5 Ways to Build a Culture of Safety in Healthcare

Patient safety culture refers to how the staff in a facility collectively protect and advocate for the safety and well-being of patients. Establishing a healthy, thriving culture of safety in healthcare settings can be incredibly challenging — even for experienced healthcare leaders — but it’s critical for achieving a high level of care and accountability.

We’ll discuss the importance of patient safety and cover five simple ways to make sure safety is a key component of your facility’s culture. Whether starting from scratch or looking for ways to improve an existing system, we’ve got you covered with research-backed tips.

Culture of Safety: Meaning and Overview

In healthcare, a culture of safety comprises the collective attitudes, beliefs, and behaviors across each level of an institution in the effort to prevent patient harm. There are many key characteristics of organizations that successfully help to promote patient safety. Some of the key factors that create a culture of safety in healthcare include:

• Trust — Patients, staff, and leaders must be able to rely on each other’s abilities and intentions to foster high quality care.

• Accountability — Staff and leaders should take ownership over their actions, even when things don’t go as planned. This facilitates corrective action.

• Identifying unsafe conditions — Targeting the root of potential or existing problems is necessary to begin implementing better safety measures.

• Strengthening systems — Once an issue is identified, it’s crucial to act on it in a timely manner to help improve safety processes and prevent further harm.

• Assessment — Once new initiatives or protocols are put in place, it’s important to continually monitor how they impact patient care and safety.

Why Is a Culture of Safety so Important?

The simple answer is that a commitment to safety prevents patient harm. As many as 400,000 people die every year as a result of hospital-associated preventable harm in the U.S. alone. Error rates are lower in organizations with a robust safety culture. For example, nursing homes with higher safety culture scores have lower risks of resident falls, urinary tract infections, and pressure ulcers.

Building organizational commitment can be a slow process and it may take as long as five years to fully ingrain an optimal standard that establishes a culture of safety. It’s never too early for facilities to work on implementing quality improvement initiatives that can help minimize patient-related harm.

How to Promote a Culture of Safety in Healthcare

Every organization has its own unique strengths and weaknesses to consider when building a culture focused on safety. Once you’ve identified the areas you’d like to work on, use the following ideas to help formulate your plan.

1. Measure and Track Safety Culture Metrics

One of the best — and easiest — ways to start the journey is by conducting a culture of safety survey to assess the current state of the facility. Once you establish a baseline score, compare the results to those of similar facilities to see how your team stacks up. You can continue to follow these metrics annually to identify trends over time and evaluate the effectiveness of your improvement plan.

Tips:

• Use a validated survey, like AHRQ Surveys on Patient Safety Culture (SOPS) or the Safety Attitudes Questionnaire.
• Measure beliefs, norms, and attitudes about safety practices to evaluate culture rather than relying on process measures like patient outcomes and safety metrics.
• When possible, assess culture at unit and facility levels.

2. Launch a Non-Punitive Reporting System

You can set up a reporting system to help identify any gaps in practice related to patient safety. Knowing when and where errors and near misses occur helps the facility address underlying process issues. Establishing a formal process to report errors and adverse events encourages active participation from everyone involved.

One key to success is creating a policy that makes safety incident reporting non-punitive. Staff must feel confident they won’t be blamed or punished for speaking up when mistakes occur. If they think they’ll be reprimanded, or even lose their job, it’s unlikely they’ll use the system, and a culture of fear — rather than safety — will take root.

Effective follow-up on safety reports should focus on the human factors, process errors, and system failures that contributed to the event. Doing so eliminates blame and promotes an open, non-judgmental environment to analyze problems, create solutions, and learn from mistakes.

Tips:

• Make the system confidential or anonymous.
• Incentivize reporting through rewards and positive reinforcement.
• Create a “no retaliation” policy to protect reporters from bullying and intimidation.
• Follow up with reporters privately so they know their concerns were addressed.
• Consider implementing a just culture to distinguish between human errors, at-risk behaviors, and reckless behaviors.

3. Conduct Patient Safety Walking Rounds

The senior organizational leadership team needs to model the same behaviors and attitudes around safety they expect from their team members. One effective way to do this is by performing walking safety rounds on a regular basis, ideally once per week. These walks provide an opportunity to demonstrate leadership involvement and commitment to safety.

Checking in with the team about their safety concerns and listening carefully to suggestions shows you recognize and value their commitment to patient safety. Be sure to ask team members what they’re doing to build a strong culture of safety in healthcare. Effective safety rounds should be two-way conversations to build trust and teamwork.

Tips:

• Let staff know ahead of time when you’ll be rounding.
• Dedicate a full hour to safety walking rounds.
• Acknowledge and thank staff for their suggestions.
• Follow-up on any concerns that are shared with you.

4. Assemble a Unit-Based Safety Team

Many facilities have adopted a shared governance nursing practice model and have established a variety of unit-based councils. Forming a unit-based safety team is an excellent way to engage the unit in decision-making and accountability. These councils are organized and led by staff on the unit with minimal oversight or leadership involvement.

Teams can raise awareness about patient safety and develop unit-based initiatives to address issues, like preventing pressure ulcers or surgical site infections. Unit-based teams share their successes — and challenges — with larger, facility-wide councils, which promotes the adoption of a strong safety culture at the organizational level.

Tips:

• Use unit-based teams to enlist support and participation from the entire unit.
• Empower all staff to take ownership of safety issues.
• Establish a system to stay updated with the team’s work.
• Celebrate every success.

5. Organize Safety Briefings

Safety briefings are a way to encourage communication, transparency, and teamwork. They’re held at the unit or facility levels (many facilities do both) and occur at regularly scheduled intervals, like once per shift or daily when the leadership team is present. Maintaining consistency and prioritizing briefings is essential for making them a routine part of the team’s workflow.

Safety briefings provide a forum to discuss safety events and coordinate a team approach to addressing immediate issues. Typically, they’re brief and less formal than an extensive root cause analysis that the same event might trigger. The primary goal is to alert frontline staff to issues that could affect safe patient care during the upcoming shift.

Tips:

• Hold briefings by phone, video, or in-person huddle, depending on the participants’ needs.
• Schedule safety briefings around shift changes.
• At the unit level, teams should be able to conduct briefings independently, with or without the presence of senior leadership.

Frequently Asked Questions About Safety in Healthcare

Building a culture of safety in healthcare requires a multifaceted understanding of your organization. Below are answers to additional safety FAQs that can inform your process for implementing protective measures.

What values support a culture of safety in healthcare?

Beyond the organizational factors that go into building a culture of safety, it’s also important to promote positive values that will help your efforts come to fruition. According to the Agency for Healthcare Research and Quality (AHRQ), key values that go into promoting safety include:

• Acknowledgment of the high-risk nature of healthcare and commitment to maintaining safe practices
• A blame-free environment where staff of all ranks are able to report errors or near misses without fear of judgment
• Encouragement of interdisciplinary collaboration when formulating solutions to address patient safety problems
• Strong leadership and determination in addressing safety concerns
• Engagement among staff that feel empowered to take action when needed

What are common safety concerns for patients?

Patient harm can occur in a number of ways. It’s important to be aware of common causes and proactively try to prevent them. Examples of medical errors that can be avoided through a robust safety culture include:

• Medication, surgical, and diagnostic errors
• Healthcare associated infections
• Patient misidentification
• Patient falls and pressure ulcers
• Unsafe transfusion or injection practices

What are common safety concerns for healthcare workers?

Beyond patient safety, it’s also crucial to protect your staff. Healthcare workers can also be subject to harm on the job, and taking the following safety concerns into account can help you build a more comprehensive culture of safety:

• Stress and burnout
• Workplace violence
• Chemical/drug exposure
• Infectious disease exposure
• Needle stick injuries
• Back and muscle injuries

Through identifying and minimizing worker-related situations that are high risk, staff members can be better trained and protected by their leaders.

Looking for More Ways to Create a Culture of Safety?

Now that you have some useful suggestions for building a culture of safety in healthcare, you might be interested in learning more. We’re here to help — the IntelyCare newsletter is full of free healthcare facility tips, news, and strategies, shared right to your inbox.