Assessing Organizational Readiness for Just Culture in Health Care

BACKGROUND: A Just Culture promotes fairness, accountability, and psychological safety in response to adverse events. Despite growing interest in its implementation, Spanish-speaking health care systems lack validated tools to assess organizational readiness. OBJECTIVE: To develop and validate a Spanish-language instrument [Organizational Readiness for Just Accountability Scale (ORJA-S)] to assess health care professionals' attitudes that reflect organizational readiness to adopt Just Culture principles. METHODS: A cross-sectional study was conducted among 603 health care professionals from various care settings. The ORJA-S scale was developed through expert input, cognitive interviews, and pilot testing. Content validity, structural validity (via EFA and CFA), internal consistency (Cronbach α, McDonald ω), reliability (split-half), construct validity, criterion validity, interpretability, and feasibility were evaluated according to the COSMIN guidelines. RESULTS: The final 16-item ORJA-S demonstrated a unidimensional structure (CFA: CFI=0.95, TLI=0.94, RMSEA=0.05, SRMR=0.04) and adequate internal consistency (α=0.93, ω=0.93). Criterion validity was supported by significant correlations with fear of punishment, reluctance to report, and unsafe risk-taking. Significant score differences were found by professional profile. Interpretability analysis indicated a left-skewed distribution, reflecting overall positive attitudes. Feasibility was confirmed via high response rates and favorable feedback. CONCLUSIONS: The ORJA-S is a psychometrically sound, feasible, and culturally appropriate tool for assessing organizational readiness for Just Culture in Spanish-speaking health care settings.