The term was first used in 1988 after the Chernobyl nuclear power plant disaster. The aviation and the oil and gas industries use ways to shape a positive safety culture and track it (1).
But while the risk of preventable harm is high, healthcare has yet to develop similar methods.
Some healthcare organisations use survey tools, such as the Manchester Patient Safety Framework, to gather feedback about how staff see "things are done around here".
We have a clearer idea of the behaviours, systems and competencies associated with proactive safety cultures (2).
A change in culture is not a necessary precursor for changes in outcomes. But it can determine the success and sustainability of patient safety initiatives (3).