Analysis of punitive workplace cultures across industries signals improvements are still needed for healthcare workers

Research from ECRI includes call-to-action for healthcare leaders to repair punitive cultures

WILLOW GROVE, Pa., June 26, 2025 /PRNewswire/ -- New research from ECRI, a global independent healthcare and patient safety nonprofit, and The Just Culture Company urges healthcare leaders to address punitive workplace cultures that undermine patient safety, erode trust, and drive burnout among healthcare workers. The findings are featured in a recently-published article, The Quiet Power of Accountability: 10 Leadership Steps to Transform Healthcare's Punitive Culture.

The article, coauthored by experts from ECRI and The Just Culture Company, analyzes two decades of data from AHRQ's Patient Safety Culture Survey. Authors also gathered thousands of data points from 12 industries over two years, measuring how punitive these industries are in response to errors made by their workforce, including healthcare, aviation, policing, emergency medical services (EMS), energy, construction, manufacturing, utilities, research laboratories, hospitality, and education (K-12 plus higher education). 

Key findings include: 

• Police, aviation, and EMS are most punitive toward human error. 

• Education, research labs, and healthcare are the least punitive industries. 

• Despite modest gains, only 60% of healthcare workers today believe their organization responds non-punitively to error. 

• To access the article, visit ecri.org/the-quiet-power-of-accountability. 

Although healthcare is less punitive than most other industries, the authors say healthcare has a long way to go to create cultures that prioritize patient safety, workforce wellness and reliable outcomes in care delivery. 

"Too often, healthcare professionals are punished for being human. This drives fear, suppresses error reporting, and ultimately puts patients at risk," said Marcus Schabacker, MD, PhD, president and CEO of ECRI, who recently penned an op-ed on why punitive cultures are damaging to healthcare. "We must create environments where people can speak up, learn from mistakes, and feel supported while doing their jobs. The focus must shift from determining who is at fault when errors happen, to determining what went wrong, what we can learn, and how to improve the system overall."

"To produce better outcomes in healthcare, we need to design better systems around our team members and help them make better choices within those systems. We do this, in part, by learning from our mistakes," said David Marx, founder of the Just Culture Company. "Encouraging employees to self-report actions they did not intend is foundational to fully functional organizational systems of learning. We should judge the quality of a person's choices, not the triumph or tragedy those choices produce."

The study's authors are optimistic, adding that when a healthcare organization is committed to implementation of just culture concepts, they can see improvements in the rate of punitive responses to error as high as 35 percent in one year. 

"The good news is that we know what works," said Barbara Olson, MS, RN, CPPS, coauthor and chief clinical officer of The Just Culture Company. "When leaders better understand human behavior and can differentiate human error and common workarounds—choices people often perceive as necessary or inconsequential—from culpable acts, they are able to foster a more just workplace and build trust and psychological safety for their staff." 

The article outlines a ten-step approach to shifting organizational culture, including: 

1. Evaluate actions based on an individual's intentions, not just outcomes. 
   
   
2. End disciplinary actions for errors and at-risk behavior. 
   
   
3. Design systems that support safe and effective choices. 
   
   
4. Be fiercely intolerant of highly culpable behavior. 
   
   
5. Reject the "no harm, no foul" philosophy. 
   
   
6. Educate healthcare leaders and team members on the tenets of just culture. 
   
   
7. Consider how "just culture" impacts far more than patient safety. 
   
   
8. Educate professional boards, regulators, and the community. 
   
   
9. Measure results and progress over time. 
   
   
10. Lead with mercy, grace, and forgiveness. 

About ECRI

ECRI is an independent, nonprofit organization improving the safety, quality, and cost-effectiveness of care across all healthcare settings. With a focus on technology evaluation and safety, ECRI is respected and trusted by healthcare leaders and agencies worldwide. For more than fifty-five years, ECRI has built its reputation on integrity and disciplined rigor, with an unwavering commitment to independence and strict conflict-of-interest rules. ECRI is the only organization worldwide to conduct independent medical device evaluations, with labs located in North America and Asia Pacific. ECRI is designated an Evidence-based Practice Center by the U.S. Agency for Healthcare Research and Quality and a federally certified Patient Safety Organization by the U.S. Department of Health and Human Services. ECRI acquired The Institute for Safe Medication Practices (ISMP) in 2020 to address one of the most prolific causes of preventable harm in healthcare, medication errors; then acquired The Just Culture Company in 2024 to transform healthcare workplace cultures – thus creating one of the largest healthcare quality and safety entities in the world. Visit www.ecri.org to learn more.

 About The Just Culture Company 

The Just Culture Company, an ECRI company, helps healthcare organizations create accountable, safe, and supportive cultures that improve the healthcare experience and outcomes for patients and staff. For 30 years, The Just Culture Company has helped transform work systems that erroneously demand perfection from fallible human beings. The Just Culture Company has helped healthcare institutions and regulatory agencies reduce patient harm through workplace cultural transformation by implementing its proprietary algorithm through advisory services, educational programs and coaching. CEO and founder David Marx developed novel risk modeling methods that have been used to mitigate risk in high-consequence industries worldwide, from aviation to space exploration to patients' bedsides. "Just culture" is an essential component of ECRI's Total System Safety (TSS) approach to drive efficiencies, improve healthcare and reduce preventable patient harm by designing systems for impact and sustainability. Learn more at www.justculture.com.

SOURCE ECRI