About patient safety culture

Defining patient safety culture 

Organisational culture is a set of values, expectations, formal and informal practices, and behaviours that define the unique corporate environment. Culture is deeply ingrained in the fabric of organisational life; it determines how the organisation conducts its business, treats its employees, evaluates its leaders, serves its customers, and handles productivity and performance.¹ A common interpretation of culture is ‘the way things are done around here’.

Safety culture is the aspects of organisational culture that relate to health and safety management. It 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’.²

Patient safety culture is focused on the aspects of organisational culture that relate to patient safety. It is defined as a pattern of individual and organisational behaviour, based upon shared beliefs and values that continuously seeks to minimise patient harm, which may result from the process of care delivery.³

Positive patient safety culture

Positive patient safety cultures have strong leadership that drives and prioritises safety. Commitment from leaders and managers is key, 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.

When things go wrong

Patient safety inquiries provide insights into the potentially catastrophic impact of dysfunctional workplace cultures on patient care.

A review of inquiries identified the following common deficits⁴:

• Limitations in the standard of clinical governance
• An absence of monitoring important metrics in relation to patient outcomes
• A preference to focus on financial targets rather than healthcare process and outcome targets
• Pressure on staff
• An organisational culture that is considered unhealthy and fails to place the patient at the centre of all activities.

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. 

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.

• See measures of patient safety culture for more information

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, Review of key attributes of high-performing person-centred healthcare organisations and the Communicating for Safety program.

References

1. Veterans Health Administration. Blueprint for Excellence. Washington DC: US Department of Veterans Affairs; 2014.
2. Sexton JB, Helmreich RL, Neilands TB, Rowan K, Vella K, Boyden J, Roberts PR, Thomas EJ. The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research. BMC health services research. 2006 Dec;6(1):1-0.
3. Kristensen S, Bartels P. Use of patient safety culture instruments and recommendations. Denmark: European Society for Quality in Healthcare - Office for Quality Indicators; 2010.
4. Hodgen A, Ellis L, Churruca K, Bierbaum M. Safety Culture Assessment in Health Care: A review of the literature on safety culture assessment modes. Sydney: ACSQHC; 2017.