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A Regulatory Model/Decision Tree for Collaboration and Practice Accountability

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. The Just Culture Model (simplified). Human Error. At-Risk Behavior. Reckless Behavior.

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A Regulatory Model/Decision Tree for Collaboration and Practice Accountability

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  1. 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

  2. The Just Culture Model (simplified) Human Error At-Risk Behavior Reckless Behavior A Choice: Risk Believed Insignificant or Justified Conscious Disregard of Substantial and Unjustifiable Risk Product of Our Current System Design and Behavioral Choices • Manage through changes in: • Choices • Processes • Procedures • Training • Design • Environment • Manage through: • Removing incentives for at-risk behaviors • Creating incentives for healthy behaviors • Increasing situational awareness • Manage through: • Remedial action • Punitive action Console Coach Punish

  3. The Just Culture Model • Repetitive errors – yes, there is a process • Repetitive at-risk behaviors – yes, there is a process • Both may lead to disciplinary action… Repetitive Events A Single Event

  4. Just Culture Examines the fallibility of the system as well as inevitable human error and flawed behavioral choices • System • Human Error • Flawed decisions

  5. Regulation • Public Protection • Holding systems and individuals accountable for their actions • Safer care for Patients

  6. 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

  7. 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

  8. Regulatory Decision Model

  9. 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

  10. Our Goal Help BONs make consistent decisions that protect the public and lead to safer systems and competent practitioners.

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