v]

MedPro Group recognizes the criticality of establishing a culture of safety in all chiropractic settings and encouraging chiropractors and other healthcare professionals to speak up and report errors. We offer various resources that contain guidance and strategies for creating a non punitive environment that promotes patient safety, learning, and improvement. These materials, as well as other curated content, are found in MedPro’s Risk Resources: Culture of Safety.

MedPro insureds who have questions about implementing a culture of safety may call their senior risk solutions consultant or MedPro’s Risk Solutions Center at 1-833-ASK-RISK (1-833-275-7475), email [email protected], or schedule an appointment at www.medpro.com/dynamic-risk-tools (click on “schedule appointment with risk consultant”).

Endnotes

1. Parker, J., & Davies, B. (2020, August). No blame no gain? From a no blame culture to a responsibility culture in medicine. Journal of Applied Philosophy, 37(4), 646-660. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33362325/
2. Murray, J. S., Clifford, J., Larson, S., Lee, J. K., & Sculli, G. L. (2023, July/August). Implementing just culture to improve patient safety. Military Medicine, 188(7-8), 1596-1599. doi: https://doi.org/10.1093/milmed/usac115
3. Institute of Medicine. (2000). To err is human: Building a safer health system. Washington, DC: National Academies Press. Retrieved from https:lfnap.nationalacademies.org/catalog/9728/to-err-is-human­ building-a-safer-health-system
4. Brigham and Women’s Faulkner Hospital. (n.d.). What is just culture? Changing the way we think about errors to improve patient safety and staff satisfaction. Retrieved from https://www.brighamandwomensfaulkner.org/about-bwfh/news/what-is-just-culture-changing-the-way-we-think-about-errors-to-improve-patient-safety-and-staff-satisfaction
5. Marx, D. (2001, April 17). Patient safety and the ”just culture”: A primer for health care executives.Columbia University & University of Texas Southwestern Medical Center at Dallas. Retrieved from www.mnhospitals.org/wp-content/uploads/Portals/Documents/ptsafety/Marx.pdf

This document does not constitute legal or medical advice and should not be construed as rules or establishing a standard of care. Because the facts applicable to your situation may vary, or the laws applicable in your jurisdiction may differ, please contact your attorney or other professional advisors if you have any questions related to your legal or medical obligations or rights, state or federal laws, contract interpretation, or other legal questions.

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