[Article] Patient Safety Culture How to promote an environment free from punishment that encourages transparency
Patient safety is a fundamental pillar of quality in health care. In recent decades, international organizations such as the World Health Organization (WHO) and the Pan American Health Organization (PAHO) have emphasized the importance of developing and consolidating a safety culture in healthcare institutions, recognizing its direct impact on behaviors, clinical practices, and care outcomes (WHO, 2021).
Patient safety culture can be understood as a set of values, attitudes, perceptions, skills, and behavior patterns that support a commitment to safety at all organizational levels (Agency for Healthcare Research and Quality — AHRQ, 2019). Among its key elements, the promotion of a non-punitive environment and the encouragement of transparency and reporting of adverse events, incidents and near-misses stand out.
Punitive environments and their consequences
Organizations that adopt punitive approaches to human error tend to inhibit open communication and incident reporting. Fear of disciplinary sanctions, retaliation, or damage to personal reputation contributes to the underreporting of events, making it challenging to identify systemic failures and implement structural improvements (Kohn, Corrigan, & Donaldson, 2000).
The Institute of Medicine (IOM) report “To Err is Human” was a landmark in recognizing that healthcare errors rarely result from individual negligence. Most of the time, they are a consequence of system failures, poorly designed processes, poor communication, and organizational gaps. From this perspective, holding professionals exclusively responsible is not only unfair but also ineffective in preventing new events (IOM, 2000).
Just Culture
The implementation of Just Culture has become an essential strategy for overcoming the culture of blame. This approach seeks to balance individual accountability with institutional responsibility by separating unintentional human errors, risky behaviors (which increase risks unnecessarily), and intentional or negligent conduct (Marx, 2001).
While unintentional errors should be addressed with support, learning, and improvement of systems, deliberately unsafe behaviors (those that actively seek to violate rules) require proportionate corrective actions. This clear distinction fosters a more equitable and safer environment where professionals feel encouraged to report failures and contribute to ongoing improvement.
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Lucas Garcia
Bruno Stefan