Classifying Unsafe Health and Care Behaviors in the Context of Just Culture: A Comparative Video-Based Vignette Study.
19 affiliations
- 1Hospital Universitario Fundación Alcorcón, 28922 Alcorcón, Spain.
- 2ATENEA Research Group, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 03550 Sant Joan d'Alacant, Spain.
- 3Health Psychology Department, Miguel Hernández University, 03202 Elche, Spain.
- 4Multiprofessional Teaching Unit for Family and Community Health of Alicante, 03009 Alicante, Spain.
- 5Príncipe de Asturias University Hospital, 28805 Alcalá de Henares, Spain.
- 6Andalusian Patient Safety Strategy, Ministry of Health, Presidency and Emergencies, Government of Andalusia, 41020 Seville, Spain.
- 7Andalusian School of Public Health, Ministry of Health, Presidency and Emergencies, Government of Andalusia, 18011 Granada, Spain.
- 8Intensive Care Unit, San Cecilio University Hospital, 18016 Granada, Spain.
- 9ibs.GRANADA Health Research Institute, 18071 Granada, Spain.
- 10San Juan de Dios del Aljarafe Hospital, 41930 Bormujos, Spain.
- 11Territorial Unit II, Province of San Juan de Dios of Spain, 41005 Seville, Spain.
- 12Department of Public Health, History of Science and Gynaecology, University Miguel Hernández of Elche, 03550 Alicante, Spain.
- 13Department of Preventive Medicine, Sant Joan d'Alacant University Hospital, 03550 Sant Joan d'Alacant, Spain.
- 14Primary Care Centre of Mutxamel, Alicante-Sant Joan Health District, 03110 Alicante, Spain.
- 15Primary Care Directorate, Alicante-Sant Joan Health District, 03550 Sant Joan d'Alacant, Spain.
- 16Department of Preventive Medicine and Public Health, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain.
- 17Faculty of Health Sciences, International University of La Rioja, 26006 Logroño, Spain.
- 18CIBER of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain.
- 19Provincial-Pla Hospital, Alicante-Sant Joan Health District, 03013 Alicante, Spain.
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.
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BibTeX
@article{lorenzo2026classifying,
title = {{Classifying Unsafe Health and Care Behaviors in the Context of Just Culture: A Comparative Video-Based Vignette Study.}},
author = {Susana Lorenzo and Eva Gil-Hernández and Irene Carrillo and Cristina Navarro and Pedro Lozano Gago and Marta Macías Maroto and Elvira Eva Moreno Campoy and Paloma Trillo López and Elena Corpas Nogales and Ángel Cobos-Vargas and Mª Del Carmen Jiménez Estrada and Pastora Pérez-Pérez and María Teresa Gea-Velázquez de Castro and Mercedes Arencibia-Jiménez and Alberto Asencio and Juan Molina Ribera and Jesús María Aranaz-Andres and Diego San Jose-Saras and José J Mira},
journal = {Healthcare (Basel, Switzerland)},
year = {2026},
month = oct,
doi = {10.3390/healthcare14193275},
url = {https://europepmc.org/article/MED/42881714},
note = {CC BY},
}
RIS
TY - JOUR
TI - Classifying Unsafe Health and Care Behaviors in the Context of Just Culture: A Comparative Video-Based Vignette Study.
AU - Susana Lorenzo
AU - Eva Gil-Hernández
AU - Irene Carrillo
AU - Cristina Navarro
AU - Pedro Lozano Gago
AU - Marta Macías Maroto
AU - Elvira Eva Moreno Campoy
AU - Paloma Trillo López
AU - Elena Corpas Nogales
AU - Ángel Cobos-Vargas
AU - Mª Del Carmen Jiménez Estrada
AU - Pastora Pérez-Pérez
AU - María Teresa Gea-Velázquez de Castro
AU - Mercedes Arencibia-Jiménez
AU - Alberto Asencio
AU - Juan Molina Ribera
AU - Jesús María Aranaz-Andres
AU - Diego San Jose-Saras
AU - José J Mira
PY - 2026
DA - 2026/10/02
JO - Healthcare (Basel, Switzerland)
DO - 10.3390/healthcare14193275
UR - https://europepmc.org/article/MED/42881714
AB - 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.
SN - 2227-9032
ER -