By Eva van Baarle, Guy Widdershoven, Bert Molewijk
The notion of just culture has become a buzzword in healthcare organizations. It refers to the need for repair and learning when things go wrong, rather than blame and punishment. This orientation, which is also known as a restorative just culture approach, implies a fundamental change in dealing with incidents in healthcare, aiming at openness and attention for the impact on those who are involved. Yet in practice, just culture risks becoming a management slogan or organizational catchphrase without engaging with underlying philosophical and moral underpinnings.
In our paper, we argue that reflection on underlying theoretical presuppositions of just culture is needed to understand what is at stake in fostering a restorative way of dealing with incidents. Clarifying these presuppositions is necessary — not only for theoretical coherence, but also for ensuring that restorative practices promote justice and moral and organizational learning in organizations.
The need for theoretical depth
In many organizations incidents are still analyzed primarily in terms of individual error or decision-making. Even when restorative elements are introduced, this underlying image often persists, limiting the transformative potential of a restorative just culture.
In practice, however, healthcare work is not individual or linear. It is deeply relational, involving shared meanings and mutual dependencies. Recognizing this requires a shift in how we think about moral action and learning from incidents.
Dialogical hermeneutics and care ethics
To articulate this shift, we draw on two traditions in contemporary philosophy and ethics: dialogical hermeneutics and care ethics. These perspectives conceive human beings not as detached decision-makers but as relational and interpretive participants in shared practices of meaning-making.
From this standpoint:
- Repair is a relational practice: attending to harm and restoring trust within relationships.
- Understanding is interpretive: a collective process of making sense of events and identifying different perspectives and needs.
- Moral learning is dialogical: an open, democratic exploration of experiences and values.
Together, these frameworks provide a philosophical foundation for restorative just culture — one that explains not only what it means to repair but how learning and responsibility can emerge through shared reflection.
From theory to organizational practice
In our paper, we illustrate how these conceptual insights can inform real-world practice in healthcare organizations. Drawing on a case study, we describe how restorative processes can become structured spaces for dialogical moral learning, where those involved in an incident jointly explore what happened, what is needed, and how to move forward.
Such processes require organizational conditions that support openness, equality of voice, and mutual trust. When these are present, restorative practice can move beyond a procedural response to error and become a continuous form of learning at team and organizational levels.
Looking ahead
The growing interest in just culture offers an opportunity for organizations to rethink how they understand accountability, justice, and learning. Our contribution is to show that a restorative just culture cannot rest on individualistic assumptions about agency and blame. It requires an ethical and philosophical foundation that recognizes the relational and interpretive nature of human life.
Reflecting on theoretical underpinnings of just culture can help us to understand what is needed to foster a restorative just culture in concrete practices. By translating philosophical reflection into practice, we aim to deepen both the meaning and the practical effectiveness of just culture — moving from blame towards shared moral learning.
Author: Eva van Baarle
Affiliation: Associate Professor at the Netherlands Defence Academy
Social Media: LinkedIn
Conflicts of Interest: None to declare