Patient safety and human factors: human factors - safety culture

Definition: ‘The safety culture of an organization 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.’ (Advisory Committee on the Safety of Nuclear Installations 1993, p.23).

The use of the term safety culture was first recorded in 1988 after the Chernobyl nuclear power plant disaster (Halligan and Zecevic 2011). It has since been applied by several industries, especially high-reliability organisations (HROs), such as aviation and the oil and gas industry. Both use the term to describe the "acquisition of good attitudes to safety issues and the application of systematic management of the hazards of the business" (Hudson 2003, p.i8).

It is only comparatively recently that this concept has been applied to health care and reviews suggest that there is some confusion about definitions (Sammer et al. 2010;  Halligan and Zecevic 2011). This poses challenges for organisations aspiring to achieve a positive safety culture and organising how they monitor progress (Hudson 2003; Sammer et al. 2010).

Researchers looking at high risk industries have described the distinct stages in the development of a positive safety culture and these are being applied to health care (Hudson 2003). Survey tools such as the Manchester Patient Safety Framework (University of Manchester 2006) are supporting organisations in gathering feedback from staff about their perception of "how things are done around here". We also have a clearer idea of the behaviours, systems and competencies associated with proactive safety cultures (National Patient Safety Agency 2004; Carthey and Clarke 2009).

The current evidence looking at the relationship between safety culture and patient outcomes does not suggest that a change in culture is a necessary precursor for changes in outcomes. It is more likely that here is a "complex interrelationship, with changes to processes and patient outcomes having an impact on the way staff think about patient safety" (Health Foundation 2011, p.18). The relationship is a two way, reciprocal relationship rather one-way causal link (Health Foundation 2011).

For ideas about how to reduce risks to do with safety culture go to our Action on safety culture page.

References

These resources were last accessed on 21 November 2012. Some of them are in PDF format - see how to access PDF files.

Advisory Committee on the Safety of Nuclear Installations (1993) ACSNI study group on human factors. Third report. Organising for safety, London: Health and Safety Executive.

Carthey J and Clarke J (2010) The "how to guide" for implementing human factors in healthcare (PDF 323.4KB), London: Patient Safety First.

Halligan M and Zecevic A (2011) Safety culture in healthcare: a review of concepts, dimensions, measures and progress, BMJ Quality and Safety, 20 (4) April, pp.338-343.

Health Foundation (2011) Research scan: does improving safety culture affect patient outcomes? London: Health Foundation.

Hudson P (2003) Applying the lessons of high risk industries to health care, Quality and Safety in Health Care, 12(suppl 1) December, pp.i7-i12.

National Patient Safety Agency (2004) Seven steps to patient safety, London: NPSA.

Sammer CE et al (2009) What is patient safety culture? A review of the literature, Journal of Nursing Scholarship, 42(2), pp.156-165.

University of Manchester (2006) Manchester Patient Safety Framework (MaPSaF), London: National Patient Safety Agency.