How to Measure and Sustain a Safety Culture

February 12, 2021
How safe is your culture?
  • Does your organization place harm event reports in personnel files or mention them in performance evaluations?
  • Does your organization blame care team members who “make an error” and cause harm?
  • Does your organization discourage harm event reporting by never providing feedback to team members who report an event?

The answer to these questions can indicate whether you have a safe or an unsafe culture.

Safe culture

The culture of an organization consists of the shared beliefs and values established and communicated by leaders that guide employee behavior and accountability. Culture is often described as what happens in an organization when no one is looking.

How to assess and measure your culture

In order to know where your culture is on the safety spectrum, you first have to assess and measure it. “We recommend assessing your existing culture every year or two using tools such as AHRQ’s Surveys on Patient Safety Culture and Safety Attitudes Questionnaire, or by using questions from your employee engagement survey,” says Kristi Eldredge, Senior Risk Consultant for Constellation®. “To encourage forthcoming, honest input from all team members in all departments, communicate top-level leadership support indicating that retribution for openness will not be tolerated,” Eldredge continues. Setting deadlines and providing regular reminders for team members to complete the safety survey will help ensure a better return of surveys and improve the quality of results. Celebrating the completion of the survey, and reporting the key learnings and opportunities, will encourage team members to continue the journey of improving your culture.

“To encourage forthcoming, honest input from all team members in all departments, communicate top-level leadership support indicating that retribution for openness will not be tolerated.”

Kristi Eldredge, Senior Risk Consultant at Constellation
Sustaining a safety culture

To sustain a safe culture, ensure that your policies and procedures support your cultural mission, such as policies around event reporting, chain of command, disruptive behavior, or non-retaliation. Providing regular education for all team members on culture initiatives keeps the initiatives fresh and top of mind.  We recommend implementing unit-based safety huddles where team members commit to a quick daily meeting to check in and share information about patient safety. Be sure to enlist your human resources personnel in supporting your cultural initiatives with training for leaders on coaching or standardized discipline for mistakes. Encouraging early and transparent reporting of harm events, errors, mistakes and near-misses with no fear of retribution is key to sustaining your safety culture.

Doing better after a harm event: 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 includes 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) patient communication, and (4) moving forward. Sign in to to access the HEAL Prepare Toolkit found in Risk Resources.

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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