What is Patient Safety Culture? A Review of the Literature

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Abstract

Purpose: To organize the properties of safety culture addressed by many studies and to develop a conceptual culture of safety model.

Design and Methods: A comprehensive review of the culture of safety literature within the U.S. hospital setting. The review was a qualitative metaanalysis from which we generated a conceptual culture of safety framework and developed a typology of the safety culture literature.

Findings: Seven subcultures of patient safety culture were identified: (a) leadership, (b) teamwork, (c) evidence-based, (d) communication, (e) learning, (f) just, and (g) patient-centered.

Conclusions: Safety culture is a complex phenomenon that is not clearly understood by hospital leaders, thus making it difficult to operationalize. We found senior leadership accountability key to an organization-wide culture of safety.

Clinical Relevance: Hospital leaders are increasingly pressured by federal, state, regulatory, and consumer groups to demonstrate an organizational safety culture that assures patients are safe from medical error. This article defines a safety culture framework that may support hospital leadership answer the question "what is a patient safety culture?"

Key words

Hospital safety culture framework, patient safety

A review of the patient safety literature must necessarily begin with the seminal Institute of Medicine (IOM) report To Err Is Human: Building a Safer Health System that found medical errors kill between 44,000 and 98,000 people in U.S. hospitals each year. Using the lower estimate, more people die from medical errors in a year than from highway accidents, breast cancer, or AIDS. The IOM committee recommended that healthcare organizations create an environment in which culture of safety is an explicit organizational goal, becomes a top priority, and is driven by leadership (Kohn, Corrigan, fr Donaldson, 2000). In response to the recommendations of the IOM, healthcare organizations began the process of improving the widespread deficits in patient safety, including a focus on organizational safety culture (Leape, Berwick, & Bates, 2002). This led healthcare leaders to ask "how will we know?" when we have created a culttire of safety within our hospitals (Pronovost et al., 2006). A first step is to define safety culture. We use the Agency for Healthcare Research and Quality (AHRQ) definition from the Health and Safety Commission of Great Britain:

The safety culture of an organization is the product of individual and group...