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Patient safety culture in primary care: developing a theoretical framework for practical use
  1. Susan Kirk1,
  2. Dianne Parker2,
  3. Tanya Claridge2,
  4. Aneez Esmail3,
  5. Martin Marshall4
  1. 1School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
  2. 2School of Psychological Sciences, University of Manchester, Manchester, UK
  3. 3Division of Primary Care, University of Manchester, Manchester, UK
  4. 4National Primary Care Research and Development Centre, University of Manchester, Manchester, UK
  1. Correspondence to:
 Dr Susan Kirk
 School of Nursing, Midwifery and Social Work, University of Manchester, Coupland 3, Oxford Road, Manchester M13 9PL, UK; Sue.Kirk{at}


Objective: Great importance has been attached to a culture of safe practice in healthcare organisations, but it has proved difficult to engage frontline staff with this complex concept. The present study aimed to develop and test a framework for making the concept of safety culture meaningful and accessible to managers and frontline staff, and facilitating discussion of ways to improve team/organisational safety culture.

Setting: Eight primary care trusts and a sample of their associated general practices in north west England.

Methods: In phase 1 a comprehensive review of the literature and a postal survey of experts helped identify the key dimensions of safety culture in primary care. Semistructured interviews with 30 clinicians and managers explored the application of these dimensions to an established theory of organisational maturity. In phase 2 the face validity and utility of the framework was assessed in 33 interviews and 14 focus groups.

Results: Nine dimensions were identified through which safety culture is expressed in primary care organisations. Organisational descriptions were developed for how these dimensions might be characterised at five levels of organisational maturity. The resulting framework conceptualises patient safety culture as multidimensional and dynamic, and seems to have a high level of face validity and utility within primary care. It aids clinicians’ and managers’ understanding of the concept of safety culture and promotes discussion within teams about their safety culture maturity.

Conclusions: The framework moves the agenda on from rhetoric about the importance of safety culture to a way of understanding why and how the shared values of staff working within a healthcare organisation may be operationalised to create a safe environment for patient care.

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  • Funding for the study was provided by the National Primary Care Research and Development Centre, which is funded by the UK Department of Health.

  • Competing interests: None.

  • The views expressed in this paper are those of the authors and not those of the Department of Health.