The Nebraska Center for Rural Health Research

Fundamentally, a safe organization is dependent on the willingness of front-line workers to report their errors and near-misses—organizational practices support a Reporting Culture.

This willingness of workers to report depends on their belief that management will support and reward reporting and that discipline occurs based on risk-taking (Marx)--organizational practices support a Just Culture.

The willingness of workers to report also depends on their belief that authority patterns relax when safety information is exchanged because those with authority respect the knowledge of front-line workers—organizational practices support a Flexible Culture.

Ultimately, the willingness of workers to report depends on their belief that the organization will analyze reported information and then implement appropriate change—organizational practices support a Learning Culture. The interaction of these four components produces an informed, safe organization that is highly reliable. We recognized that the organizational beliefs and practices associated with these components of culture are assessed by the AHRQ Hospital Survey on Patient Safety Culture.

Safety culture within an organization can be changed. Pronovost’s change model summarizes four strategies for leading change within an organization. Those leading a change effort must Engage and Educate about the relevance and content of a proposed practice, Execute change to implement the practice, and then Evaluate whether the change made a difference.