Just culture algorithm from the UK National Health Service

Incident decision tree adapted from the UK National Health Service’s National Patient Safety Agency (NPSA), and a Guide to Use (from the 2003 version). The National Health Service (NHS) also issued Guidelines for Action Following Patient Safety Incidents. This algorithm focuses on identifying whether an individual was at least partially culpable for the event. The following is a brief summary of the decision tree, from the NPSA web site.

The Deliberate Harm Test

In most patient safety incidents, the individual had the patient’s well-being at heart.

However, in some cases the intent was to cause physical or emotional harm.

The Deliberate Harm Test asks questions to help identify or eliminate this possibility at the earliest possible stage.

The Physical/Mental Health Test

If intent to harm has been discounted, the Physical/Mental Health Test helps to identify whether the individual’s (not the patient’s) ill health or substance abuse caused or contributed to the patient safety incident.

The Foresight Test

If intent to harm and incapacity have been discounted, the Foresight Test examines whether protocols and safe working practices were adhered to.

The Substitution Test

Finally, if protocols were not in place or proved ineffective, the Substitution Test helps to assess how a peer would have been likely to deal with the situation.