What is patient safety culture? A review of the literature

J Nurs Scholarsh. 2010 Jun;42(2):156-65. doi: 10.1111/j.1547-5069.2009.01330.x.


Purpose: To organize the properties of safety culture addressed by many studies and to develop a conceptual culture of safety model.

Design and methods: A comprehensive review of the culture of safety literature within the U.S. hospital setting. The review was a qualitative meta-analysis from which we generated a conceptual culture of safety framework and developed a typology of the safety culture literature.

Findings: Seven subcultures of patient safety culture were identified: (a) leadership, (b) teamwork, (c) evidence-based, (d) communication, (e) learning, (f) just, and (g) patient-centered.

Conclusions: Safety culture is a complex phenomenon that is not clearly understood by hospital leaders, thus making it difficult to operationalize. We found senior leadership accountability key to an organization-wide culture of safety.

Clinical relevance: Hospital leaders are increasingly pressured by federal, state, regulatory, and consumer groups to demonstrate an organizational safety culture that assures patients are safe from medical error. This article defines a safety culture framework that may support hospital leadership answer the question "what is a patient safety culture?"

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Attitude of Health Personnel
  • Communication
  • Cooperative Behavior
  • Evidence-Based Practice / organization & administration
  • Health Knowledge, Attitudes, Practice
  • Hospital Administration* / methods
  • Humans
  • Leadership
  • Medical Errors / prevention & control*
  • Models, Organizational
  • National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division
  • Organizational Culture
  • Patient-Centered Care / organization & administration*
  • Personnel, Hospital / education
  • Personnel, Hospital / psychology
  • Qualitative Research
  • Safety Management / organization & administration*
  • Systems Analysis
  • United States