RT Journal Article SR Electronic T1 Patient safety culture in primary care: developing a theoretical framework for practical use JF Quality and Safety in Health Care JO Qual Saf Health Care FD BMJ Publishing Group Ltd SP 313 OP 320 DO 10.1136/qshc.2006.018366 VO 16 IS 4 A1 Kirk, Susan A1 Parker, Dianne A1 Claridge, Tanya A1 Esmail, Aneez A1 Marshall, Martin YR 2007 UL http://qualitysafety.bmj.com/content/16/4/313.abstract AB 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.