A few days ago I went to a lecture by Lynda Carpenito in Barcelona. She is a nurse responsible for the Bifocal model created in 1983 for clinical practice. The bifocal model tries to identify the types of independent problems (about a discipline) and interdependent (in collaboration with other professionals).

And I was not the only one interested in the Conference.

In her presentation she spoke of responsible communication, and the importance of generating a just culture. Understand justice, not from a moral point of view of care, in the most pragmatic way.

A just culture focuses on and reviews issues related to the system that leads individuals to adhere to unsafe behaviors, while maintaining individual accountability by setting zero tolerance to reckless behaviors. That is a culture where honesty protects the patient.

Her approach is interesting, and it made me think about some questions:

Are we able to take criticism from colleagues in our ICUs? Can we feel “free professionals” to communicate errors?

Since the publication of “Err Is Human, Building a Safer Health System” (Linda T. Kohn, Janet M. Corrigan, and Molla S. Donaldson, in 1999) safety culture has been spreading in the health system. It is true that according to this “safe perspective”, systems and not people allow errors. But people are who have the ability to communicate, and are therefore responsible for what we can do. Systems, sometimes perverse, do not have that responsibility by themselves.

I think that generate more “fair” working environments, means not being afraid to say what we are doing wrong, or to express our suspicions as to the work of other colleagues.

A mistake could change your life. It could make you forget about the professional who you were, but if we are able to talk about it, to prepare for errors, and to share them, our ICUs will certainly be more secure, and according to L.Carpenito, also fairer.

Yasmina Díaz
ICU Nurse at Hospital Clinic de Barcelona