Though long a subject of scholarly interest outside of healthcare,1 ,2 attention to safety climate within healthcare began in earnest following the report by the Institute of Medicine: To Err is Human. Accomplishments of the growing body of literature on safety climate in healthcare include developing and validating a number of comprehensive measures of safety climate3–5; linking safety climate to a wide range of patient outcomes, such as patient safety indicators,6 ,7 rates of hospital readmission,8 and medication and other errors9 ,10; and identifying leader and organisational practices that influence safety climate, such as Leadership WalkRounds11 and multifaceted interventions.12 This body of research has also impacted practice. For example, bolstered by a Joint Commission accreditation requirement, most hospitals now participate in regular efforts to survey and benchmark their safety climate.13

The two papers on safety climate in this issue represent additional contributions to this literature.14 ,15 At the same time, they provide an opportunity to reflect on the nature of safety climate research, what scholars have already accomplished, and what additional research is needed now, in light of the chasm yet to be crossed.16 ,17 In this commentary, we describe what we see as the key contributions of these papers and use them as an occasion to take stock of the state of safety climate research. We then identify lingering conceptual and empirical challenges and suggest several strategies for resolving them and advancing the field.

The review of safety climate interventions by Morello and colleagues14 highlights that present enthusiasm for interventions outstrips the evidence supporting them. These authors found minimal effects from the interventions they studied. Moreover, very few studies examined interventions in comparison with a control group. These findings highlight …