Just Culture in EMS

Just Culture “What is it exactly?” Are bad outcomes always the result of an individual intentionally causing harm?

Just Culture, the balance between Human and System accountability, is a hot topic in patient safety and reduction of errors in today’s medical industry. The Center for Patient Safety fully supports the implementation of a Just Culture in healthcare organizations across the continuum of care. The reporting of events is important and necessary to learn how to prevent errors from occurring. Organizations with cultures that support open communication of errors while in a non-punitive environment (a “just” culture) are more likely to see high levels of improvement in patient safety.

The Center has provided and supported the education of hundreds of healthcare individuals across the country to implement Just Culture in:

  • Hospitals
  • Long-Term Care
  • EMS services
  • Individual Organizations
  • State Associations

What is Just Culture

How we think about workplace accountability is inherently important. The concept of justice is the foundation of our society and is something that every American expects, including in the workplace.

Safety in the workplace is important, but how do we establish a culture that encourages open reporting of adverse events and risky situations, yet hold people and organizations accountable in a just manner?  The challenge lies in distinguishing between a system that might create risks, human error which may result in a bad outcome, and reckless behavior that intentionally puts lives or organizations at risk.

As the result of a movement in the aviation industry, Just Culture is redefining our system of work place justice in many other industries over the last 20 years, including health care.

As an example, currently there is a 60% compliance rate for hand washing in healthcare. Why? Is it because human error results in our forgetting to wash our hands prior to patient contact, or is it a reckless choice made by individual healthcare providers intentionally disregarding the need to wash their hands, or is it a system perpetuated by the organization that presents barriers and lack of incentives for proper hand washing?

Just Culture reshapes our understanding of accountability, the role of the system, and the role of human behavior, allowing us to distinguish between human behaviors to help us arrive at a consistent way to establish a safe environment by managing the system, and behavior.

"Our efforts to engage practitioners in the changing of our culture will ultimately result in a safer EMS system and will help drive better outcomes for our patients... Our hope is that you, too, will consider the impact of the Just Culture within your service and state, and join us as we work to make EMS a safer place for our staff and our patients."  Mark Alexander, Missouri Ambulance Association and CoxHealth

Visit Outcome Engenuity's site to learn more about Just Culture and hear a message from the founder, David Marx.

Upcoming Training Opportunities

Visit our calendar to find the next training opportunities.

To set up training at your facility, request more information or call the Center for Patient Safety at 573.636.1014.

David Marx

Whack-a-MoleIn 2009, Marx published Whack-a-Mole: The Price We Pay For Expecting Perfection, an easy-to-read explanation of the Just Culture and how we can benefit from its ideas in our everyday lives.

For more than two decades now, Outcome Engenuity has advanced the concept of Just Culture and its role in the design of effective socio-technical systems. (Just Culture)

CPS Collaborates with Outcome Engenuity on EMS Manager's Training

The Center for Patient Safety is proud to announce its participation in Outcome Engenuity's video, On The Scene, a Just Culture training film for EMS. CPS assisted with general content for script development and participated in the panel discussion filming segment. Also including the Missouri Ambulance Association (MAA), the 30 minute film portrays rich character-driven scenarios from the EMS working environment that are easy to relate to and designed to engage the attention of staff member.


Contact the Center at 573.636.1014 to find out how we can work together.

Contact the Center for Patient Safety for upcoming training near you!

  • NAEMT Position Statement: Just Culture in EMS
  • "A Just Culture for EMS can improve safety"

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The Center for Patient Safety believes that collaboration and sharing are the best ways to drive improvement. We strive to provide the right solutions and resources to improve healthcare safety and quality.