Zero Harm by Craig Clapper

Author:Craig Clapper
Language: eng
Format: epub
Publisher: McGraw-Hill Education
Published: 2019-11-08T16:00:00+00:00

Figure 7.1 Performance Management Decision Guide

If an employee intended no harm, the next question to ask is whether he or she was suffering from an incapacity that might have negatively impacted performance (the “Incapacity Test”). Incapacity can include illness, reactions to prescribed medications, or substance abuse. Sometimes an illness or disability can develop subtly or gradually, and the individual might not understand its impact on his or her performance. A diet clerk might deliver the wrong tray to a patient on a restricted diet despite stating that she checked the name and date of birth. A vision test might reveal that the clerk needs reading glasses. In this case, the organization would regard the individual as less culpable than if he or she didn’t suffer from an impairment.

If investigators have ruled out both intent and incapacity, the inquiry goes on to consider the question of compliance (the “Compliance Test”). Performance issues often reflect failures to follow policies, processes, or protocols. However, investigators must consider whether employees had access to the policies and whether those policies were comprehensible and in routine use. If the answer to those questions is yes, then in the absence of mitigating circumstances investigators might find the individual culpable for the policy violation. Let’s say a medical technician administered an expired vaccine to a child in a clinic and admitted that he didn’t check the date before administering. The policy for checking vaccines (for right med, right dose, expiration data, and so on) was clear and in routine use by other medical technicians. In this case, the technician would bear culpability.

If investigators have discounted all the other tests, the inquiry should consider whether other similarly trained and experienced individuals would have made the same choice (the “Substitution Test”). Leaders should refrain from applying broad generalities such as “no radiologists do positive patient identification when consulting with physicians,” but rather evaluate how a peer in this specific context, acting reasonably and in a mature manner, might have responded to the situation. The substitution test also evaluates whether training, experience, or supervision may have played a factor in decision-making.

In implementing a just culture algorithm, organizations should consider customizing it to reflect local terminology and to reference the organization’s specific actions, policies, and procedures. The organization might also wish to develop a version of the algorithm formatted as a documentation tool in order to create a written record on performance. When Virginia Commonwealth University Health System (VCUHS) wanted to implement a Performance Management Decision Tree for their organization, leaders reviewed examples from other industries and healthcare organizations. They found that none of those examples represented a good “fit” for VCUHS because they weren’t specific enough to VCUHS’s culture, language, and policies (for instance, they didn’t refer VCUHS managers to the organization’s existing human resources policies related to progressive discipline). Applying the principles of rapid cycle improvement, the VCUHS Just Culture Steering Group developed a number of versions of the algorithm, tested those versions with real-life examples of events from their

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