This can be answered in various ways depending on your organization and the existing culture. One measure that tends to give us a sense about the direction of our culture is the increase in self reporting.  This monitoring can then be expanded in several different directions.

First, it is important for an organization to gain a better understanding of the under reporting rate that exists within the organization/culture. We do this by identifying a particular top-level event and building a predictive risk model that will predict the frequency of the event within our socio-technical system.

From there, we overlay our event data to identify the gap between our predicted rate and reported rate. In our work around medication events, for example, almost every predictive model we have built has predicted ten times the reported rate.  These findings are supported with studies conducted by the Institute for Safe Medication Practices (ISMP) and other research agencies who have found that medication errors are generally under reported by 90% in most healthcare organizations. Armed with this knowledge, we know now the size of the gap we need to close within our learning culture. A characteristic of a strong learning culture is the self-reporting of events and near misses when they happen. In particular, there is a willingness by the front line staff to not only share the error but also any at-risk behaviors that may have existed within the self-reported event.

For this level of self-reporting to occur, staff has to believe that the organization’s intent is to learn and not punish. We enhance our learning culture and diminish the under reporting rate within our organization through the Just Culture model as we seek to console the human error and coach the at-risk behavior, reserving our corrective action/punishment for the reckless choice.