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Adapting existing guidelines to develop an evidence-based just culture decision-making guideline: a methodological study
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Byung Yun Song, Dong Yeon Kim, Su Yeon Hong, Nack-Gyun Chung, Hyun Hye Woo
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Received April 13, 2026 Accepted September 19, 2026 Published online October 12, 2026
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DOI: https://doi.org/10.4040/jkan.26053
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 Abstract
 ePub
- Purpose
This study aimed to develop an evidence-based just culture decision-making guideline for the Korean healthcare context by systematically adapting existing international guidelines.
Methods
From March 2025 to February 2026, this methodological study followed a guideline adaptation framework comprising three phases, nine modules, and 24 steps. The process involved establishing development committees; formulating key questions using the patient population, intervention, professionals/patients, outcomes, and healthcare setting framework; systematically searching for and appraising international guidelines; assessing guideline quality through independent review using the Appraisal of Guidelines for Research and Evaluation II instrument; adapting recommendations; and obtaining external review by potential users and patient safety experts. Reviewers resolved disagreements through discussion and consensus.
Results
The final guideline contained 41 recommendations in five domains: the concept of just culture, principles for using the just culture decision-making tool, the just culture decision-making tool, follow-up actions, and support and learning. External review of the recommendations’ understandability, appropriateness, and applicability informed their refinement, followed by expert consensus. Evidence was classified as level II, level III, or a legal and regulatory basis; recommendation strengths were classified as A, B, or C.
Conclusion
This study provides a just culture decision-making framework specific to Korean healthcare organizations. The guideline is expected to support fair and reliable responses to patient safety incidents and promote a shift from individual blame toward organizational learning and system-based improvement.
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