Book of the month: Just culture: balancing safety and accountability by Sidney Dekker (2nd edition)

Preamble

Last month, when I was looking for a picture of the book cover for "Just culture" I noticed that there was now a second edition. What to do? Having spent many hours reading and taking notes on the first edition I didn't want to start all over and I didn't have the time to read another book. So I decided to post my  comments on the first edition, buy the second edition and comment on that this month.

What's New?

5 years after the first book, Dekker wrote this second edition, which he claims is more logical and addresses the needs of organisations who continue to struggle in the creation of a Just Culture. He has also added some material on ethics and on caring for the second victim. A number of new narratives have been added which provide a good intro for the ensuing argument. Dekker also makes a good claim for the importance of stories; stories are often told from one point of view and take on a life of their own, e.g. "The doctor as a murderer" (p.119) Whichever story is more believable or acceptable or promoted will prevail.

What's good about this book?

Dekker does concentrate more on the organisational requirements of a Just Culture. Headings such as "Responding to Failure: The Organization"(p.6) and "Ask What is Responsible, Not Who is Responsible"(p.12) explore the problems faced by organisations. He has also written a new section on what a successful reporting system looks like (voluntary, non-punitive, protected) (p.58) The re-organisation makes the book easier to read and the argument more logical. The additions Dekker has made strengthen his case that safety and accountability must be balanced.

Dekker's addition of the second victim material (p.76-78) is timely. He explains how failure can be devastating to the professional involved and that criminalisation is neither just nor logical.

What's bad about this book?

Dekker's arguments around utility and utilitarianism (p.2) are simplistic. In essence, he argues that utilitarianism would support the removal of a supposed unsafe worker as this would benefit the majority and harm only one person. However utilitarianism does not mean short-termism and the removal of the worker would be considered within a longer-term "greater good". Utilitarianism then would probably not support the removal of this worker for a supposed infarction for all the reasons that Dekker discusses in this book.

Final thoughts

This is a better book than the first edition. It is more logically organised and the writing is clearer. The additions are useful and little has been removed (the book is now 13 pages longer). Should you buy the second edition rather than the first? Yes. If you already have the first edition should you buy the second? Probably not, although you might want to loan it from your medical library.