Just culture in healthcare settings: A narrative review of implementation practices and outcomes

Abstract

Introduction

Healthcare organisations are increasingly adopting Just Culture (JC) and Restorative Just Culture (RJC) to improve safety, staff well-being, and accountability. JC distinguishes between human error, at-risk, and reckless behaviours to promote fairness without blame, while RJC incorporates restorative practices to address emotional harm and rebuild trust. This review synthesised empirical evidence on JC/RJC implementation in healthcare, with emphasis on mental health settings.

Methods

Systematic searches of MEDLINE, EMBASE, and PsycINFO (2011–2024) identified 23 eligible qualitative, quantitative, and mixed-methods studies. Due to heterogeneity in design and measures, a narrative synthesis was undertaken.

Results

Common strategies included leadership engagement, tailored staff training, non-punitive reporting systems, and multidisciplinary collaboration. Outcomes reported across settings included improved incident reporting, enhanced safety culture, reduced adverse events, greater staff competence, and economic benefits. Mental health studies demonstrated reductions in repeated suicide attempts and improved psychological safety. Implementation was challenged by inconsistent definitions, lack of standardised measures, and resistance to change.

Conclusion

JC/RJC approaches are associated with cultural, clinical, and economic benefits, particularly in high-risk environments such as mental healthcare. Sustainable implementation requires integrated leadership commitment, transparent reporting systems, and targeted research – especially in mental health – to strengthen evidence and guide best practice.