Improving workforce wellbeing to support high-quality patient care
Southern Adelaide Local Health Network's Restorative Just Culture policy removes blame but not accountability.
Southern Adelaide Local Health Network (SALHN) is creating an environment where staff and patients feel safe to speak up, share ideas and report incidents without fear of retribution.
Executive Director of Medical Services, Dr Diana Lawrence, says SALHN was the first health service in South Australia to implement a Restorative Just Culture policy in August 2024. This policy is designed to balance accountability with learning about how the organisation deals with incidents.
‘It’s an approach to incidents whereby we understand who’s been harmed – both patients and staff – and ensure support and healing for those people,’ Dr Lawrence says. ‘It’s also a way of looking forward to harness system learnings for improvement so that it doesn’t happen again.’
Within 24 hours of any incident, teams are brought together in a 30-minute ‘pit-stop huddle’, where they discuss what went wrong, who was harmed, whether there are immediate lessons, and who is supporting affected staff.
The huddles comprise the most junior staff, including medical students, to the most senior, Dr Lawrence says. ‘It’s a very flat hierarchy such that our leaders model the behaviour and acknowledge and thank the junior staff who have been involved in the huddle.’
Since the introduction of the Restorative Just Culture policy, these huddles have followed an agreed script that explains what a Restorative Just Culture is and how everyone needs to speak up for safety without fear of punishment. If anyone feels unsafe during a pit-stop huddle, they can put their hand up and say ‘RJC stop’.
Dr Diane Lawrence, Executive Director Medical Service, Southern Adelaide Local Health Network
‘It sets the whole tone that we are removing the blame – it’s about the system and system learnings,’ Dr Lawrence says.
While blame is removed, there is still shared accountability for failures.
Teams agree on who will be accountable and what will happen as a result. Serious incidents go through normal M&M processes and clinical review and, if necessary, systems are adjusted to prevent future incidents.
The Restorative Just Culture policy is being implemented slowly to ensure support from all of the workforce, human resources department and board.
Christy Pirone, the Senior Project Manager who developed the policy with engagement from the SALHN Board, Executive Leadership and SALHN clinicians, says SALHN is continually looking at how to make improvements and encourage behaviours that will lead to a restorative just culture.
The policy is gradually working. When SALHN surveyed staff, it had the highest patient safety culture of any OECD country, Dr Lawrence says.
‘At the end of the day what we’re talking about is creating psychological safety. It’s been a journey of maturity and improvement and we’re continuing to improve and review, but I’m really proud of our pit-stop huddles because they’re an exemplar and they’re working.’