Safety culture

What we observe, measure and experience is defined as the culture of a workplace. Culture is the way we think — our values, our attitudes, our perceptions and our beliefs. It is also how we act — our habits and our typical behaviours – and is often referred to 'how we do things around here'.

In practice, culture represents the way that people within the organisation behave towards each other e.g. how they engage with one another and with patients; the care taken place when performing tasks, the adherence to guidelines and protocols.

Healthcare Safety Culture Framework

A resilient and reliable Healthcare Safety Culture is one where safety is everyone’s responsibility and compassionate behaviours are evident at all levels of the system.

The purpose of this framework is to promote a shared mental model of the interconnected components of Healthcare Safety Culture and highlight the importance of compassionate leadership as an enabler.

This framework will support and connect the work we do across NSW Health to promote a psychologically safe work environment for our staff and improved outcomes and experiences for patients, families and carers.

The components of the Safety Culture framework

Restorative: We aim to repair trust and build relationships that may be damaged when errors occur. We support all parties to discuss how they have been affected and decide collaboratively on actions to repair the harm and improve the system for safer care

Just: People are always treated fairly and without blame, including when errors occur

Learning: We learn from what is working well. We also learn from what goes wrong and continuously make appropriate improvements

High trust: High trust relationships form the foundation for openness, learning, and reporting to occur in a psychologically safe environment

Reporting: People feel safe to report safety and quality problems with the confidence they will be heard and considered

Adaptive: Managers, teams and individuals respond to and adapt appropriately to changing conditions, particularly after an incident or error

Informed: We collect, analyse, and learn about our performance and impact from a range of data and use this to inform best practice in a timely manner

Why do we talk about Compassionate Leadership in a safety culture framework?

Compassionate leadership is respectful, inclusive and distributed across the whole care system, from patients, clinical and support staff, to management and boards. We all play a part in leading with compassion by focusing on relationships through listening to, understanding, empathising with, and supporting people to feel respected and valued, so that we can all realise our full potential. Compassionate leadership behaviours enable a safety culture.

Safety culture measurement

Safety culture is a reliable predictor of clinical safety behaviours and patient safety outcomes.

The CEC's position on safety culture is that it is best measured at the team-level through a mixed method approach and is always wrapped in a structured and supported improvement framework. A safety culture measurement enables wards, departments, facilities and organisations understand and improve their culture of care.

The following guidance has been developed to assist teams and organisations in undertaking a valid and reliable safety culture measurement and to provide resources to report and interpret the results. We have outlined what is required to undertake the culture survey in four stages.

Safety culture measurement and accreditation

The importance of measuring safety culture for quality improvement is articulated in the Australian Commission for Safety and Quality in Healthcare National Safety Clinical Governance Standard, Action 1.1 Governance, leadership and culture. Engaging in a safety culture measurement process will demonstrate commitment to safety and quality improvement as well as provide evidence to support accreditation.

If you have any comments or feedback please contact CEC-CapabilityAndCulture@health.nsw.gov.au.