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11 Actions Leaders Can Take to Develop a Safety Culture

Patient Safety Awareness Week is an annual education and awareness campaign led by the Institute for Healthcare Improvement. Every year, healthcare organizations take part in the event by highlighting the importance of patient safety among staff, patients, and the community.

The Challenge

Despite progress in patient safety over the years, studies suggest that medical error remains a major source of injury and death among patients.

As a serious global public health concern, patient safety  is an ongoing issue in healthcare. To put into perspective with other industries, it’s estimated that there’s a 1 in 3 million risk of dying while traveling by airplane. In comparison, the risk of patient death occurring due to a preventable medical accident, while receiving healthcare, is estimated to be 1 in 300. Industries with a perceived higher risk, such as the aviation and nuclear industries, have a much better safety record than healthcare does.

One of the most commonly cited reasons for slow improvement in medical errors is that they frequently go unreported, and thus are likely to be repeated. The Department of Health and Human Services’ Office of the Inspector General (OIG) estimates that only 1 out of every 7 hospital-based errors, accidents, and other adverse events are reported.

Fear of retribution remains a leading reason given by health professionals for failing to make a report. Nearly 600,000 physicians, nurses, pharmacists, and other health professionals surveyed at more than 1,100 hospitals nationwide believed their organizations were still more interested in punishing individuals for errors and enforcing hierarchy than learning from the errors themselves.

Why is Leadership Important in a Safety Culture?

According to a Health Science Journal article: The development of a patient safety culture, “senior leaders are the only ones who are able to create the culture and commitment needed to solve underlying system causes of medical errors and harm to patient.” Senior leaders are responsible for driving the culture change by demonstrating commitment to safety through their own actions, as well as encouraging open communication and using adverse event reports to learn what went wrong.

Here are 11 ways leaders can improve their safety culture, per The Joint Commission:

1. Employ a transparent, non-punitive approach to reporting and learning from adverse events and unsafe conditions.

All staff should be able to easily access easy-to-use reporting systems and feel they can report safety concerns without fear of punishment for unintentional mistakes. These factors are essential for learning to be achieved from errors and for creating a proactive process for preventing patient harm.

2. Separate errors caused by poorly-designed systems from unsafe individual actions.

Leaders must create an open, fair, and accountable culture and establish clear, just, and transparent processes for separating errors. Punishing or failing to support an employee who makes a mistake that contributes to an adverse event can undermine an organizational safety culture.

3. Adopt and model appropriate responses in all interactions.

Champion efforts to eliminate intimidating behavior, and promote respect in regards to all safety-related feedback. Recognize those who report adverse events, close calls, and unsafe conditions—or who have good suggestions for safety improvements.

4. Clearly communicate policies that support safety culture, including reporting of adverse events, close calls and unsafe conditions.

All team members should be fully informed and must understand their role and expectations related to safety.

5. Acknowledge reports and share lessons with all team members.

Effective share findings through shift and unit huddles, visual management boards, and debriefs. The Joint Commission Center for Transforming Healthcare’s Safety Culture project found that individuals stopped making suggestions when they received no feedback from leaders.

6. Establish an organizational baseline measure on safety culture performance.

The Joint Commission recommends using the AHRQ Hospital Survey on Patient Safety Culture (HSOPS) or another tool, such as the Safety Attitudes Questionnaire (SAQ). These tools measure staff perceptions on a range of dimensions of a safety culture, such as communication openness, management support for patient safety, teamwork, non-punitive response to errors, and job satisfaction.

7. Analyze safety culture survey results to find opportunities for improvement.

Analysis must drill down to the unit levels so that specific solutions can be implemented. Results should be shared with frontline staff and governing bodies, including the board.

8. Encourage unit-based initiatives to improve the culture of safety.

Initiatives should be based on information from safety surveys and lessons learned from adverse events, close calls, and unsafe conditions.

9. Include safety culture team training in quality improvement projects and organizational processes.

Evidence-based team training can enhance the performance in high-stress, high-risk areas, such as operating rooms, ICUs and emergency departments.

10. Assess system strengths and vulnerabilities and prioritize them for improvement.

(such as medication management and electronic health records)

11. Repeat safety culture assessments every 18 to 24 months to review progress and sustain improvement.

Make sure assessments provide unit-level information and make them a part of strategic measures reported to the board.


Strong leadership is needed for a patient safety program to be successful. Leaders must make patient safety a priority and consistently communicate that message through words and actions. All staff should feel safe speaking up and feel that their voice in doing so is valued. Leaders foster trust with timely feedback and when mistakes and errors occur, leaders should use those experiences to promote learning and performance improvement. Education and training should be provided and encouraged on a wide variety of patient safety topics for staff and physicians in all disciplines and settings.

With a growing body of evidence showing that higher safety culture scores are correlated with positive outcomes, such as fewer readmission, lower infection rates, better surgical outcomes, and decreased staff turnover, what actions will you take today to improve your safety culture?

Learn more about improving care quality with evidence-based education.


Five Things You Can Do This Week to Make Your Patients Safer

Download this white paper to learn more about how leadership, focused listening to both care teams and patients, team communication, and staff education and development are essential components of a culture of safety and about practical actions you can take right now, this week, to advance each domain.

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