In this resource :

Patient Safety Culture 

Culture refers to shared values (what is important) and beliefs (what is held to be true) that interact with a system’s structures and control mechanisms to produce behavioural norms.  It influences patient safety directly by determining accepted practices and indirectly by acting as a barrier or enabler to the adoption of behaviours that promote patient safety.  Understanding the components and influencers of culture and assessing the safety culture is essential to developing strategies that creates a culture committed to providing the safest possible care for patients. 

“Culture is tribal; it lives and breathes at provider level and in middle management level. The reality is that there are significant cultural differences between shifts and even team members. Furthermore, a unit’s culture can be influenced – both negatively and positively – by a single individual.” -- Hugh MacLeod, past CEO Canadian Patient Safety Institute (now Healthcare Excellence Canada) 

Recommended strategies 

Understand patient safety culture and its components. 

  • Recognize that patient safety culture is multi-dimensional consisting of a number of features: 
    • informed culture – relevant safety information is collected, analyzed and actively disseminated 
    • reporting culture – an atmosphere where people have the confidence and feel safe to report safety concerns without fear of blame, and they trust that concerns will be acted upon 
    • learning culture – preventable patient safety incidents are seen as opportunities for learning and changes are made as a result 
    • just culture – the importance of fairly balancing an understanding system failure with professional accountability 
    • flexible culture – people are capable of adapting effectively to changing demands 
  • Understand how culture influences patient safety outcomes directly by determining accepted norms and practices and indirectly by acting as a barrier or enabler to the adoption of interventions designed to promote patient safety 
  • Appreciate the interconnection between people, system and culture and how focusing on system improvement and learning, rather than individual performance, drives actions that support patient safety and incident management 

Understand key contributors to a patient safety culture. 

  • Appreciate and understand patient safety culture’s multiple influencers, including: 
    • leadership and board commitment and ongoing visibility (at the organization and team levels) 
    • patient/family engagement 
    • effectiveness and openness of teamwork and communication 
    • openness of all team members, including patients/families, in reporting problems and incidents measurement/monitoring and learning from safety and incidents 
    • organizational learning 
    • organizational resources for patient safety 
    • priority of safety versus production 
  • Provide education, training and resources so that everyone is aware of the critical role of culture in patient safety and what they can do to support it 

Assess patient safety culture. 

  • Determine the best methods and tools to assess patient safety culture in the organization, engaging safety and measurement experts whenever possible 
  • Consider assessing both perceptual indicators (front line staff provide majority of data)  and organizational indicators of culture (senior leaders provide majority of data)   
  • Obtain informed leadership support for the use of patient safety culture measurement tools to ensure an understanding of the resources required, the barriers that may be encountered, and the potential outcomes 
  • Engage frontline caregivers in the planning and implementation of the culture measurement initiative 
  • Analyze the results and identify opportunities for improvement, mapping to the various patient safety dimensions and influencers 
  • Communicate the results to key stakeholders in a meaningful way including a timeline for next steps and how improvement actions will be identified 
  • Understand that patient safety culture measurement is a snapshot in time and that ongoing measurement will be needed to monitor progress 

Develop and implement a patient safety culture strategy. 

  • Based on the assessment results and environmental factors and with leadership support develop a shared vision and plan for improving patient safety culture   
  • Identify potential opportunities to implement the plan as well as barriers along with corresponding mitigating strategies 
  • Address patient safety culture gaps and weaknesses at the organizational and unit/program/service (micro-system) level recognizing that in the same organization culture can be different across units and even between shifts 
  • Partner with patients and families in patient safety 
    • empower them to be active participants in their care by encouraging them to speak up, participate in shared decision-making and the development of personalized care plans 
    • engage them in the design of care models, care processes and quality improvement/patient safety initiatives 
  • Partner with providers in patient safety 
    • develop multiple strategies that empower staff at all levels to share their concerns and speak up (e.g. anonymous incident reporting system, team training that addresses the authority gradient, safety huddles, anonymous email or telephone “hot line” where staff can share concerns) 
    • engage staff in all phases of quality improvement and patient safety initiatives to leverage their expertise 
    • a successful patient safety strategy leads to frontline ownership of local issues and challenges and enables clinicians and providers to action their own solutions 
    • design communication systems that allow for a continuous patient safety conversation between frontline staff and leaders