Dr. MANAL ELSAYED ABDELAZIZ
B.Sc. Pharm, CPHQ, DTQM, CLSSGB
TeamSTEPPS Master Trainer

PATIENT SAFETY CULTURE
“The safety culture of an organization is the product of
individual and group values, attitudes, perceptions,
competencies, and patterns of behavior that determine
the commitment to, and the style and proficiency of, an
organization’s health and safety management.” Study Group
on Human Factors. Organizing for safety: third report of the ACSNI (Advisory
Committee on the Safety of Nuclear Installations). Sudbury, England: HSE
Books; 1993
Organizations with a positive safety culture are
characterized by communications founded on mutual
trust, by shared perceptions of the importance of safety,
and by confidence in the efficacy of preventive measures.
It’s organization’s personality! The way things are done
around here!

THE PATIENT SAFETY CULTURE
LADDER
PROACTIVE
Safety leadership and values
drive continuous improvement
PREDICTIVE
That is how we do business
round here
PATHOLOGICAL
Who cares as long as
we're not caught
REACTIVE
Safety is important, we do a lot
every time we have an accident
CALCULATIVE
We have systems in place to
manage all hazards
PATHOLOGICAL
Who cares as long as
we're not caught

PATIENT SAFETY CULTURE & PATIENT
SAFETY CLIMATE
 Safety climate relates to the
perceptions held across the
workforce at a given
moment in time, about the
way things are done around
here. It’s measurable.
 Safety culture is the
underlying shared values,
beliefs and habitual working
practices that influence
health and safety
performance, and these
aren’t always apparent.

WHY SHOULD WE MEASURE
PATIENT SAFETY CLIMATE?
Patient safety climate is a robust leading indicator of
health and safety performance. Organization with a
successful health and patient safety record use an
appropriate mix of both leading and lagging indicators.
Patient safety climate consists of a number of
antecedents. These are the elements that contribute
towards a strong patient safety culture.
By understanding the patient safety climate in the
organization, we can build on our strengths, focus on
areas of improvement and in doing so we’ll find that we
have less injuries and near misses, and a workforce
that is competent, motivated and engaged to work
safely

WHY SHOULD WE MEASURE
PATIENT SAFETY CLIMATE?
Adapted from Zohac 2014

ELEMENTS OF SAFETY CULTURE

PATIENT SAFETY CULTURE
ASSESSMENT
Several tools have been developed to measure
patient safety culture within organizations. They
have focused on dimensions of a patient safety
climate, including:
Leadership and management (e.g., Personality and
attitudes),
Teamwork
Communication
Staffing
Attitudes/perceptions about safety, responses to error
Policies, and procedures.

Some of these tools could be used for individual or
team assessment, or to compare organization-wide
perceptions or unit-specific perceptions. Another of
these tools has been used to compare patient
safety cultures among hospitals.
AHRQ's Patient Safety Culture Survey is one of the
most validated surveys to assess the safety
culture. AHRQ provides yearly updated
benchmarking data from the hospital survey
SAFETY CULTURE ASSESSMENT

HOSPITAL SURVEY ON PATIENT SAFETY CULTURE
(HSOPS)

PATIENT SAFETY CULTURE (HSOPS )
DIMENSIONS
42 items assess 12 dimensions of patient safety culture
1. Communication openness
2. Feedback & communication about error
3. Frequency of event reporting
4. Handoffs & transitions
5. Management support for patient safety
6. Nonpunitive response to error
7. Organizational learning--continuous improvement
8. Overall perceptions of patient safety
9. Staffing
10. Supv/mgr expectations & actions promoting patient safety
11. Teamwork across units
12. Teamwork within units
Patient safety “grade” (Excellent to Poor)
Number of events reported in past 12 months

PURPOSE FROM USING AHRQ
COMPARATIVE DATABASE REPORT
1. Comparison—To allow hospitals to compare their
patient safety culture survey results with those of
other hospitals.
2. Assessment and Learning—To provide data to
hospitals to facilitate internal assessment and
learning in the patient safety improvement process.
3. Supplemental Information—To provide
supplemental information to help hospitals identify
their strengths and areas with potential for
improvement in patient safety culture.
4. Trending—To provide data that describe changes
in patient safety culture over time.

IDENTIFICATION OF SURVEY
PARTICIPANTS
• All staff asked to complete the survey should have enough knowledge about your
hospital and its operations to provide informed answers to the survey questions.
Types of Staff
The survey can be completed by all types of hospital staff—from housekeeping and
security to nurses and physicians. However, the survey is best suited for the
following:
 Hospital staff who have direct contact or interaction with patients (clinical staff,
such as nurses, or nonclinical staff, such as unit clerks);
 Hospital staff who may not have direct contact or interaction with patients but
whose work directly affects patient care (e.g., staff in units such as pharmacy,
laboratory/ pathology);
 Hospital-employed physicians or contract physicians who spend most of their work
hours in the hospital (e.g., emergency department physicians, hospitalists,
pathologists); and
 Hospital supervisors, managers, and administrators.

MODIFICATIONS TO THE SURVEY
• Making changes to the survey only when absolutely necessary
because any changes may affect the reliability and validity of
the survey and make comparisons with other hospitals difficult.
• We do not recommend removing items from different
composites across the entire surveys because the hospital’s
composite measure scores will not be comparable with other
hospitals if any items are missing.

TASK TIMELINE FOR PROJECT PLANNING

IMPROVING PATIENT SAFETY CULTURE
Step #2:
Communicate &
Discuss Results
Step #4:
Communicate
Plans &
Deliverables
Step #6 and 7:
Track Progress
& Evaluate
Impact and Share
Step #1:
Understand
Your Results
Step #3:
Create Focused
Action Plans
Step #5:
Implement
Action Plans

EXAMINE CULTURE AT THE UNIT LEVEL
Culture clusters in units
Provide results to each unit
Empower units to identify areas to
improve
Implement patient safety initiatives at
the unit level
Measure improvement at the unit level

KEY SUCCESS FACTORS OF
PATIENT SAFETY
Effective clinical leadership
Psychological safety
Comfort learning from errors
Teamwork behavior
Continuing learning and improvement
Conduct Patient Safety Leadership WalkRounds
Create a Reporting System
Involve Patients in Safety Initiatives
Conduct Safety Briefings