a regulatory model/decision tree for collaboration and ... · a regulatory model/decision tree for...
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![Page 1: A Regulatory Model/Decision Tree for Collaboration and ... · A Regulatory Model/Decision Tree for Collaboration and Practice Accountability Maryann Alexander, PhD, RN Nancy Spector,](https://reader034.vdocuments.us/reader034/viewer/2022050100/5f3f61dab37f28778543f1f8/html5/thumbnails/1.jpg)
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
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© 2012
The Just Culture Model (simplified)
Reckless
Behavior
Conscious Disregard of
Substantial and
Unjustifiable Risk
Manage through:
• Remedial action
• Punitive action
At-Risk
Behavior
A Choice: Risk Believed
Insignificant or Justified
Manage through:
• 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
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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…
The Just Culture Model
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Just Culture
Examines the fallibility of the system as well as inevitable human error and flawed behavioral choices
• System
• Human Error
• Flawed decisions
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Regulation
• Public Protection
• Holding systems and individuals accountable for their actions
• Safer care for Patients
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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
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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
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Regulatory Decision Model
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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
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Our Goal
Help BONs make consistent decisions that protect the public and lead to safer systems and competent practitioners.