Teaching the Culture of Safety

Jane Barnsteiner, PhD, RN, FAAN

Disclosures

Online J Issues Nurs. 2011;16(3) 

In This Article

Essential Elements of a Culture of Safety

A safety culture requires strong, committed leadership, along with the engagement and empowerment of all employees. Key elements of a culture of safety in an organization include the establishment of safety as an organizational priority, teamwork, patient involvement, openness/transparency, and accountability (Lamb, Studdert, Bohmer, Berwick, & Brennan, 2003). In addition a safety culture is characterized by shared core values and goals, non-punitive responses to adverse events and errors, and promotion of safety through education and training. A safety culture requires strong, committed leadership, along with the engagement and empowerment of all employees.

Today, in a culture of safety, when an adverse event occurs, the focus is on what went wrong, not who caused the problem. In a culture of safety, a balance is achieved between not blaming individuals for errors and not tolerating egregious behavior. This balance is currently referred to as a 'just culture' (Mitchell, 2008; Yates et al., 2005). In a just culture the focus is on effective teamwork to accomplish the goal of safe, high-quality patient care. Traditionally, a culture of blame has been pervasive in healthcare. The focus has often been on trying to determine who has been at fault so that the offender can be disciplined. This approach has led to the hiding, rather than the reporting of errors; it is the antithesis of a culture of safety. In contrast a patient safety culture should be non-punitive and emphasize accountability, excellence, honesty, integrity, and mutual respect (Association of periOperative Registered Nurses [AORN], 2006). Today, in a culture of safety, when an adverse event occurs, the focus is on what went wrong, not who caused the problem.

A number of tools are available for assessing the healthcare safety culture within an organization. The most widely used is the Culture of Patient Safety Assessment developed by the Agency for Healthcare Research and Quality (AHRQ), (Sorra, Famolaro, Dyer, Nelson, & Khanna, 2008). Table 1 describes some of these tools.

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