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Assessing safety culture
Assessing safety culture: guidelines and recommendations
  1. P Pronovost,
  2. B Sexton
  1. Department of Anaesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, MD, USA
  1. Correspondence to:
 Associate Professor P J Pronovost
 Department of Anaesthesiology and Critical Care Medicine, The Johns Hopkins University, 600 North Wolfe Street, Meyer 295, Baltimore, MD 21287, USA;

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A step nearer to the reliable measurement of safety culture

“The journey of a thousand miles begins with one step.” Latsu

Safety culture is increasingly recognized as an important strategy—and perhaps a necessary precursor—to improving the widespread deficits in patient safety. The Joint Commission for Accreditation of Healthcare Organizations (JCAHO) included an annual assessment of safety culture in its 2007 patient safety goals. The Institute of Medicine (IOM) report “To Err is Human” spurred healthcare organizations to implement initiatives that improve patient safety.1

Despite this, culture is defined and measured in various ways. Definitions of culture commonly refer to values, attitudes, norms, beliefs, practices, policies, and behaviors of personnel. In essence, culture is “the way we do things around here”, whereby the word “here” refers not to the hospital, but rather to a particular work unit. In a safe culture employees are guided by an organization-wide commitment to safety in which each member upholds their own safety norms and those of their co-workers. A number of tools are available to measure safety culture, but each instrument has unique domains of culture, limited validity and reliability data, and average response rates that vary from poor (29%) to excellent (83%). The science of measuring safety culture is evolving, even as the demand for rigorous cultural assessment intensifies.


Many organizations have embarked on efforts to measure safety culture. It is not uncommon for senior leaders in these hospitals to use culture survey scores as a system level measure of patient safety to hold managers accountable, often with the use of bonuses. Although these efforts are laudable, the enthusiasm for measuring culture may be outpacing the science. Due perhaps to the nascent nature of cultural assessment in health care, culture researchers lack consensus and clarity about domains important in a culture …

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