# Reconciling Safety and Safeguarding in Health and Social Care: Implications for Just Culture

## TL;DR

This paper discusses how to balance staff accountability and organizational responsibility in health and social care to promote a fair culture, especially in cases of peer harm.

## Contribution

The paper introduces tailored just culture principles for safeguarding situations and critiques the use of AARs in cases of serious aggression.

## Key findings

- Organizational accountability is crucial in safeguarding cases involving individuals with limited capacity.
- After Action Reviews (AARs) are unsuitable for serious aggression and abuse incidents but useful for preventative learning.
- Involving social workers, service users, and families can enhance learning and prevent future incidents.

## Abstract

Facilitating a just response to staff involved in patient safety events is complex, with varying perceptions of safe behaviour and practice across settings. This viewpoint paper explores the challenges of developing a just culture, particularly in safeguarding situations involving peer-to-peer harm. It argues that established just culture principles, such as balancing staff and organisational accountability and using After Action Review (AAR) debriefs, need to be tailored to these contexts. In particular, organisational accountability is paramount in safeguarding situations, especially where individuals do not have the capacity to understand or intend their behaviours. Furthermore, AARs are inappropriate incident responses for serious aggression, violence, and abuse cases. To counter this, a consistent AAR practice can be valuable for preventative learning when applied to the service user care journey and comprehensive incident learning responses. The incorporation of social workers, service users, and families can help promote learning and the prevention of events. Finally, this paper emphasises the need for consistency in core safety principles across settings and the need to tailor just cultural principles to particular contexts. Future research on the role of AAR in diverse settings is recommended.