Culture of Safety, Leadership’s Responsibility

What is Culture of Safety?

Culture of Safety or Safety culture is viewed as an organization's shared perceptions, beliefs, values, and attitudes that combine to create a commitment to safety and an effort to minimize and/or eliminate harm.  It begins with the attitudes and behaviors toward patient safety that are consistently conveyed by leaders through their actions, communications, and collaborations and as a result drives the culture of the organization by eliminating unsafe processes and people from the organization. This concept originated out of the high-reliability organization studies in non-healthcare organizations that proactively mitigate the risk of adverse events despite carrying out intrinsically complex and hazardous work. These organizations maintain a commitment and expectation for safety at all levels, from frontline providers to managers and executives.

Are you falling short when it comes to culture of safety?

Some of the areas where healthcare organizations fall short of a culture of safety are:

  • Insufficient support of or complex systems for patient safety event reporting.
  • Failure to provide feedback or response to staff and others who report actual or potential safety issues.
  • Intimidation of staff who report safety events or near-misses.
  • Failure to consistently prioritize and implement safety recommendations.
  • Failure to identify and address staff burnout.
  • Lack of meaningful engagement and support of those who directly provide services.
  • Blaming and assuming surface-level reasons as root causes of incidents rather than focusing on systems.

Does your organization have the components for improving your culture of safety?

Improving the culture of safety within health care is an essential component of preventing or reducing errors and degrees of harm and improving overall healthcare quality. In order to develop a culture of safety there needs to be:

  • Acknowledgment of the high-risk nature of an organization's activities and the determination to achieve consistently safe operations.
  • A blame-free environment where individuals feel comfortable reporting errors or near misses without fear of reprimand or punishment.
  • Encouragement of collaboration across ranks and disciplines to seek solutions to patient safety problems.
  • Organizational commitment of resources to address safety concerns.
  • Recognition that staff involvement/engagement is essential when designing and evaluating systems and defer to their expertise.

What can leaders do to support a culture of safety?

Leaders have an invaluable opportunity to shape the safety and quality of care within their organization through their actions in creating and supporting thriving culture of safety. For instance:

  • Leaders need to demonstrate commitment to safety in their decisions and behaviors. They need to communicate their support for a culture of safety and model the expected behaviors. This includes demonstrating zero-tolerance for behaviors that undermine that culture.
  • Leaders need to ensure decisions that support or affect safety are systematic, rigorous, and thorough.
  • Leaders need to demonstrate trust and respect throughout the organization. They need to develop and enforce a code of conduct that defines appropriate behavior to support a culture of safety and unacceptable behavior that can undermine it.
  • Leaders need to provide opportunities to learn methods that ensure safety initiatives are sought out and implemented. They need to apply a fair and consistent approach to evaluate the actions of staff involved in patient safety incidents.
  • Leaders need to ensure that issues potentially impacting safety are promptly identified, fully evaluated, and promptly addressed and corrected commensurate with their significance.  They need to support event reporting of near misses, unsafe conditions, and adverse events as well as identify and address organizational barriers to event reporting.
  • Leaders need to ensure that a safety-conscious work environment is maintained where personnel feel free to raise safety concerns without fear of intimidation, harassment, discrimination, or retaliation. They need to create an environment in which people can speak up about errors without fear of punishment and use the information to identify the system flaws that contribute to mistakes.
  • Leaders need to ensure that the process of planning and controlling work activities is implemented so that safety is maintained. They need to promote collaboration across disciplines and service lines to seek solutions to identified safety problems.
  • Leaders need to cultivate an organization-wide willingness to examine system weaknesses and use the findings to improve care delivery.
  • Leaders need to periodically assess the safety culture of an organization to identify gaps, track changes and improvements over time.
  • Leaders need to recognize those reporting safety issues and share with the organization the improvements made due to the reporting of safety issues (i.e.: infection rates, turnover, reduced medication errors, readmissions, decreased mortality, etc.). This can be done at huddles, during walkarounds, team safety meetings or whatever means of communication the organization decides to utilize. Reporting of near-misses should be celebrated within the organization.

In summary, a culture of safety is made up of the following three key elements:

  • A just culture where people are encouraged, even rewarded, for providing essential safety-related information with clear lines drawn between human error and at risk or reckless behaviors.
  • A reporting culture where people report their errors and near-misses.
  • A learning culture where there is willingness and the competence to draw the right conclusions from safety information systems, and the will to implement major reforms when their need is indicated.

In Summary:

Leaders must work at keeping their finger on the pulse of the culture of safety within their organization. This includes periodically, (1) reviewing the safety processes that the organization has in place and taking the time to evaluate if they are working or need focused attention, (2) repeating your organizational assessment of safety culture every 18 to 24 months provides data and information to assist in the review  of progress and sustainment of  improvement, (3) ensuring that the assessment drills down to unit/department levels and making these assessments both part of strategic measures reported to the Board and the operational goals of each unit/department.  By implementing these various proven strategies, leaders can build and sustain a culture of safety in which patients receive great care and staff can thrive.


  • Culture of Safety, AHRQ-PSNet, 9/7/2019.
  • Culture of Safety - An Overview, ECRI, 10/28/2019.
  • The essential role of leadership in developing a safety culture, Sentinel Event Alert, The Joint Commission, Issue 57, updated June 18, 2021.   

To learn more about Culture of Safety and/or Leadership training and programs contact the C&A team at 704-573-4535 or email us at

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