Just culture and restorative just culture in healthcare settings: a scoping review of interventions, activities, factors and outcomes

Abstract Background Just culture and, more recently, restorative just culture interventions are increasingly recognised as nonpunitive approaches to the reporting of incidents in which healthcare professionals trust that they will receive fair treatment and support. However, despite this recognition, evidence concerning the range of interventions, implementation strategies and factors for successful outcomes supported by systematic approaches remains limited. This review sought to address this gap. Methods We searched PubMed, HBE, CINAHL, PsycINFO, Scopus, Embase and grey literature from January 2000 to December 2024. We included peer-reviewed studies or quality improvement reports of any design and used an iterative, inductive approach to thematically categorise the data supplemented with descriptive statistics. Results We analysed 36 interventions across six thematic categories, which were a mix of just culture or restorative just culture interventions or existing safety interventions used to operationalise these approaches. Barriers and enablers to implementation included system improvements and accountability, a safe and supportive culture, leadership support, engagement and participation, organisational influences and external influences. Seven outcomes were identified: knowledge and confidence, communication and engagement in incident reporting, leadership engagement and support, shift towards a just, learning and safety culture, continuous improvement in processes, impact on patient safety outcomes and organisational benefits. A challenge was found in identifying the specific activities and factors contributing to the success of the interventions. Conclusions The interventions identified in this review are reflective of just culture and restorative just culture as a growing area in terms of quality and safety and incident management practices. The results suggest a number of preexisting safety interventions that can be used to operationalise these approaches, with restorative culture adding a further step of addressing the harm to the healthcare professional, crossing the boundaries of traditional patient safety functions to include Human Resources, Organisational Development and even Union functions. This review progresses the study of just culture and restorative just culture from a traditional quality improvement approach to implementation science. However, further work is needed to refine definitions to capture the extent and progress of preexisting work in this field and to develop implementation methodologies that identify relationships between interventions, barriers, enablers, outcomes and systematic methods for implementation.