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  • Just Culture in aerospace medicine: balancing safety, accountability and autonomy

    Diederik de Rooy, LLM, MD, PhD

    Department of Psychiatry,

    Leiden University Medical Center

    The Netherlands

  • Disclosure statement

    We have no conflicts of interest

    21-sep-18Just Culture: balancing safety, accountability and autonomy2

  • Introduction

    Concern for aircrew mental health

    EASA action plan & opinion 14/2016

    EU-regulation 1042/2018 Alcohol and drugs testing, Psychological testing, Peer support

    Consensus-based

    Regulations or culture change?

    Just Culture for mental health

    Focus on mental health, also other health problems (diabetes)

    21-sep-18Just Culture: balancing safety, accountability and autonomy3

  • Outline

    What is a Just Culture?

    Just Culture in European aviation industry

    European Corporate Just Culture declaration

    Legal background of Just Culture, especially in European Law

    Some ethical remarks Just Culture for mental and other health risks

    Balancing safety, accountability and autonomy

    Regulatory vs conceptual approach to mental health risks

    European situation!

    21-sep-18Just Culture: balancing safety, accountability and autonomy4

  • What is a Just Culture?

    Developed in safety-critical industries such as aviation and oil industry

    Improving safety by learning from accidents and incidents

    Safe reporting possible

    Goal: improving future safety but at the same time justice for all involved

    In a Just Culture, people are not punished for accidents and mistakes unless they were dishonest, grossly negligent or performed willful misconduct

    Balance between providing safety and accountability

    21-sep-18Just Culture: balancing safety, accountability and autonomy5

    Safety Accountability

  • Just Culture in Industry

    European Corporate Just Culture declaration

    Non-legally binding declaration for Just Culture within the context of an organisation

    Set of key principles that each organisation is encouraged to implement

    21-sep-18Just Culture: balancing safety, accountability and autonomy6

    https://www.google.nl/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiGg8fqjdDXAhWJbxQKHQD8DJQQjRwIBw&url=https://en.wikipedia.org/wiki/Airports_Council_International&psig=AOvVaw2YjqnUIv7yP-jdB2nYYfZ0&ust=1511368843874494 http://www.google.nl/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjR4oGNjtDXAhVLVxQKHUBfBucQjRwIBw&url=http://www.asd-europe.org/&psig=AOvVaw0TBfDp0ciSsc4kYvseC7_L&ust=1511368915735605 http://www.google.nl/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiWs6abjtDXAhVJUBQKHZyvCdAQjRwIBw&url=http://news.gtp.gr/event/era-regional-airline-conference-2017/&psig=AOvVaw10F6Jc4qQFkXt4FfSMZVCe&ust=1511368946085189 https://www.google.nl/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj759K-jtDXAhUBEBQKHW2mCfAQjRwIBw&url=https://en.wikipedia.org/wiki/File:AEA_Logo2.JPG&psig=AOvVaw267kXEYKjH_E9Bm8GFv1Ii&ust=1511369018036129 http://www.google.nl/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiyhJbKjtDXAhWLbxQKHYhBCkkQjRwIBw&url=http://www.atceuc.org/&psig=AOvVaw0Qj62m_eQI7-YdNqnJtRWL&ust=1511369044630961 https://www.google.nl/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwihzPPbjtDXAhUHtBQKHZptDe0QjRwIBw&url=https://twitter.com/etfaviation&psig=AOvVaw2zWUTTkjVAnyOb9CfEELXZ&ust=1511369081662928 https://www.google.nl/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjt9YztjtDXAhXJuhQKHaz7ACsQjRwIBw&url=https://www.canso.org/north-american-dinner-2015-0&psig=AOvVaw2OrwTRaU47ZLwMB4zYiw6Z&ust=1511369116008723 https://www.google.nl/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjFuNT_jtDXAhXBVhQKHR_cDkgQjRwIBw&url=https://www.airengineers.org/&psig=AOvVaw3rfDMub3uJnxU6NJ37a2i6&ust=1511369153774318 https://www.google.nl/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjL48iej9DXAhWHSBQKHWFKC3gQjRwIBw&url=https://www.uia.org/s/or/en/1100039897&psig=AOvVaw3aHJblH2lBcvSRonZnr1t0&ust=1511369221741560 http://www.google.nl/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwihh7jGj9DXAhUFPxQKHUJuDusQjRwIBw&url=http://airportregions.org/&psig=AOvVaw1EtVUFhxq28mV-3gYQ_cBX&ust=1511369305021447 http://www.google.nl/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjinZDRj9DXAhWIPBQKHSkfCj0QjRwIBw&url=http://esors.ebaa.org/&psig=AOvVaw1R1fUBZum60B5Iu0x57yLj&ust=1511369327598425 http://www.google.nl/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj04IXcj9DXAhWEuBQKHQlPC9UQjRwIBw&url=http://fs21.formsite.com/IFAIMA/AppMemb/index.html&psig=AOvVaw3gmQ1maNP2qCRuwfFhw07_&ust=1511369350611031 https://www.google.nl/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj-xYTrj9DXAhXK1xQKHd76D_cQjRwIBw&url=https://www.cargoforwarder.eu/2014/05/26/asa-representing-the-ground-handling-world/&psig=AOvVaw1gDH5TKUM0oAkSO1AlaRbx&ust=1511369382217796 http://www.google.nl/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwig4OCAkNDXAhXIOBQKHX4IArYQjRwIBw&url=http://wideo.co/blog/how-the-european-cockpit-association-achieved-294000-views-on-facebook-with-animated-video/&psig=AOvVaw34CyDMtkdeKt7Kw5xwzQoK&ust=1511369427607918 http://www.google.nl/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjX1O2ZkNDXAhVDWRQKHbc1AOsQjRwIBw&url=http://www.ifatca.org/&psig=AOvVaw1v2zkyccP3SyuiZAoY9AaB&ust=1511369478880655

  • European Just Culture declaration

    Safety Accountability

    Acting safely is a top priority

    Despite training, expertise, experience, abilities and good will undesirable outcome

    Focus on system performance and contributing factors first

    Not apportioning blame and/or focus on individual responsibilities

    Reporters are protected from adverse consequences

    Positive behaviour and actions should be captured and encouraged

    Support provided by organisations, in cases where staff are subject to external procedures

    Provide staff with the appropriate environment, tools, training and procedures

    Actions, omissions or decisions taken commensurate with experience and training?

    Define a process to determine unacceptable behaviour

    Document how safety data is managed, stored, protected and disclosed

    Understand and accept responsibility with regards to Just Culture principles

    Regularly review and assess the maturity of their Just Culture internal rules

    21-sep-18Just Culture: balancing safety, accountability and autonomy7

  • Just Culture in medicine (n=29)

    Many, highly different, definitions

    Most focus on finding a balance between safety and accountability

    21-sep-18Just Culture: balancing safety, accountability and autonomy8

  • Just Culture and law

    Seems to be fundamentally different

    Sometimes at odds with civil and criminal law

    Civil law: liability and settling damages

    Criminal law: provide retribution

    Just Culture: future safety

    Difficult to ‘survive’ in law

    Need for specific regulations (such as EU 376/2014, accident

    investigation)

    Sometimes informal agreements industry and prosecution office

    21-sep-18Just Culture: balancing safety, accountability and autonomy9

  • Just Culture in (High) Court

    High Court England and Wales

    Two recent judgements

    [2016] EWHC 2279 (Admin) & [2016] EWHC 2280 (QB)

    First acceptance of Just Culture in a High Court!

    Differentiation accident and criminal investigations Importantly: In accident investigation no protection of criminal

    suspect No caution, right to remain silent

    Data obtained in safety investigation cannot be used directly in criminal investigation

    21-sep-18Just Culture: balancing safety, accountability and autonomy10

  • Just Culture for (mental) health

    No civil or criminal liability, no legal difficulties

    Mentioned in EASA-opinion

    By EPPSI (European Pilot Peer Support Initiative)

    Not specifically mentioned in EU-regulation 1042/2018

    However

    Alcohol testing: ‘objective, transparent and non-discriminatory’

    Peer support ‘non-punitive’ & ‘confidential’

    (At least partially) in line with Just Culture principles

    21-sep-18Just Culture: balancing safety, accountability and autonomy11

  • Some ethical remarks

    Just Culture carries elements of:

    Utilitarianism (Best for society as a whole)  Safety

    Deontology (Moral rules are absolute, people never be used as a means)  Accountability

    Balance

    21-sep-18Just Culture: balancing safety, accountability and autonomy12