Creating a Culture of Safety: Q&A for Healthcare Leaders

As a healthcare leader, how can you foster a culture of safety at your organization? Can investing in a safety culture actually result in organizational change and reduced risk? What specific actions can you take to build and maintain a safety mindset among all team members? Whether you are an emerging leader or an experienced veteran in search of additional ideas, here are answers to commonly asked questions about fostering a culture of safety in healthcare.

What does a “culture of safety” in healthcare entail?

According to The Joint Commission, a safety culture is “the product of individual and group beliefs, values, attitudes, perceptions, competencies, and patterns of behavior that determine the organization’s commitment to quality and patient safety.”

The Agency for Healthcare Research and Quality (AHRQ) goes further in describing a culture of safety as having traits, including:

• 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 are able to report 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

What obstacles do healthcare leaders face when it comes to creating and sustaining a culture of safety?

Leaders may encounter a range of challenges in creating a safety culture, all of which can hinder the ability to address safety concerns effectively.

The Institute of Medicine describes the following as common barriers to creating a culture of safety:  

• Resistance to cultural change
• Hierarchical communications and silos
• Resource constraints, including time, personnel, training, and budget
• Misaligned programs, safety goals, or performance metrics
• Human fallibility
• Technological challenges

How can silos threaten an organization’s culture of safety?

Silos are the bane of any healthcare organization’s culture of safety. Since patient care is often divided between independent entities – patients receive care from their primary care provider, outpatient specialist clinics, hospitals, and, even, family members – it can be difficult to avoid siloed care delivery, which increases the risk of errors.  Some institutions struggle to comply with safety regulations because of the lack of information exchange across these different organizations and practices.

“Serious gaps in care guidelines and processes continue to have an adverse impact on the quality and safety of care, particularly in outpatient settings,” according to researchers of a study published in Population Health Management. “Specifically, poor care coordination processes lead to failures in transmitting critical patient information, adverse drug interactions, conflicting treatment plans, and/or lapses in necessary treatment.”

Even within a single organization, siloes exist across different departments and can be detrimental to safe patient outcomes.  

“Efforts to advance healthcare safety culture, workforce engagement, and inclusion are all too often siloed…Since these areas are historically ‘owned’ and led by different teams and functions—safety, HR, and diversity, equity, and inclusion (DEI), respectively—breaking down the silos between them is essential to achieve positive results,” Dr. Tejal Gandhi, MPH, CPPS, reported for Press Ganey. “For example, dismantling hierarchies, promoting teamwork, and encouraging staff to speak up are all endeavors that nurture these three domains simultaneously.”

Can investing in a culture of safety result in measurable organizational change and reduced risk?

The direct results of investing in a culture of safety may be challenging for busy healthcare leaders to quantify, but the link is clear.

Poor workplace safety culture, such as a culture associated with fear of blame or punishment, can impede systems designed to improve safety and discourage healthcare professionals from effectively reporting incidents.

Hospitals with more positive AHRQ patient safety culture scores have lower rates of in-hospital complications and adverse events/Patient Safety Indicators (PSIs), according to research. One study also found that hospitals with a better overall safety climate had lower incidence rates of AHRQ PSIs. Additionally, data has indicated that frontline workers’ perceptions of a better safety climate predict a reduced risk of experiencing PSIs, but senior managers’ perceptions did not.

Certain safety culture measures, such as teamwork training, leadership walk rounds, and establishing unit-based safety teams, have been associated with improvements in safety culture measurements and have been linked to lower patient harm in some studies, stated data published on AHRQ’s Patient Safety Network.

Strong organizational cultures of workplace safety and patient safety are both essential for advancing safety in healthcare and eliminating harm to both patients and healthcare workers.

How can healthcare leadership assess their organization’s culture of safety?

Leaders can gauge their organization’s safety culture using AHRQ’s Surveys on Patient Safety Culture™ (SOPS®) for hospitals, medical offices, nursing homes, community pharmacies, and ambulatory surgery centers. Another helpful tool is the Safety Attitudes Questionnaire, developed by AHRQ and available for download in long or short form from UTHealth Houston.

When healthcare leadership actively evaluates the safety culture of their organization, they are demonstrating their commitment to prioritizing safety. Because culture is a product of what actions are taken on a consistent daily basis, it requires leaders to regularly and visibly support and promote safety measures in everyday work. Employees value that commitment because it can reduce their workplace anxiety and stress about potential hazards, it gives them the perception that they are more protected, and it can create a more positive and supportive work environment.

What actions can healthcare leaders take to create a culture of safety in their organization?

To build and maintain a strong safety culture throughout the organization, leaders can take these steps, as recommended by The Joint Commission:

1. Foster an open and nonpunitive environment for reporting and learning from adverse events, unsafe conditions, and close calls.
2. Create clear, equitable risk-based procedures for identifying human errors versus system errors.
3. Adopt and model appropriate behaviors and eradicate intimidation.
4. Create, communicate, and enforce policies that support a safety culture and reporting of adverse events, unsafe conditions, and close calls.
5. Acknowledge team members who report adverse events or unsafe conditions or suggest safety improvements.
6. Use tools to establish baseline safety culture measures.
7. Analyze survey results and seek opportunities for improvement.
8. Create unit-based safety improvement initiatives based on survey results.
9. Embed safety culture training into quality improvement projects and processes.
10. Assess systems (i.e., medication management, electronic health records systems) for safety strengths and weaknesses and plan improvements.
11. Repeat safety culture assessments every 18-24 months and strive for continual improvement.

Why is healthcare leadership development important for creating a culture of safety?

Leaders at all levels, from senior executives to clinical managers, must be on the same page regarding building an organization-wide culture of safety. Whether in compliance, HR, operations, or clinical care, all leaders must adhere to the same standards of safety, understand root causes, recognize systemic flaws, and ensure team members feel supported.

For these reasons, organizations must prioritize leadership development. Effective training will empower emerging and existing leaders to build a strong culture of safety among team members throughout the entire organization.

HealthStream’s Leadership Development solution helps healthcare organizations develop rising leaders, build employee trust and confidence, and standardize pathways for emerging and existing leaders. Features include:

• Content backed by industry experts
• Adaptive tool with 200+ self-paced targeted courses
• Leadership Guide with 10 curated course series and 30+ curriculums
• Self-care interventions for risk reduction
• Exclusive Leadership Confidence Survey

Learn more about our Leadership Development Solution.