What It Means to Support a Just Culture (Podcast)

Cleveland Clinic’s chief safety officer explains the importance of speaking up

After an accident that left her father a quadriplegic when she was only 10, Leslie Jurecko, MD, Cleveland Clinic’s Chief Safety and Quality Officer, spent a long time in hospitals and experienced firsthand the kinds of things that went right and wrong there.

In an interview with Brian Bolwell, MD, for the podcast “Beyond Leadership,” Dr. Jurecko explained how that experience influenced the trajectory of her career.

“I started asking questions about why things were done certain ways – I think I was pretty into science by then – and that led me into this nonstop journey over steep and rugged territory to try to improve healthcare,” says Dr. Jurecko. “That’s how I got involved in more quality and safety. It was really just about trying to get better, as I became a doctor, trying to lean in and understand, ‘Why does it have to be like this? Why are patients suffering more than they have to?’ And trying to solve for some of that.”

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Podcast excerpt

Dr. Bolwell: A lot of people talk about a just culture to generate quality and safety. What does that mean to you?

Dr. Jurecko: So “just” to me means “fair.” It means when something happens that doesn’t go well for the team or an individual, that we approach it in a non-biased way. And it’s about having that person’s back whether they are a caregiver or they’re on your business team. Whatever kind of leader you are, you have to have their back and you have to make the assumption that they were doing what was in the interest of the situation at the time. And so a just culture to me is asking those deeper questions of why this human being may have gone this route and then applying really just and fair questions to the situation.

Dr. Bolwell: What are some of the behaviors that we teach?

Dr. Jurecko: We teach our staff to speak up, especially against an authority gradient or any power distance. [That could be] a nurse or a pharmacist speaking up against a surgeon or an attending physician and saying, this doesn’t seem right. That’s one of the basic skills we try to teach staff, and it’s probably one of the most difficult skills that staff is able to engage in because of the environment we put them in. We detect something before it reaches the patient. We also teach skills about good communication – how to actually effectively communicate your message, so you get across what’s most important. So we try to do what seems like basic communication and human skills of interacting and teamwork, but we really have to recommit to it, especially in the environments that we see. There’s quite a lot of hierarchy in medicine.

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