Outcome Engenuity is pleased to offer our Just Culture Certification Course. This course is designed to help organizations achieve better outcomes, pursue sustainable and positive culture change through learning and justice, and to reduce adverse events. We take an in-depth look at specific accountabilities of all levels of staff and leadership, the nature of duties owed by organizations to their staff and clients, regulators, investors and other organizational influences.

This is accomplished by developing in-house expertise in the 5 Skills and the Just Culture AlgorithmTM. Participants are provided with the tools and knowledge to lead cultural change and build effective socio-technical, justice and learning systems in their organizations.

The Just Culture AlgorithmTM is the premier tool used to achieve both justice and accountability across industries worldwide. During the course, participants will gain insight into the history behind the Algorithm, and explore its connections to the Declaration of Independence, the U.S. Constitution, the Model Penal Code and the ‘natural’ law. We will also examine how this tool integrates the law with key principles of systems engineering, social engineering, and individual human factors. Opportunities are provided throughout the course to apply the learning and explore how organizations can realize consistently better outcomes in support of organizational values.

  • Describe the five skills that lead to producing better outcomes
  • Identify the role of an organization’s mission and values
  • Define the factors of system design and good design strategies
  • Describe the principles of managing the three human behaviors
  • Describe the legal principles that provide the foundation for Just Culture
  • Define the role played by imposers and the tools they use
  • Identify the role of ‘the reasonable person standard’
  • Evaluate the role of the ‘natural’ law
  • Define and contrast outcome-based and procedure-based duties
  • Define and describe the three duties and how to identify breaches of those duties
  • Demonstrate proficiency using the Just Culture AlgorithmTM through guided practice
  • Describe Just Culture implementation strategies


  • Leaders from operations, Safety/Risk/Quality and HR
  • Chief Operating Officers
  • Chief Medical Officers 
  • Chief Human Resources Officers 
  • Quality Management Executives
  • Individuals interested in the Just Culture Model to improve leadership effectiveness


Customers have asked the question. A manager can learn to walk through the Algorithm in a matter of hours. A manager can learn to build a rudimentary cause and effect diagram in an hour. A manager can receive an introduction to human factors in an hour or two. In total, a manager will generally spend a day learning about accountability and what it looks like. Those managers will feel a bit overwhelmed by the day’s learning, some from the complexity of the tools, some from the foreign nature of the ideas as compared to what organizations typically do today.

It’s material that cannot be condensed into an eight-hour managerial course. Every organization that chooses to implement Just Culture will need a critical mass of internal champions who understand the concepts and tools at a greater-than introductory depth. It has been said that not everyone is a doctor, not everyone an astronaut not everyone a gymnast, but we are, indeed, all judges. Employees have deeply held beliefs about how their peers, and their managers, should be held accountable. The Just Culture model will likely be at odds with many of those beliefs. The workplace is just too complex, and currently beliefs too deeply held, to create a culture change through one day of manager’s training.

Scenarios will arise that will test a manager’s skill, and a manager’s resolve to manage in a different way. Perhaps it’s an at-risk behavior leading to harm, but with the recognition that many of the other staff are skipping the same safety task. Perhaps it’s the recognition that one group of employees is being held accountable to a standard when others are not. These are not easy scenarios to address.

An organization needs well-trained internal champions to make Just Culture concepts a reality. And that’s what the three-day certification course creates – certified culture changing champions.