• Joy Slaughter

13.2 Just Culture

Megan’s stress level is now interfering with her job performance. She fails to recognize a diabetic crisis in a patient who then ends up in hyperosmolar hyperglycemia (HHS) or “high blood sugar.” In fact, it’s so high, the machine cannot even read it. This condition causes the patient to drive on the opposite side of the road and wreck his car. Megan is shocked, but even then, she has tunnel vision on scene and only sees him…and does not recognize the presence of another patient.


One problem with HHS is that there is very little she can do in the ambulance besides start an IV. She begs medical control for some further treatment…but there’s nothing to do. He will need an ICU stay to stabilize again. She is left to worry over her mistakes.


Reporting mistakes is a touchy subject in medicine. On one hand, they are very serious and can lead to loss of life, yet if they are punished too harshly, they will be hidden and never addressed.


This is where the concept of Just Culture comes into play. This is a quality improvement program that helps build an organization that addresses mistakes in full awareness of systemic issues rather than only individual failures. It allows for the humanity of individuals and takes intent into account.





Healthcare organizations that incorporate Just Culture allow their employees to come forward, address mistakes, and work for an answer that will prevent problems in the future. It works for growth–not punishment.


Many EMS services do not have robust quality assurance/improvement programs, let alone Just Culture. From Megan’s actions and Nathan’s sidestepping of the problem, we can see that Barrington County is one of those services.