Acquisition to Help ECRI Focus System Safety on ‘Just Culture’

ECRI, a nonprofit organization focused on quality and safety of healthcare, recently acquired The Just Culture Company, which assists organizations in deploying a balanced system of accountability between the organization and employees that seeks to foster a fair, learning culture – referred to as a “just culture” – through advisory services, educational programs and coaching.  

The Just Culture Company has partnered with healthcare providers, health departments and insurers to assess and improve workforce culture, from C-Suite to frontline staff, through a holistic systems-based approach. 

ECRI’s Total Systems Safety (TSS) framework is based on principles of leadership and governance, engaging patients and families, continuous learning systems and a “just culture” for the workforce. The acquisition of The Just Culture Company expands its capabilities to lead the cultural transformation TSS requires, creating healthcare environments where errors and “near misses” are seen as learning opportunities rather than catalysts for isolated, punitive responses against staff.

“Alarming rates of preventable harm are inflicted on patients every day. By offering Just Culture programs throughout ECRI’s global network, we can prevent harm before it happens,” said Marcus Schabacker, Ph.D., president and CEO of ECRI, in a statement. “To create lasting change and improve patient and workforce safety, we must shift from evaluating accidents and errors after they’ve taken place, to designing systems and cultures that prevent harm from happening in the first place.” 

ECRI points out that the significance of just culture in the healthcare workforce was highlighted in the CMS Patient Safety Structural Measure taking effect in 2025. The measure requires hospitals to demonstrate they have established a culture and structure that prioritizes patient safety, specifically referencing just culture in the domain about strategic planning and organizational policy. 

“Too many healthcare staff, through no fault of their own, are operating in poorly designed systems, with hierarchical cultures that prevent staff from speaking up about safety hazards and ‘near misses,’” explained Schabacker. “Not only does this lead to more incidents of patient harm, but it fuels high rates of burnout and stress among overworked healthcare personnel. We can’t train our way to improved safety and quality. Only through a cultural transformation can we adopt a completely new way of supporting and collaborating with our healthcare workforce.”  

The recent acquisition comes four years after ECRI’s move to acquire the Institute for Safe Medication Practices (ISMP) to help healthcare partners tackle one of the leading causes of preventable harm: medication errors. 

Several large health systems in the U.S. are undergoing the TSS assessment and implementation. New Jersey-based St. Joseph’s Health recently received the 2024 Safety Excellence Award for their work leveraging ECRI’s TSS assessment to align with the most recent CMS guidelines for patient safety and improve workforce culture.

St. Joseph’s Health created core working groups to address each of the four principles in the Total Systems Safety Assessment: Culture Leadership, and Governance; Workplace Safety; Learning System; and Patient and Family Engagement. Multiple targeted action plans were developed for each category.

Inspired by the TSS assessment results, St. Joseph’s began holding quarterly institutional patient safety symposiums that focus on successful patient safety initiatives that can be celebrated as a learning opportunity throughout the healthcare system.

The action plans included other changes, such as a new Just Culture policy and education, safety improvement education plans, expanding the Patient and Family Advocacy Council, unit-based huddles, safety coaches, and engaging in learning systems and networks.

The safety team also began introducing “safety stories” into all leadership and board meetings to highlight staff’s positive actions related to safety and incident reporting. These efforts helped to shift the culture towards a focus on safety, transparency, communication across expert teams, and overall brought tangible safety actions to the forefront for senior leaders.

“Our entire team has taken a hands-on approach to patient safety,” said Pam Upadya, M.D., patient safety officer and interim vice president, physician services at St. Joseph’s Health, in a statement. “Our partnership with ECRI and their encouragement for us to undergo the safety assessment has aligned our institution completely with the most recent CMS guidelines for patient safety. We’re thrilled for the recognition of our vast efforts around safety excellence, which represents the heart of what we do.”