Patient safety culture measurement and improvement: a "how to" guide.

is widely accepted that the desired improvements in patient safety require a change in the culture within healthcare (CPSI 2004; IOM 2000; NPSA 2004). The Institute of Medicine (IOM) report “To Err Is Human” concluded that “the status quo is no longer acceptable ... Health care organizations must develop a culture of safety” (IOM 2000: 14). In the UK, building a safety culture is the first step of the National Patient Safety Agency’s (NPSA) seven-step guide to improving patient safety. In Canada, safety culture is one of the Canadian Council on Health Services Accreditation’s (CCHSA) five patient safety goals and required organizational practices. It is therefore important that senior administrators and clinical managers have a sound understanding of safety culture, so that they can make informed decisions about improvement strategies. The recognition of the importance of cultural factors is based on research conducted in other high reliability industries such as nuclear power and petrochemical processing. The investigation into the Chernobyl disaster concluded that a poor safety culture at the facility was a significant causal factor. The Advisory Committee on the Safety of Nuclear Installations produced the most widely accepted definition of safety culture.