From a blame culture to a just culture in health care
Abstract
BACKGROUND: A prevailing blame culture in health care has been suggested as a major source of an unacceptably high number of medical errors. A just culture has emerged as an imperative for improving the quality and safety of patient care. However, health care organizations are finding it hard to move from a culture of blame to a just culture. PURPOSE: We argue that moving from a blame culture to a just culture requires a comprehensive understanding of organizational attributes or antecedents that cause blame or just cultures. Health care organizations need to build organizational capacity in the form of human resource (HR) management capabilities to achieve a just culture. METHODOLOGY: This is a conceptual article. Health care management literature was reviewed with twin objectives: (a) to ascertain if a consistent pattern existed in organizational attributes that lead to either blame or just cultures and (2) to find out ways to reform a blame culture. CONCLUSIONS: On the basis of the review of related literature, we conclude that (a) a blame culture is more likely to occur in health care organizations that rely predominantly on hierarchical, compliance-based functional management systems; (b) a just or learning culture is more likely to occur in health organizations that elicit greater employee involvement in decision making; and (c) human resource management capabilities play an important role in moving from a blame culture to a just culture. PRACTICE IMPLICATIONS: Organizational culture or human resource management practices play a critical role in the health care delivery process. Health care organizations need to develop a culture that harnesses the ideas and ingenuity of health care professional by employing a commitment-based management philosophy rather than strangling them by overregulating their behaviors using a control-based philosophy. They cannot simply wish away the deeply entrenched culture of blame nor can they outsource their way out of it. Health care organizations need to build internal human resource management capabilities to bring about the necessary changes in their culture and management systems and to become learning organizations.
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A transparent, objective, and consistent approach to the management of quality issues is foundational to the development of a "just culture" that encourages reporting of issues and eschews blame, and without an integrated culture of reliability, HROs would be considered as just "well‐run" entities.
“A transparent, objective, and consistent approach to the management of quality issues is foundational to the development of a “just culture” that encourages reporting of issues and eschews blame [44], and without an integrated culture of reliability, HROs would be considered as just “well‐run” entities [41].”
From Quality issue management and disclosure in forensic science: A survey of practice and perceptions (2025) · cites this paper as [44]
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Quality issue management and disclosure in forensic science: A survey of practice and perceptions
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“…and consistent approach to the manage - ment of quality issues is foundational to the development of a “just culture” that encourages reporting of issues and eschews blame [ 44 ], and without an integrated culture of reliability, HROs would be considered as just “well-run” entities [ 41 ].”
- Authors
- Khatri, N., Brown, G. D., & Hicks, L. L.
- Affiliations
- University of Missouri (US)
- Venue
- Health Care Management Review
- Published
- 2009-10
- Volume
- 34
- Issue
- 4
- Pages
- 312-322
- ISSN
- 0361-6274 (ISSN-L)
- OpenAlex
- W2331023248
- Semantic Scholar
- ecc4fe39c6de9c8ade30f43b93945b47a2e3bc75
- Cited by
- 298
- References
- 49
- Citations by year
- 2026: 14 · 2025: 18 · 2024: 22 · 2023: 26 · 2022: 26 · 2021: 26 · 2020: 21 · 2019: 12 · 2018: 27 · 2017: 19 · 2016: 15 · 2015: 9 · 2014: 18 · 2013: 16 · 2012: 17
- FWCI
- 2.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Care Management Review (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Health Sciences › Health Professions › Radiological and Ultrasound Technology › Occupational Health and Safety Research
- Keywords
- blame culture, just culture, organizational culture, medical errors, patient safety, learning organization, employee participation, hierarchical management, health care organization
- MeSH terms
- Delivery of Health Care, Guilt, Hospital Administration, Humans, Quality Assurance, Health Care, Social Responsibility, United States, Organizational Culture, Medical Errors
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