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Measuring and improving patient safety culture: still a long way to go
  1. P L Trbovich1,2,3,
  2. M Griffin1
  1. 1 HumanEra, Techna Institute, University Health Network, Toronto, Ontario, Canada
  2. 2 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  3. 3 Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr P L Trbovich, HumanEra, Techna Institute, University Health Network, R. Fraser Elliott Bldg, 4th Floor, 190 Elizabeth Street, Toronto, Ontario, Canada M5G 2C4; patricia.trbovich{at}

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Patrick Waterson. Published by Ashgate Publishing Ltd. 2014. ISBN: 978-1-4094-4814-3

Patient safety culture (PSC) has become a hot topic within the healthcare safety community. PSC papers now appear by the hundreds; hospitals across the USA and Canada are mandated to survey culture; and numerous translations and validations in other countries have occurred. However, it is important to consider whether we are really gaining anything from all this surveying. PSC surveys have been compared with ‘describing the water to a drowning man’.1 That is, although PSC surveys are instrumental in helping organisations to identify opportunities to improve safety, they typically do not inform solutions. Plus, sometimes it does feel like we are drowning in PSC surveys.

PSC: Theory, Methods and Applications, edited by Patrick Waterson, examines the field of PSC and highlights the pervasive use of surveys and questionnaires in the current landscape. In contrast to other high-risk industries, healthcare researchers and practitioners seem to have embraced only a small subset of methods that could be used to measure PSC. PSC is commonly defined according to the following nuclear industry definition: “The safety culture of an organisation is the product of individual and group values, attitudes, perceptions, competencies, and patterns of behaviour that determine the commitment to, and the style and proficiency of, an organisation's health and safety management”.2 Using this definition, which describes values, attitudes and perceptions, and competencies and patterns of behaviour, it appears the healthcare industry has only focused on measuring the first half of the definition (ie, values, attitudes and perceptions) but has neglected measurement of the second half (ie, competencies and patterns of behaviour).

PSC surveys and questionnaires have been invaluable for subjectively measuring and raising awareness about PSC. However, it seems we are missing an important opportunity to objectively measure competencies and patterns of behaviour that determine PSC in healthcare. Competencies and …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.