Join a Twitter Chat

Building a Culture of Safety in Health Care 

Friday, March 16, 2018 | 12 Noon–1:00 PM ET

Use the hashtag #PSAW18 to join the conversation!  Twitter


Estimates suggest that preventable harm in health care is a leading cause of death, disability, and long-term quality-of-life implications.

In advocating for safer care, the patient safety experts at IHI stress the importance of safety culture in health care organizations.1,2 Safety culture can be defined as a culture in which health care professionals are held accountable for unprofessional conduct, yet not punished for human mistakes; errors are identified and mitigated before harm occurs; and systems are in place to enable staff to learn from errors and near misses and prevent recurrence.3

Experts have cited the lack of safety culture as a contributing factor in the risk and occurrence of harm to patients and staff. 4 Yet creating a safety culture remains a huge challenge for many health care organizations. While leaders at the executive level are largely responsible for shaping the vision and tone of an organization, sustaining a lasting safety culture requires commitment to certain values at every level within an organization.2

How can those in health care create a safety culture? How can such a culture thrive? What can patients and families do to influence the culture of the organizations where they receive care? In this Twitter Chat, @TheIHI and other participants will share insights and pose questions to get you thinking.

Topics we will discuss during the chat include:

Trust, respect, and inclusion
A safety culture is one in which staff and clinicians trust the leadership and where everyone practices respect and inclusion throughout the organization without regard to rank, role, or discipline.

T1 What actions and initiatives foster trust, respect, and inclusion in health care? What gets in the way?

Experts often point to health care leaders at the executive level as being the ones who set the tone by which an organizational culture develops. But leaders exist at every level of a health care system, including within the families that are served.2

T2 What innovative leadership strategies have you seen at the executive, unit, or department level to drive safety culture?

Patients, families, and culture
Patient safety research suggests that involving patients and families in all aspects of care results in better processes, improved care, happier patients, and potentially better outcomes. IHI’s framework puts patient engagement at the center.2

T3 What does a culture of safety look like to the patient and family?

Culture as a key to learning
Safety culture and learning systems are interdependent: Organizations need a strong safety culture to be able to learn from deficiencies, but sometimes learning needs to take place to improve the culture. A safety culture is a just culture and recognizes that human error is always possible. Reporting problems in order to learn from them is essential.1,2

T4 How does your organization promote reporting of errors and learning from them?

Burnout and culture
Protecting the physical and psychological safety of the workforce is a fundamental requirement for a culture of safety. Behaviors that help ensure physical and psychological safety include effective teamwork, active communication, just culture, respect, and direct and timely feedback.1

T5 What tools and tactics does your organization use to promote the physical and psychological safety of clinicians and staff?

Bring your questions and share your thoughts with us on March 16.

In the meantime, use our online assessment tool to assess your organization’s safety culture and review these free resources:

Leading a Culture of Safety: A Blueprint for Success. Boston, MA: American College of Healthcare Executives and Institute for Healthcare Improvement; 2017.

A Framework for Safe, Reliable, and Effective Care. Cambridge, MA: Institute for Healthcare Improvement and Safe & Reliable Healthcare; 2017.


  1. American College of Healthcare Executives and IHI/NPSF Lucian Leape Institute. Leading a Culture of Safety: A Blueprint for Success. Boston, MA: American College of Healthcare Executives and Institute for Healthcare Improvement; 2017. Available at:
  2. Frankel A, Haraden C, Federico F, Lenoci-Edwards J. A Framework for Safe, Reliable, and Effective Care. White Paper. Cambridge, MA: Institute for Healthcare Improvement and Safe & Reliable Healthcare; 2017. Available at:
  3. Agency for Healthcare Research and Quality Patient Safety Network. Patient Safety Primer: Culture of Safety. Accessed 28 Feb 2018. Available at
  4. National Patient Safety Foundation. Free from Harm: Accelerating Patient Safety Improvement Fifteen Years after To Err Is Human. Boston, MA: National Patient Safety Foundation; 2015. Available at:

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The Institute for Healthcare Improvement salutes Mallinckrodt Pharmaceuticals for their generous support of this year's Patient Safety Awareness Week.