{"id":4717,"date":"2025-11-04T00:37:46","date_gmt":"2025-11-03T23:37:46","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=4717"},"modified":"2025-11-04T00:37:46","modified_gmt":"2025-11-03T23:37:46","slug":"why-just-culture-needs-philosophy-understanding-the-theoretical-presuppositions-of-moving-from-blame-and-punishment-to-repair-and-learning","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2025\/11\/04\/why-just-culture-needs-philosophy-understanding-the-theoretical-presuppositions-of-moving-from-blame-and-punishment-to-repair-and-learning\/","title":{"rendered":"Why \u2018just culture\u2019 needs philosophy: Understanding the theoretical presuppositions of moving from blame and punishment to repair and learning"},"content":{"rendered":"

By Eva van Baarle, Guy Widdershoven, Bert Molewijk<\/p>\n

The notion of just culture<\/em> 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.<\/p>\n

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 \u2014 not only for theoretical coherence, but also for ensuring that restorative practices promote justice and moral and organizational learning in organizations.<\/p>\n

The need for theoretical depth<\/strong><\/p>\n

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.<\/p>\n

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.<\/p>\n

Dialogical hermeneutics and care ethics<\/strong><\/p>\n

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.<\/p>\n

From this standpoint:<\/p>\n