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Maryann Alexander, PhD, RN

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1 Maryann Alexander, PhD, RN
A Regulatory Model/Decision Tree for Collaboration and Practice Accountability Maryann Alexander, PhD, RN Nancy Spector, PhD, RN Maureen Cahill, MS, RN Kathy Russell, JD, RN

2 The Just Culture Model (simplified)
Reckless Behavior Conscious Disregard of Substantial and Unjustifiable Risk Manage through: Remedial action Punitive action At-Risk A Choice: Risk Believed Insignificant or Justified Removing incentives for at-risk behaviors Creating incentives for healthy behaviors Increasing situational awareness Human Error Product of Our Current System Design and Behavioral Choices Manage through changes in: Choices Processes Procedures Training Design Environment Console Coach Punish 2

3 The Just Culture Model A Single Event Repetitive Events
Repetitive errors – yes, there is a process Repetitive at-risk behaviors – yes, there is a process Both may lead to disciplinary action… 3

4 Just Culture Examines the fallibility of the system as well as inevitable human error and flawed behavioral choices System Human Error Flawed decisions

5 Regulation Public Protection
Holding systems and individuals accountable for their actions Safer care for Patients

6 Regulatory Model Encourage reporting of errors so that systems, processes and behaviors can be improved Collaborative/Partnership (Facility and BON and Nurse and Facility) Centers around the patient Focus is on ethical behavior Encourages remediation Employs discipline where needed

7 Accountability of Nurse
Recognize Contributions of System Errors Patient Outcome Not Primary to BON Decision Boards and Employers Collaborate Use Reliable Tools to Evaluate Behaviors and Systems

8 Regulatory Decision Model



11 Next Steps Volunteers Try out the decision tree
Send us your feedback/comments Feedback from Outcomengenuity Develop a resource kit Pilot the model/algorithm once completed

12 Our Goal Help BONs make consistent decisions that protect the public and lead to safer systems and competent practitioners.

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