{ "abstract": "Background: Just Culture requires organizations to distinguish human mistakes from unsafe behavior while maintaining transparency, accountability and trust. However, little is known about how different stakeholders interpret these boundaries in realistic healthcare situations. This study aimed to explore how unsafe healthcare behaviors are classified by professionals and community and public-opinion stakeholders within the framework of Just Culture. Methods: This structured judgment study used standardized video vignettes across primary care, hospital, and nursing home settings. A purposive and convenience sample of 449 healthcare professionals, managers, and community/public representatives classified behaviors as honest error, at-risk behavior, or reckless behavior and provided written justifications. Concordance with a prespecified study-defined reference classification was examined using mixed-effects logistic regression. Results: Across 2976 classification opportunities, 2610 were analyzable within the three predefined categories. At-risk behavior was most frequent (40.5%), followed by honest error (33.5%) and reckless behavior (25.9%). Exact concordance with the prespecified reference classification was 48.4% and was highest for reckless behavior (67.4%). Participants' justifications for their classification choices centered on intention, contextual pressure, foreseeability, omitted safety barriers, professional duty, and relational expectations. Conclusions: Participants generally distinguished human fallibility from the omission of available safeguards, but many behaviors were located in an intermediate zone of at-risk conduct rather than clear error or recklessness. The observed variability in interpreting error, risk, and responsibility, particularly around at-risk behavior, may be relevant to the implementation of Just Culture.", "abstract_shown": true, "affiliations": [ "Hospital Universitario Fundación Alcorcón, 28922 Alcorcón, Spain.", "ATENEA Research Group, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 03550 Sant Joan d'Alacant, Spain.", "Health Psychology Department, Miguel Hernández University, 03202 Elche, Spain.", "Multiprofessional Teaching Unit for Family and Community Health of Alicante, 03009 Alicante, Spain.", "Príncipe de Asturias University Hospital, 28805 Alcalá de Henares, Spain.", "Andalusian Patient Safety Strategy, Ministry of Health, Presidency and Emergencies, Government of Andalusia, 41020 Seville, Spain.", "Andalusian School of Public Health, Ministry of Health, Presidency and Emergencies, Government of Andalusia, 18011 Granada, Spain.", "Intensive Care Unit, San Cecilio University Hospital, 18016 Granada, Spain.", "ibs.GRANADA Health Research Institute, 18071 Granada, Spain.", "San Juan de Dios del Aljarafe Hospital, 41930 Bormujos, Spain.", "Territorial Unit II, Province of San Juan de Dios of Spain, 41005 Seville, Spain.", "Department of Public Health, History of Science and Gynaecology, University Miguel Hernández of Elche, 03550 Alicante, Spain.", "Department of Preventive Medicine, Sant Joan d'Alacant University Hospital, 03550 Sant Joan d'Alacant, Spain.", "Primary Care Centre of Mutxamel, Alicante-Sant Joan Health District, 03110 Alicante, Spain.", "Primary Care Directorate, Alicante-Sant Joan Health District, 03550 Sant Joan d'Alacant, Spain.", "Department of Preventive Medicine and Public Health, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain.", "Faculty of Health Sciences, International University of La Rioja, 26006 Logroño, Spain.", "CIBER of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain.", "Provincial-Pla Hospital, Alicante-Sant Joan Health District, 03013 Alicante, Spain." ], "article_type": "research article", "arxiv": null, "author_total": 19, "authors": [ { "affs": [ 0 ], "name": "Susana Lorenzo", "orcid": "0000-0003-0954-7830" }, { "affs": [ 1 ], "name": "Eva Gil-Hernández", "orcid": "0000-0002-4619-0503" }, { "affs": [ 2 ], "name": "Irene Carrillo", "orcid": "0000-0002-6981-7284" }, { "affs": [ 1 ], "name": "Cristina Navarro" }, { "affs": [ 3 ], "name": "Pedro Lozano Gago" }, { "affs": [ 4 ], "name": "Marta Macías Maroto" }, { "affs": [ 5 ], "name": "Elvira Eva Moreno Campoy", "orcid": "0000-0001-6972-884X" }, { "affs": [ 5 ], "name": "Paloma Trillo López", "orcid": "0009-0000-7976-5695" }, { "affs": [ 5, 6 ], "name": "Elena Corpas Nogales" }, { "affs": [ 7, 8 ], "name": "Ángel Cobos-Vargas", "orcid": "0000-0001-9431-9466" }, { "affs": [ 9 ], "name": "Mª Del Carmen Jiménez Estrada" }, { "affs": [ 10 ], "name": "Pastora Pérez-Pérez", "orcid": "0000-0001-8779-0591" }, { "affs": [ 11, 12 ], "name": "María Teresa Gea-Velázquez de Castro" }, { "affs": [ 12 ], "name": "Mercedes Arencibia-Jiménez" }, { "affs": [ 13 ], "name": "Alberto Asencio" }, { "affs": [ 14 ], "name": "Juan Molina Ribera" }, { "affs": [ 15, 16, 17 ], "name": "Jesús María Aranaz-Andres" }, { "affs": [ 15, 16 ], "name": "Diego San Jose-Saras", "orcid": "0000-0002-7063-5912" }, { "affs": [ 1, 2, 18 ], "name": "José J Mira", "orcid": "0000-0001-6497-083X" } ], "bibtex": "https://research.draconitic.com/paper/dn9mmqb1yk46q.bib", "cited_by": 0, "doi": "10.3390/healthcare14193275", "fulltext_url": "https://europepmc.org/articles/PMC13664786", "id": "dn9mmqb1yk46q", "issns": [ "2227-9032" ], "landing_url": "https://europepmc.org/article/MED/42881714", "language": "eng", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "3604|Patient Safety and Medication Errors" ] ], "openalex": "W7216570186", "pdf_url": "https://europepmc.org/articles/PMC13664786?pdf=render", "pmcid": "PMC13664786", "pmid": "42881714", "published": "2026-10-02", "publisher": null, "ris": "https://research.draconitic.com/paper/dn9mmqb1yk46q.ris", "sources": [ { "first_seen": "2026-10-30T12:19:00Z", "native_id": "MED:42881714", "source": "europepmc", "url": "https://europepmc.org/article/MED/42881714" } ], "subjects": [], "title": "Classifying Unsafe Health and Care Behaviors in the Context of Just Culture: A Comparative Video-Based Vignette Study.", "title_text": "Classifying Unsafe Health and Care Behaviors in the Context of Just Culture: A Comparative Video-Based Vignette Study.", "type": "peer-reviewed", "updated_at": "2026-10-30T12:19:00Z", "url": "https://research.draconitic.com/paper/dn9mmqb1yk46q", "venue": "Healthcare (Basel, Switzerland)", "versions": [] }