OB Case Studies for Application of QSEN Safety Competencies: Examination of the Concept of a ‘Just Culture’ through Root Cause Analysis
MN, RN, WHNP-BC, CNE
Assistant Professor of Nursing
Research College of Nursing
- Describe factors that create a culture of safety (such as open communication strategies and organizational error reporting systems).
- Describe processes used in understanding causes of error and allocation of responsibility and accountability (such as root cause analysis).
- Participate appropriately in analyzing errors and designing system improvements.
- Engage in root cause analysis rather than blaming when errors or near misses occur.
- Value vigilance and monitoring (even of own performance of care activities) by patients, families, and other members of the health care team.
- Value own role in preventing errors.