Finding Justice in the Workplace

MUSC Professor Brings Outcome Engenuity’s Just Culture into the Classroom

Tom Crawford, PhD, MBA, FACHE, says he spent a lifetime learning from making mistakes.

“I worked in very rural environments and in those environments, like a lot of leaders, we weren't necessarily proactively measuring the quality of our decision-making, we were more focused on addressing the outcomes,” recalls the former President and CEO of Springfield Medical Care Systems in Vermont. 

Crawford arrived at MUSC in 2015 after spending six years teaching in the MHA program at the University of Florida, where he won numerous awards for his classroom efforts. Because of his dedication, he was constantly looking to improve the education provided to MHA students, and he still felt like there was something missing in how he prepared students to be healthcare leaders.

“I would circle back to my MHA students and ask them, ‘Did I prepare you for the realities and challenges associated with your first leadership role?’,” Crawford says. “Almost uniformly, they would state that they felt prepared from an academic standpoint but they didn't feel prepared to handle situations or difficult conflicts with employees when things did not go as planned.”

Knowing he needed to supplement this deficit, he searched for a solution that would give students the necessary tools to problem solve when adverse events occurred, Crawford sought a best practice approach to improving human systems that would easily adapt to the hospital world. And he found it in Outcome Engenuity’s Just Culture course.

“I went through the Just Culture training course put on by SCHA and l had the epiphany that this was exactly what I was searching for,” he says. “Almost everything I learned about being a leader I learned through the mistakes that I made. I thought I had an opportunity to educate all of these graduate students, right out of the gate, to use the Just Culture algorithms and be consistent in the way they looked at situations and scenarios.”

This spring, MUSC became the first academic program nationally to formally integrate the Just Culture training into their curriculum. MUSC’s MHA program currently ranks in the Top 20 nationwide according to the US News and World Report

The Just Culture Mindset

Just Cuture was conceived by David Marx, a trained engineer and lawyer who spent his career working on safety assessment and improvement in the aviation industry. The program is a set of management skills and tools combined with values and practices that breed an accountable culture across the entire span of an organization. The central goal of Just Culture is to give high-consequence organizations a way to become a Highly Reliable Organization (HRO), and it’s seen tremendous results, often with more than a 90% reduction in adverse events in organizations where it is successfully implemented.

Central to installing a Just Culture is Marx’s Outcome Engenuity Workplace Accountability model. This clear, concise approach for improving systems establishes a culture where employees feel safe to identify errors or bad choices because process improvement, rather than punitive action, is the most common result.

The model focuses on the decision-making process in a fair and equitable way that avoids the “outcome bias” that comes from overreacting to an adverse event and instead thinking rationally through what led to the event. By systemically distinguishing between human error, at-risk behavior, and reckless behavior using the Just Culture Algorithm TM, the core issue and the appropriate, just response can be easily identified. Outcome Engenuity has a brief video that outlines their workplace accountability principles here.

Bringing Just Culture into the Classroom

Crawford integrated Just Culture heavily into his human resources class, assigning David Marx’s novel about workplace accountability, Dave’s Subs, along with a traditional HR textbook. 

“It’s the focal point of every single class,” he emphasizes. “I present real-live case study scenarios to supplement what they are learning, and it’s interesting to see the students make the same mistakes [that I did] initially. But then they start applying the Just Culture methodology, and you can see how it will influence the communities they will be leading later. And they begin to see, more than anything, the relevant application of how this will help transform each of them into consistent leaders.”

Parker Rhoden, a recent student of Crawford’s who just accepted an administrative fellow position with the Carolinas Health System, agrees. 

“I had heard of Just Culture at MUSC, but truthfully I hadn't really gotten into the weeds of what it was or what MUSC was doing specifically in order to effectuate that type of idea throughout the system,” Rhoden admits. “As we progressed, I got so much more out of reading the book and the practical discussions of how it applied to not only healthcare but management and leadership decisions in any setting or industry.”

Rhoden is now a certified Champion of Just Culture and says it will “definitely pay off in the long-term with how I manage and lead people throughout my career.”

Crawford is very excited about his new curriculum and plans to also have his next round of students go through the certification process with Outcome Engenuity to become certified Just Culture Champions.

“It allows them to view the world through a different lens, and that lens will promote a learning environment where we can enhance the collective intellect and consistency of an organization, not just in healthcare, any institution,” he says of the training’s importance. “It’s the gateway for creating a learning organization.”

He also praises SCHA for offering Just Culture courses and promoting them so heavily to members.

“What I'm doing in the classroom is a direct result of [SCHA's] early adoption,” he says gratefully. “I would not be using Just Culture to train my future health system CEOs, COOS and CFOs if SCHA wasn’t blazing this trail.”

Now, Crawford is committed to spreading the word of Just Culture himself. 

“It’s about letting Just Culture integrate and become a fundamental element of our culture. Meaning, this is who we are, this is how we approach our decision-making and this is how we coach our employees,” he concludes. “I'm educating and passing this on to the next generation of executives who will be leaving MUSC and leading organizations across the country.