Patient safety culture

Measuring patient safety culture from the perspective of staff can provide insights that lead to improvements in care.

Defining patient safety culture 

Safety culture is defined as:

‘a product of individual and group values, attitudes, perceptions, competencies and patterns of behaviour that determine the commitment to, and the style and proficiency of an organisation’s health and safety management’.1 A common interpretation of safety culture is ‘the way things are done around here’. 

The Commission uses the term 'patient safety culture' as our work focuses on the aspects of culture that relate to patient safety.  

Positive patient safety culture

Positive patient safety cultures have strong leadership that drive and prioritise safety. Commitment from leaders and managers is important, their actions and attitudes influence the perceptions, attitudes and behaviours of the wider workforce. 

Other important aspects of positive patient safety culture include:

  • Shared perceptions of the importance of safety
  • Constructive communication
  • Mutual trust
  • A workforce that is engaged and always aware that things can go wrong
  • Acknowledgement at all levels that mistakes occur
  • Ability to recognise, respond to, give feedback about, and learn from, adverse events.

Measuring patient safety culture

Measurement of patient safety culture enables the identification of strengths and areas for improvement. This information can be used to develop appropriate interventions. Patient safety culture measures can also be used to evaluate new safety programs by comparing results before and after implementation. 

Patient safety culture can be measured through surveys of hospital staff, qualitative measurement (focus groups, interviews), ethnographic investigation or a combination of these. Surveys of hospital staff are the most common way of measuring patient safety culture. Hospital staff are often the first to notice patterns of unsafe practice and the conditions which increase or decrease the likelihood of such practice. 

Patient safety culture forms one component of a comprehensive measurement and improvement system; it should be measured alongside other indicators of safety and quality, such as, complications acquired while in hospital, accreditation outcomes, mortality, patient-reported measures and serious in-hospital incidents.

Developing a measurement toolkit 

To support local monitoring of patient safety culture in Australian hospitals, the Commission is developing a toolkit which will include a short validated survey for regular monitoring, along with an implementation guide. The guide will provide advice on options for more detailed examination of patient safety culture, and advice on how to use this information to improve care. 

Substantial amounts of work to define and measure patient safety culture has been done internationally. The Commission's project will identify or modify an existing validated survey. This will involve a literature review and environmental scan, consultation to identify the key requirements of stakeholders, identification of candidate surveys, survey selection, modification and testing.

Updates will be provided on this page as the project progresses. For more information on the project please contact:

Related Commission work

The importance of culture in safety and quality improvement is articulated in a range of the Commission's work, including the National Safety and Quality Health Service Standards, the National Model Clinical Governance Framework, and the Communicating for Safety program.

The 2017 review of the Australian Health Service Safety and Quality Accreditation (AHSSQA) scheme considered a range of options to improve the scheme, including the inclusion of patient safety culture assessment. The decision was made to not include any new requirements to use a particular tool to assess patient safety culture. The Commission contracted a literature review to support this policy development. The information in this review will be used to help guide the current work on local monitoring patient safety culture.  



1. Sexton B, Helmreich R, Neilands T, Rowan K, Vella K, Boyden J, et al. The Safety Attitudes Questionnaire: psychometric properties, Sexton B, Helmreich R, Neilands T, Rowan K, Vella K, Boyden J, et al. The Safety Attitudes Questionnaire: psychometric properties, benchmarking data and emerging research. BMC Health Services Research 2006;6(44):1–10.