Pharmacies, like all healthcare settings, have a responsibility to ensure patient safety. However, achieving a culture where safety is embedded in every action and decision requires more than just policy changes—it requires a fundamental shift in the organizational mindset towards what is known as a “Just Culture.” 

In a pharmacy, a just culture is an approach that promotes accountability, learning, and safety by balancing a no-blame philosophy with responsibility for actions. It recognizes that errors can and do happen, and fosters an environment where pharmacy staff feel comfortable reporting mistakes or near misses without fear of punishment for unintentional errors.

In a just culture, there is a focus on understanding the causes of errors—whether they stem from human error, system design, or a combination of factors. This allows pharmacies to make meaningful improvements, enhancing safety and reducing the likelihood of future mistakes. However, it also distinguishes between honest mistakes and reckless behaviour. While unintentional errors are addressed through support and training, any willful disregard for patient safety or negligent behaviour is still held accountable.

By implementing a just culture, pharmacies can improve communication, encourage transparency, and build a stronger culture of safety, ultimately leading to better patient outcomes and a more supportive work environment.

If you’re ready to build a just culture in your pharmacy or healthcare setting, here are seven guiding principles to shape the foundation and guide you on your journey:

1. Engage Patients and Families as Partners in Safe Care

The first step in establishing a just culture is to involve patients and their families in the safety process. By explaining the steps taken to ensure that prescriptions are appropriate and safe, you create a partnership built on trust. Always inquire about any new drug allergies or health changes your patients might have experienced. This proactive communication not only enhances safety but also empowers patients to be active participants in their healthcare.

2. Achieve Results Through Collaborative Working

Your pharmacy staff is your greatest asset in fostering a just culture. Encourage open dialogue and invite their input on processes, staffing, and workflow. A collaborative environment is one where staff feel valued and responsible for the safety and efficiency of operations. Regular team huddles can be an effective way to gather insights and foster a sense of collective ownership over patient safety.

Related: Download our template for a 10-minute safety huddle for topics to cover in your team huddles. 

3. Analyze and Share Data to Generate Learning

Transparency is key in a just culture. Use data from error reports to educate and inform your team. By sharing this information, you encourage a collective brainstorming process to identify solutions that will help prevent future harm. This shared learning experience helps build an environment where staff members are not afraid to report errors, knowing their input will lead to positive changes.

4. Translate Evidence into Actionable and Measurable Improvement

In a just culture, small changes can lead to big improvements. Show your team that reports and suggestions lead to action, no matter how minor they may seem. Implementing small, measurable changes demonstrates that all feedback is valued and contributes to a safer environment, preventing reports from disappearing into a “black hole.”

5. Base Policies and Action on the Nature of the Care Setting

Every healthcare setting is unique. What works in one pharmacy might not be feasible in another. Tailor your policies and actions to fit the specific needs and realities of your environment. This adaptability helps ensure that the changes you implement are not only practical but also effective in enhancing safety.

For example, let’s consider two different pharmacy settings: a community pharmacy focused mainly on dispensing, and a pharmacy that combines immunizations, common ailment assessments, and point-of-care testing.  

In a dispensing community pharmacy, a just culture policy could focus on error reporting and rapid response to the high volume of patient interactions and fast-paced dispensing environment.

For instance, policies might emphasize addressing issues like distractions,  look-alike/sound-alike medications and creating checklists or double-check processes for high-risk drugs. Training could be delivered in short, easily digestible sessions that fit into busy workdays, focusing on recognizing and reducing risks in a fast-paced environment.

Example Policy Adaptation: To minimize interruptions, staff may establish dedicated time blocks when the dispensing area is “distraction-free,” allowing pharmacy staff to focus solely on verification without interruption.  

In a pharmacy offering both clinical services and dispensing, a just culture policy could focus on communication techniques, feasible scheduling of appointments and safe injection procedures that are separated from the dispensing area.

For instance, policies might emphasize efficient workflows, proper privacy and follow-up procedures when required. 

Example Policy Adaptation: To minimize distracting interruptions, staff may establish how appointments are best scheduled and set expectations for patients, along with collecting required information, like the number and type of vaccines prior to the appointment, allowing the pharmacy team members to focus solely on the clinical service.  

6. Use Both Scientific Expertise and Patient Experience to Improve Safety

To make impactful changes, leverage insights from both scientific data and patient experiences. Combine the technical knowledge of your staff with the firsthand experiences of your patients to develop a comprehensive approach to safety improvements. This dual perspective enriches your understanding of safety challenges and enhances the effectiveness of your interventions.

7. Instill a Safety Culture in the Design and Delivery of Healthcare

Ultimately, the goal is to embed a culture of safety in every facet of your pharmacy’s operations. Leadership should visibly prioritize patient safety by setting clear expectations and modelling safe practices. Encourage open communication among team members to discuss safety concerns and improvements, fostering an environment where everyone feels responsible for maintaining high safety standards.

+ + +

Establishing a just culture takes time, dedication, and continuous learning. By following these seven guiding principles, you can create a culture where patient safety is at the forefront of every decision and action. Learn more about the importance of fostering a just culture and the positive impact it can have on patient safety. Catch up on episode 3 of our Safety Series webinars today!