In this resource :

  • Patient Safety Culture Bundle

A Framework for Establishing a Patient Safety Culture 

Patient Safety Culture "Bundle" for CEOs/Senior Leaders 

What is the Patient Safety Culture "Bundle"? 

Strengthening a safety culture necessitates sequential, iterative and simultaneous interventions that enable, enact and learn in a way that is attuned to the existing culture. Through a literature review of more than 60 resources, we created a Patient Safety Culture “Bundle” that has been validated through interviews with Canadian thought leaders. The Bundle is based on a set of evidence-based practices that must all be applied in order to deliver good care. All components are required to improve the patient safety culture.

The Patient Safety Culture "Bundle" for CEOs and Senior Leaders encompasses key concepts of safety science, implementation science, just culture, psychological safety, staff safety/health, patient and family engagement, disruptive behaviour, high reliability/resilience, patient safety measurement, frontline leadership, physician leadership, staff engagement, teamwork/communication and industry-wide standardization/alignment.  

Download a one-pager of the Patient Safety Culture “Bundle” for CEOs/Senior Leaders

See infographic transcript

Why was this Bundle created? 

A patient safety culture is difficult to operationalize. Improving safety requires an organizational culture that enables and prioritizes patient safety. The importance of culture change needs to be brought to the forefront, rather than taking a back seat to other safety activities. 

The National Patient Safety Consortium Education Working Group verified the critical role senior leadership plays in ensuring patient safety is an organizational priority. A working group of partners, led by the Canadian Patient Safety Institute (now Healthcare Excellence Canada), Canadian College of Health Leaders (CCHL), HealthCareCAN and the Healthcare Insurance Reciprocal of Canada (HIROC), joined together to establish a framework and advance this work. 

How can you use the Patient Safety Culture “Bundle”? 

The key components required for a Patient Safety Culture are identified under three pillars: 




Within each pillar you will find links to valuable tools and resources to help you and your teams establish and sustain a patient safety culture. 

We invite your feedback and input to ensure the Bundle is current and relevant via


"Patient safety and healthcare quality are advanced when boards and senior leaders are committed to it and are able to show evidence of that commitment. Missing until now is a concise "how to" guide. The Patient Safety bundle for Leaders fills that gap."

Catherine Gaulton, CEO, HIROC

"Leadership is critical to developing a patient safety culture and building leadership capacity requires a vision of the knowledge, skills and behaviours necessary to achieve this. The Patient Safety Leadership Bundle provides this and will be a practical tool for health leaders across the healthcare continuum to assess their personal capabilities. It will also provide both organizations and the system, as a whole, a checklist for what's missing from our collective leadership education toolkits so that we can strategically respond to these needs. HealthCareCAN is committed to the spread of this tool across the country as part of a cultural shift to safety and a drive towards high-reliability culture." 

Dale Schierbeck, Vice-President, Learning & Development, HealthCareCAN 
and Co-Chair, Patient Safety Education for Leaders Working

"The drive to quality and patient safety must start at the top with the board of directors – they are a critical enabler of culture change. It has been well-recognized that taking a passive role in this fundamental responsibility is not an option. Governors need insight into best practice principles and a corresponding framework to help guide them in this important task – this bundle delivers that."

Elizabeth Martin, Board Chair, HIROC;
former Board member, Sunnybrook Health Sciences Centre

"Preventable harm must remain a focus for all Boards as they consider their organization's commitment to the people they care for. The depth of information and insight contained within the Patient Safety Culture Bundle will assist all leaders, boards and organizations to fully appreciate the importance culture plays in achieving these goals. Armed with this knowledge, the dedicated people within healthcare organizations can be supported to deliver consistently safe care."

Ruthe Anne Conyngham, Faculty, Canadian Patient Safety Institute; 
Member, Cancer Quality Council of Ontario

"For years, senior leaders have promoted the use of checklists to support evidence-informed clinical practice. Now leaders have their own checklist to support a safety culture. The Patient Safety Leadership Bundle will be an invaluable resource to help leaders walk the talk and lead by example" 

Maura Davies, Former President and CEO, Saskatoon Health Region; 
President, Maura Davies Healthcare Consulting Inc.

"The patient safety and quality culture bundle is a key resource that provides useful guidance for senior leaders on the critical knowledge and actions needed to support improvements in safety culture and outcomes."

Ross Baker, Ph.D., Professor and Program Lead, Quality Improvement and Patient Safety,
Institute of Health Policy, Management and Evaluation, 
Dalla Lana School of Public Health, 
University of Toronto

"One of many actions resulting from the work of National Patient Safety Consortium is the Safety Bundle for Leaders/CEOs, which demonstrates the critical role senior leadership plays in ensuring patient safety is an organizational priority. The Safety Bundle will help identify the best practices, skills, tools and resources healthcare leaders can deploy to advance patient safety and facilitate the spread of this knowledge within their organizations." 

Chris Power, Chief Executive Officer, Canadian Patient Safety Institute

"The Board is ultimately accountable for the performance of the organization. The "Patient Safety Culture Bundle" is an excellent resource to assist the Board in improving organizational culture and advancing its patient safety agenda." 

 Joan Dawe, Peer facilitator Effective Governance for Quality and Patient Safety 
Education Program; Past Chair, Eastern Health Regional Authority; 
Past Chair, Health and Community Services, St. John's Region

"The Board, CEO and Senior Leaders all play critical roles in setting the tone and championing the importance of a safety culture in their organizations. Engaging staff in this effort starts at the top and demands attention and concerted ongoing effort. It requires support for and engagement with front line staff and respect for what they do, and equally important, engaging those being served and the shared knowledge this experience generates for improving care processes. This work is complex and the Bundle will serve as a useful guide for the scope of effort required to improve safety and eliminate harm." 

Ray Racette, former CEO Canadian College of Health Leaders.