Just Culture: This phrase was popularized in the patient safety lexicon by a report (Marx, 2001) that outlined principles for achieving a culture in which frontline personnel are comfortable disclosing errors—including their own—while maintaining professional accountability. The examples in the report relate to transfusion safety, but the principles clearly generalize across domains within health care organizations. Traditionally, healthcare’s culture has held individuals accountable for all errors or mishaps that befall patients under their care. By contrast, a just culture recognizes that individual practitioners should not be held accountable for system failings over which they have no control. A just culture also recognizes many individual or “active” errors represent predictable interactions between human operators and the systems in which they work. However, in contrast to a culture that touts “no blame” as its governing principle, a just culture does not tolerate conscious disregard of clear risks to patients or gross misconduct. In summary, a just culture recognizes that competent professionals make mistakes and acknowledges that even competent professionals will develop unhealthy norms but has zero tolerance for reckless behavior (Agency for Healthcare Research and Quality, 2009).

Leadership: Leadership is the process of influencing others toward the attainment of one or more goals. Leadership comprises two types: formal and informal. Formal leadership occurs through official titular designations within an organization or society. Informal leadership occurs when the perceptions and actions of others are influenced by individuals without such official organizational or societal designations. Leadership is not limited to the accomplishment of organizational goals (Council on Graduate Education for Administration in Nursing, 2010).