Just Culture, Routine Activities, and the Severity Bias

March 31, 2015    |   By: Calevir

In Just CultureSM, we address two factors that often interact to undermine our efforts to provide safe and effective care.   The first is severity bias.   If an organization reacts to a harmful outcome by punishing the person involved, yet ignores the same behavior when the outcomes are good, that is severity bias.   The article at the end of this link has a perfect example.   Night nurses at a state group home frequently slept through their shifts.   This was generally known.   Yet, when a resident died because his nurse missed the two-hour check on his oxygen, the facility fired her.   While her choice to sleep was a poor one, it was poor every night.   And it was a poor choice for all the other staff members who did it.   But only the one who got “caught” was punished.

When an organization tolerates these choices, it creates a culture that says the choices are OK-just don’t get caught.   In the article, it seems that the home was able to fill hard shifts and pay staff less by allowing (or quietly ignoring) their choice to rest on shift.   It normalizes deviance.

What message does your organization send to staff members by looking past (normalizing) choices that deviate from policy?   And what further message does it send if it punishes only those individuals who are closest to a bad outcome?


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