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According to staff, and supported by our employee safety and engagement surveys, our culture was perceived as one of discipline (only viewed as positive by 33%); staff were afraid to bring issues forward in fear of negative reprisals. The Ottawa Hospital needed to take the next step, to change our healthcare culture to be “just” – a values-supportive system of shared accountability where the organization is accountable for the systems we have designed and for supporting the safe choices of both providers and staff. The Ottawa Hospital embarked on a journey to implement this Just Culture philosophy across the organization to create an environment where everyone feels safe, encouraged, and enabled to discuss and learn from quality and safety issues. In 2015, executive commitment and governance was established and 38 Senior Management Team members and senior physician leaders became Certified Champions by completing a three-day Just Culture Certification course. We continued to build our champion team in June 2016, whereby 20 leaders (VP’s, directors and managers) became certified Just Culture trainers and developed a training program tailored to meet our specific needs. A homegrown Coaching & Mentoring workshop was created and offered to all leaders. In parallel, we reviewed and revised policies and procedures related to reporting mechanisms, investigation procedures, and response protocols for consistency with a just culture approach. We have created performance management tools to support our leaders in making a decision exercising good judgment, to standardize the way we make decisions, even though the outcome may be different. We are in the process of standardizing our approach for conducting event investigations so that investigations are handled in a fair and just manner, and guidance on circumstances in which leaders are to include expert professional groups in the investigation discussions. Enhancements have been made to our internal safety learning system so that we systematically measure risk, at all levels. 

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