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How Can Safety Culture Be Improved?

The culture that exists at your workplace didn’t sprout overnight. It’s a combination of myriad factors, from the attitudes of leadership to the style of local management, that have built up over the years. So as you look to build a culture of safety, it’s wise to remind yourself that progress takes time and that the journey never really ends.

Still, we at the Center for Innovation have demonstrated that, with the right interventions, culture truly can be improved. Below are several steps that we recommend you consider. We can assist you in many of these steps:

Show Leadership’s Commitment and Encourage Accountability

Your organization’s leaders, including CEOs and trustees, must show that they are dedicated to patient safety. They also have the power to keep the organization focused on safety. They can do this by creating strategic safety goals, making safety issues a standing agenda item at meetings, and discussing safety issues with transparency in organization wide and unit/department-wide meetings. Accountability increases when upper- and mid-level managers know that top leaders are interested in safety and are following trends in adverse events.

Create a Patient Safety Program

A formal safety program can help establish an institutional agenda for safety, oversee organization-wide culture assessment surveys, monitor and triage adverse event reports, and provide training opportunities for employees. Components of these programs may include the appointment of a patient safety director, the formation of a patient safety committee with representatives from many disciplines and levels, and the appointment of department-based safety officers.

Identify and Mitigate Harm

Reports of adverse events can provide valuable insights to your organization’s vulnerabilities. Adopting an electronic event-reporting system that is easy to use is the first step, but organizations also need a structure to triage and analyze those events, and then use their findings to improve care.

Communicate Adverse Events

Newsletter articles, meeting presentations and other communications about sentinel events can help convey to your organization that it welcomes honest discussion about its vulnerabilities. By acknowledging that many medical errors are typically the result of broken systems rather than incompetent caregivers, you also help to combat the culture of “blame and shame” that prevents constructive ideas about how to improve care.

Adopt CUSP: Comprehensive Unit-Based Safety Program

Mine the wisdom of frontline caregivers by adopting CUSP, a five-step program that seeks to improve safety through culture-change. The CUSP framework was used in world-renowned campaign to reduce catheter-related bloodstream infections and deaths across Michigan.

Pass a Code of Conduct

Civility and respect for colleagues—regardless of their role or place in your organization’s hierarchy—is at the core of patient safety. Caregivers must feel welcome to speak up if they have concerns about a patient’s care. A code of conduct or similar policy can spell out the expectations for behavior and lay out the consequences for those who violate it.

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Success Story

Success StoryTwo Hopkins teams devise ways to block the interruptions that can lead to medical errors. Read the story.


We've Changed Our Name

The Center for Innovation is now part of the new Armstrong Institute for Patient Safety and Quality. Learn more about the institute.


Please review training opportunities at the Armstrong Institute for a listing of upcoming workshops and online programs.

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