Five Steps Leaders Can Take Now to Improve Organizational Culture

February 5, 2021
How safe is your culture?

A labor and delivery nurse did not communicate a persistent non-reassuring fetal heart rate pattern to the on-call obstetrician (OB) because he yelled at her for calling him in the middle of the night several hours earlier. She did not follow the chain of command policy because nothing happened to the OB the last time someone reported his disruptive behavior. The baby was born the next day with severe neurological injuries because of a delay in delivery.

A surgeon closed a patient despite the OR team telling him that the sponge count was incorrect. He told them that “they didn’t know how to count.” Six weeks later, the patient had to be taken back to the OR because of symptoms of abdominal pain and infection. A surgical sponge was found eroding into the bowel. The patient went through multiple surgeries to treat the infection and had a prolonged recovery.

A man who resided in a senior living community died after falling out of a lift sling when a care team member transferred him from his wheelchair to his bed without assistance despite his care plan and organizational policy. She testified that she was unable to find someone to assist her and that they were frequently told by administrators to “just get the work done.”

Why it matters

These malpractice claims are all examples of organizations with unsafe cultures. When an unsafe situation exists or a harm event occurs, organizational culture can determine whether a care team member feels safe admitting a mistake or speaking up in that moment. Leadership sets and models expected behaviors that reduce harm events and mitigate the degree of harm when events do occur.

Do your leaders actively show commitment to creating and sustaining a safe culture?

Safe culture models

There are many recognized cultural models in health care, but the most common are referred to as a “safety culture” or a “just culture.” A safety culture is a commitment to reducing harm events starting with the mission, vision and values at the top of the organization. The shared mission then filters down to individual and team beliefs, values and attitudes, which then shape actions and behaviors. A just culture framework focuses on beliefs, values and attitudes when a harm event occurs, and the actions taken in response. A just culture ensures a balance of accountability on the individual alongside accountability on the organization, systems, and processes that enhance safety. Both models take commitment but can reduce the risk of harm events and minimize the harm when events occur.

“To improve culture and prevent future mistakes leaders should dispel two myths. The perfection myth—if people try hard enough, they will not make any errors and the punishment myth—if we punish people when they make errors, they will make fewer of them.”

Betty VanWoert, Senior Risk Consultant at Constellation
Doing better going forward: The HEAL® Prepare Toolkit

Our HEAL® Prepare Toolkit helps your organization prepare for harm events so you can respond quickly and effectively. The Toolkit includes a unit on culture and contains assessments, best practices, sample tools and coaching.

Start your journey by taking the HEAL Assessment and then the Action Plan will guide you through the Toolkit’s four units: (1) culture, (2) event response, (3) communicating after harm events, and (4) moving forward. Sign in to to access the HEAL Prepare Toolkit found in Risk Resources.

Five steps leaders can take now to improve organizational culture
  1. Reserve agenda time in leadership meetings to review indicators of culture such as team member satisfaction scores, employee turnover rates, patient/resident experience scores and event reporting data.
  2. Conduct executive walk-arounds where leaders connect informally with front-line teams about safety issues.
  3. Share safety stories (including adverse events and near misses) during administrative, board and department team meetings.
  4. Encourage front-line team members to report risk and safety concerns by celebrating “speaking up” and incorporating accountability without fear of retribution.
  5. Ensure human resource policies are aligned with culture initiatives, such as using a standard framework to evaluate errors and promote accountability.

Constellation’s HEAL program provides healing benefits for care teams and their organizations because we truly believe that what’s good for care teams is good for business.


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