Skip to content


What is the safety Culture like at YOUR Healthcare Institution?

I recently read several critical analyses of safety cultures, or the lack thereof. Safety doesn’t just happen—it must be created by an organization and starts from the top down. One report discussed the global oil company BP’s oil refinery safety program. In 2005, the Texas City refinery explosion killed 15 people and injured more than 100 others. The analyses question how the British company would change the lack of safety culture at all five of its U.S. refineries. “Culture is forever,” said former U.S. Senator Slade Gorton of Washington, one of the 11 members of the panel led by former Secretary of State James A. Baker III. “To change hearts and minds and … the attitudes individuals have toward their jobs is difficult and a human task, and it’s never complete.”

Another disaster report discussed the January 28, 1986 Space Shuttle Challenger disaster that occurred over the Atlantic Ocean off the coast of Central Florida at 11:39 a.m. EST. Seventy-three seconds into its flight the Space Shuttle Challenger disintegrated after an O-ring seal on its right solid rocket booster failed. When the O-ring failed it allowed flames to leak from the solid rocket booster which shot out and caused structural failure of the external tank. A few seconds later the orbiter was destroyed along with all seven crew members.

Other major accidents that could have been avoided include the disasters at Three Mile Island and Chernobyl. The immediate causes of these accidents were initially identified as human error or technical failure. Further investigations revealed there were issues beyond the immediate causes. These issues relate to wider considerations of the organization.

One investigation report of the Chernobyl nuclear power plant mishap stated: “… their belief in safety was a mirage, their systems inadequate, and operator errors commonplace … From the top to the bottom, the body corporate was infected with the disease of sloppiness.”

Is our belief in healthcare worker safety in our institutions a mirage? The definition of safety culture suggested by the Health and Safety Commission in the United Kingdom is: “The safety culture of an organization is the product of the individual and group values, attitudes, competencies and patterns of behavior that determine the commitment to, and the style and proficiency of, an organization’s health and safety programs. 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 preventative measures.”

What are the patterns of behavior at your facility? Does your institution support a safety culture or suppress it? The death of the seven astronauts aboard the Space Shuttle Columbia on February 1, 2003, was the result of leaders who failed to foster a culture in which discussions about potential risks could take place without any threats of reprimand. Is your institution creating an atmosphere that allows nurses, physicians, operating room technicians, custodians and others to make you aware of safety risks without risking their jobs?

Safety Culture—What Is It?

A safety culture influences the overall attitudes and behavior of an institution. We are all familiar with companies where the leadership and management style help the whole organization focus on the institutional mission and goals. As these goals filter down through all levels of these organizations, work processes are adapted to meet these goals. As these goals are adapted, they become the accepted norms for the workplace.

Employees and management share a commitment to ensure the safety of each other. Organizations that can put together a safety culture will find this value permeates all aspects of the work environment. Everyone is encouraged to take responsibility for their own safety as well is the safety of others.

How is the safety culture at your institution?