How do you feel when you see a crew or coworker that does not do their share? They get by slacking through the system and probably should be disciplined, yet they get the same merit raise as you. How about when you perform above and beyond and it is not recognized?

One of the biggest things that always frustrated me as an employee and as a leader was the concept of treating everyone equally. Where did that concept come from? I think the real intent was to treat everyone not equally, but equitably.

Don’t throw daggers at me just yet! Certainly there should never be any discrimination of anyone. We have laws to insure this. I fully believe that every single person on the team should be given the OPPORTUNITY to succeed.  Every chance should be given to all to insure opportunities of self-development, continued education, knowledge base and professional advancement. 

We know, however, that Equal Opportunity does not insure equal PERFORMANCE or equal INTENT that leads to that performance.

This is where equitable takes over for equal. Once someone makes a decision to do something in their work they need to be held accountable.  If they do well they should be praised; if they make a mistake they should be held accountable regardless of whether the outcome was positive or negative. 

Notice that I  said accountable rather than punished. They are not synonymous. 

Should someone who was 5 minutes late for work because they stopped to help someone change a flat tire be disciplined the same as the person who is perpetually late?  What if the employee made a human error and the intent was good but there was a negative outcome?  What if the outcome was positive despite the error?  What if the error had no bearing on the patient outcome?

Equitable and not equal should be your guide.

In my organization, we use the concept of Just Culture in two parts:

• Learning
• Accountability

If someone makes an INADVERTANT error we turn it into a chance to learn what caused the error.  We visit with the staff involved and learn what led to the error.  We look for ways to make improvements that prevent the error from occurring again.  When needed, we reeducate the individual, or perhaps the entire staff.  We promote a culture where safety is the goal and encourage asking questions and sharing opinions.

The accountability culture is used to begin the remediation process, which may or may not include discipline.  If someone is making errors repeatedly or there are errors that question competency, we being a process to counsel and coach them to improve.  We develop a Performance Improvement Plan (PIP), that outlines what went wrong, what should have happened and the rationale behind why. It gives clear cut objectives and a  time frame to accomplish those objectives. At the end of PIP they are three options to consider:

1. Improvement was made and promoted off the PIP
2. Insufficient improvement made and the PIP is revised and/or extended.
3. Insufficient/no improvement made and employment is ended.

We have found this accountability model to be very valuable in identifying the intent of those making errors. Thise who unknowingly made an error or did not comprehend the potential consequences of their choice usually are promoted off the PIP with the information they were lacking.

The same can not be said for some who purposely made  bad or unsafe decisions knowing the risks. Those who make informed unsafe choices must be disciplined. That is fair. Treatment is equitable not equal.

Just Culture is something that requires participation from the entire organization. Initially we educated our leadership staff to the concept of Just Culture. With their buy-in, we gradually rolled it out to the rest of the staff and added a segment to our new employee orientation.  Anytime we have a “service inquiry” (complaint, question on care, etc) we approach it with a Just Culture mindset.

Our Just Culture has allowed us to improve on an individual provider level and a system level. It has promoted equitable (not equal) treatment. It is a tool I wish I had had 20 years ago when I first became a supervisor.