Читать книгу Kelly Vana's Nursing Leadership and Management - Группа авторов - Страница 266

Intrinsic accountability exists within the individual. Nurse leaders need to expect accountability and enhance the intrinsic motivation of the nurse to meet performance expectations. In addition, nurses need to hold their peers accountable for safety. While each type of accountability is important, the ultimate goal is for staff to practice in a safe manner even when nobody's watching.

A Performance Management Decision Guide is available to guide management decisions when human error occurs (Reason, 1997). The first step is a deliberate act test. If the individual acted with malicious intent, disciplinary action and a report to a professional group, regulatory body, and/or law enforcement is warranted. If there is confirmed ill health and the individual was unaware, a leave of absence and physician referral is appropriate. If substance abuse is suspected, testing, disciplinary action, and treatment are warranted. If the individual chose to take an unacceptable risk based on policies, procedures, and protocols commonly used within the organization, disciplinary action may be warranted. However, if the individual adhered to generally accepted performance expectations and simply made an unintended error, the individual needs to be consoled and coached. In every case, leadership is also responsible for correcting safety problems that contributed to the error.

The just culture model acknowledges that humans make mistakes. As a result, no system can be designed to produce perfect results. However, health care systems can be designed to decrease risk. Consistent with creating a Just Culture and demonstrating sensitivity toward operations, nurse leaders must identify and correct system problems.