Establishing a culture of safety.

• TeamStepps: http://teamstepps.ahrq.gov. • Comprehensive Unit-Based Safety Program (CUSP): http://www.ahrq.gov/qual/cusp.htm. • Center for Innovation in Quality Patient Care: http://www.hopkinsmedicine.org/innovation_quality _patient_care. • Improving Patient and Worker Safety–Opportunities for Synergy, Collaboration and Innovation: http://www .jointcommission.org/improving_Patient_Worker_Safety. • The Australian Commission on Safety and Quality in Health Care, http://www.safetyandquality.gov.au. Patient safety has taken an increasingly prominent place in the acute and critical care environments in the past 10 years, culminating in efforts to establish a culture of safety in every facility. In 2002, The Joint Commission announced the first set of National Patient Safety Goals that required each organization to review policies, procedures, and processes embedded within the culture to ensure compliance with the goals. Today, quality improvement efforts permeate individual critical care and acute care units. Patient safety experts emphasize that improved patient outcomes can only be sustained if a culture of safety is present throughout all levels of a health care organization. Chaboyer and colleagues examined attitudes about safety among various disciplines in Australian intensive care units. There were variations in the responses among bedside nurses, nurse leaders, and physicians, but all the responding units indicated that the key areas needing improvement were communication and teamwork, staffing, education and training, and physical resources. The results from this study are similar to studies conducted in health care organizations in the United States.