The Relationship Between Patient Safety Culture and Patient Outcomes: A Systematic Review

J Patient Saf. 2015 Sep;11(3):135-42. doi: 10.1097/PTS.0000000000000058.


Context: In the past 13 years since the Institute of Medicine report, To Err is Human, was published, considerable attention was placed on the relationship between patient safety culture and patient outcomes. Research to understand this relationship has been conducted; however, now, it is important to systematically review these studies to determine if there are tools, levels of measure and outcomes that have been shown to result in significant correlations.

Objective: The purpose of this review is to evaluate the state of research connecting patient safety culture and patient outcomes to determine nurse-sensitive patient outcomes that have been significantly correlated to culture of safety and commonly used tools to measure culture of safety in the studies with significant correlations.

Data sources: Published English only research articles were considered for the review. Only studies that directly measured patient outcomes in relationship to patient safety culture in hospitals involving registered nurses as a participant were included.

Results: Evidence of relationships between patient safety culture and patient outcomes exist at the hospital and nursing unit level of analysis; however, the number of studies finding statistically significant correlations particularly using nurse-sensitive outcomes is limited.

Conclusions: The findings from this review suggest that there are emerging trends indicating that the specific patient safety culture measurement tools, the level of analysis, and selection of outcome measures are important considerations in study design. More research is needed to determine interventions that improve patient safety culture and outcomes.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • England
  • Humans
  • Organizational Culture*
  • Patient Outcome Assessment*
  • Patient Safety / standards*
  • Practice Patterns, Nurses'
  • Safety Management / standards*
  • Safety Management / trends