Reference : Le compromis entre culture non punitive et culture juste : analyse des sous-cultures ...
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Le compromis entre culture non punitive et culture juste : analyse des sous-cultures de sécurité des patients dans un service de radiothérapie
Kamto Kenmogne, Marius mailto [Université de Liège > HEC Liège : UER > UER Finance et Droit >]
Van Caillie, Didier mailto [Université de Liège > HEC Liège : UER > Diagnostic et contrôle de l'entreprise >]
BOGA, Deniz mailto [Centre Hospitalier Universitaire de Liège - CHU > > Service médical de radiothérapie >]
DELGAUDINE, Marie mailto [Centre Hospitalier Universitaire de Liège - CHU > > Département de Physique Médicale >]
COUCKE, Philippe mailto [Centre Hospitalier Universitaire de Liège - CHU > > Service médical de radiothérapie >]
[fr] Culture de sécurité ; Culture juste ; Culture non punitive ; Radiothérapie ; Sécurité des patients
[en] The recent publication of the report "Medical error-the third leading causes of death in the US" (Makary & Daniel, 2016) has led to a renewed attention to the issue of patient safety in many developed countries. The main issue involved is the role played by medical staff work in the occurrence of deaths from the medical care. According to Makary & Daniel, communication failures, misdiagnosis, bad judgments and inadequate skills have caused an average of 251,454 deaths per year in the United States in 2013.
This report has taken the opposite view of the proponents of "No shame no blame" approach characterizing a non-punitive culture in which people are led to blame the system even though human responsibility is obvious. While the no-blame culture has often been presented as the success factor of an efficient safety /quality policy in medical settings (Amalberti et al., 2005; Woynar et al, 2007), discordant voices now stand to underline the limits of this approach (see eg Dekker & Breakey, 2016; Levitt, 2014 or Shojania & Dixon-Woods, 2013). These authors argue that the no-blame culture is difficult to implement in practice and suggest the implementation of a just culture that places more emphasis on individuals' behavior and performance and on their responsibility at work.
In this context, this study examines – based on an in-depth longitudinal case study of a radiotherapy department that has implemented a reporting system for adverse events - the extent to which non-punitive culture and just culture can live together in the same organizational unit. By combining in-depth interviews with members of the quality team and a questionnaire survey administered to all staff, we evaluate the current safety subcultures in the service. The content analysis of the interviews and the treatment of questionnaires following the methodology of the Agency for Healthcare Research and Quality allows to see the emergence of three subcultures in the radiotherapy department studied: a reporting subculture, a non-punitive subculture and, to some extent, a just subculture. The study shows that the development of the safety culture in this department is based primarily on the establishment of a non-punitive subculture used as a way to encourage spontaneous reporting of adverse events. The reporting culture is therefore the more controlled dimension of the safety culture of the department. Concerning responsibility of workers, the study shows that they have no fear of punishment and are not even familiar with the term in the workplace. On the contrary, instead of a retributive just culture, the department has focused its safety culture on learning from mistakes and substantial just culture based on a system of worker participation in the preparation of procedures that prescribe the right way to work.
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