Just culture in healthcare settings: A narrative review of implementation practices and outcomes.

This article reviews the implementation and outcomes of Just Culture (JC) and Restorative Just Culture (RJC) frameworks in healthcare, with a particular focus on mental health settings. JC distinguishes between human error, at-risk, and reckless behaviors to promote fairness and accountability without blame, while RJC incorporates restorative justice principles to address emotional harm and rebuild trust after adverse events. The review of 23 empirical studies found that leadership engagement, tailored staff training, non-punitive reporting systems, and multidisciplinary collaboration were key strategies linked to increased incident reporting, improved safety culture, reduced adverse events, enhanced staff competence, and economic benefits. Although evidence suggests positive cultural, clinical, and economic impacts—especially in mental health—challenges remain due to inconsistent definitions, lack of standardized measures, and resistance to change, highlighting the need for further robust research and sustained organizational commitment.