• patient safety
• culture of safety
• leadership
• change management

Where once poor patient safety was deemed to be the result of individuals and technical inadequacy, ways of improving safety increasingly focus on the interaction of technology, human resources and organisations, together with the value systems or culture which lie behind them.¹ In this issue of QSHC Pronovost et al² describe the development of a scale from a tool which looked at cockpit management attitudes, with questions focusing very much on the leader’s role in the enhancement of a safety culture. They found that staff saw their supervisors as having a greater commitment to safety than the more senior leaders.

Their emphasis on views of leadership—including management—is important. Leadership …