Creating a Culture of Safety

A strong safety culture can help prevent or minimize medical errors, and hospital leaders have been encouraged to take responsibility for assuring patient safety (Institute of Medicine, 2001; Joint Commission on Accreditation of Healthcare Organizations, 2003; National Quality Forum, 2002, 2003). However, leading researchers in the field of patient safety suggest that few chief executives have made safety a top priority or committed substantial resources toward improving safety (Leape & Berwick, 2005). At the same time, much remains to be learned about how hospital leaders can create a strong safety culture (Flin & Yule, 2004).

Drawing on a field study of eight hospitals, we find that strong safety leadership requires six actions: (1) setting and communicating a clear, compelling vision of patient safety; (2) valuing and empowering personnel; (3) engaging actively in the effort to improve patient safety; (4) leading by example; (5) focusing on system issues; and (6) continually searching for improvement opportunities. Our data suggests that substantial variation in these behaviors exists among senior hospital leaders. This research contributes to the safety literature by describing specific mechanisms that senior leaders use to create a strong safety culture, such as sharing patients' experiences related to safety, to personalize the importance of this issue.