Healthcare Safety Culture RESOURCES

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The leadership practices described on this page closely align with established government frameworks for safety culture, including OSHA’s Safety and Health Management System (SHMS) and AHRQ’s Patient Safety Culture dimensions. These same practices also reflect continuous improvement principles, reinforcing that safety culture is not a one-time initiative but an ongoing, learning-driven system. 

This alignment demonstrates that effective safety culture principles are consistent across both worker safety and patient safety and are strengthened through steady, incremental improvement.

Leadership commitment and visibility form the foundation of a strong safety culture. When executives consistently prioritize safety, engage directly with staff, and follow up on identified risks, they model the behaviors that sustain improvement over time. This supports OSHA’s Management Leadership element and reinforces AHRQ’s emphasis on Leadership Support for Patient Safety, while creating the conditions for continuous learning rather than episodic compliance.

Clear safety roles and accountability further support improvement by ensuring ownership at every level of the organization. When leaders and managers understand their responsibilities for identifying and reducing risk, organizations move from reactive responses toward structured problem-solving and prevention, aligning with AHRQ’s Supervisor and Manager Expectations.

Integrating safety into organizational strategy reflects OSHA’s Worker Participation and AHRQ’s Organizational Learning dimensions. Organizations with mature safety cultures align safety goals with strategic priorities and operational decisions, enabling teams to continuously identify opportunities to reduce risk and improve reliability.

Open hazard and near-miss reporting is essential to learning. Encouraging transparent reporting without fear of retaliation supports OSHA’s Hazard Identification and Assessment element and AHRQ’s Communication Openness. High-performing organizations treat reports as inputs for improvement, using them to identify trends, test countermeasures, and prevent harm before it occurs.

Incident review and organizational learning connect directly to OSHA’s Hazard Prevention and Control and AHRQ’s Continuous Improvement principles. Rather than focusing solely on individual errors, effective organizations examine systems and processes, apply root-cause thinking, and track corrective actions to ensure improvements are sustained.

Workforce engagement and teamwork are central to continuous improvement. Actively involving frontline staff in identifying risks and suggesting improvements aligns with OSHA’s Worker Participation and AHRQ’s emphasis on Teamwork Within Units. Training and competency development further reinforce safety culture by supporting OSHA’s Education and Training element and strengthening AHRQ’s Overall Perceptions of Safety.

Ongoing measurement and review support learning cycles and accountability. Regular leadership review of both leading and lagging safety indicators aligns with OSHA’s Program Evaluation and Improvement and AHRQ’s Management Support for Patient Safety, helping organizations adjust, refine, and improve over time.

This scored safety culture maturity model enables executive leaders and boards to assess the organization’s current safety culture and understand how effectively continuous improvement principles are embedded in daily operations.

Each leadership practice should be evaluated based on consistency and sustainability. A score of one point indicates the practice is not consistently in place, two points indicates partial or inconsistent implementation, and three points indicates the practice is fully implemented and routinely reinforced. Total scores help identify the organization’s overall maturity level and guide improvement priorities.

At the Basic (Reactive) level, safety efforts are driven primarily by regulatory compliance and response to incidents. Improvement activities are often isolated and event-driven, with limited executive visibility into frontline risk. Reporting typically occurs after harm, safety discussions are infrequent at leadership meetings, leading indicators are limited, and corrective actions are reactive. Leadership focus at this stage should be on establishing clear ownership of safety, improving reporting transparency, and beginning regular review of safety performance.

At the Developing (Proactive) level, leadership actively supports safety initiatives and reporting of hazards and near misses increases. Data is used to identify patterns and prevent harm, and improvement efforts become more structured. Safety metrics appear on executive dashboards, leaders participate in safety rounds or event reviews, and corrective actions are tracked and shared. Leadership focus shifts toward strengthening learning systems, engaging frontline staff in problem-solving, and expanding the use of leading indicators.

At the Advanced (Generative) level, safety is fully embedded into organizational strategy and daily decision-making. Continuous improvement is routine, trust is high, and reporting is viewed as a tool for learning rather than blame. Safety performance informs strategic priorities, frontline teams actively lead improvement efforts, and culture assessments demonstrate strong perceptions of safety. Leadership focus at this stage is on sustaining gains, benchmarking performance, and continuously refining systems to reduce risk and improve reliability.