Culture Change Can Be Crucial to Patient Safety
June 1, 2025 4 minutes read
EXECUTIVE SUMMARY
Ensuring patient safety depends on having the right organizational culture. Achieving a culture of patient safety requires an organizational-wide effort.
- The healthcare industry is more resistant than others to safety issues.
- Culture change can be initiated from the top, but it does not have to be.
- Remind senior administration that their decisions can affect the culture.
By Greg Freeman
Risk managers often hear that patient safety initiatives and other improvement efforts must have support from the top if they are to succeed, but the real key is having an organizational culture that facilitates those goals, according to a leader in culture change.
The healthcare industry has worked to improve the culture of safety at hospitals and facilities, but there still is much work to be done, says Thomas R. Krause, PhD, a thought leader focused on decision-making, leadership, and behavior in the creation of positive organizational culture. He has designed culture change interventions in the service of preventing catastrophic events, fatalities, and disasters. He founded Behavioral Science Technology and is chairman of Krause Bell Group in Ojai, CA.
“It’s not like this is all new to people, but the question is why, in spite of all of that work being done for 15 years since the original study on this subject came out, To Err is Human, it just hasn’t improved all that much,” he says. “The job is to figure out how to corral people and get some momentum toward really making a significant improvement.”
The healthcare industry is oddly resistant to a culture that puts safety first, Krause says. Other industries see a single fatality as a huge motivating event, but the healthcare industry does not, he says.
“Even in an organization with 30,000 employees, a small number of fatalities will cause a huge reaction organizationally, going up to the very top of the the organization. But in healthcare, that’s just not the case,” he says. “They’re accustomed to it, and the typical physician knows almost nothing about patient safety.”
Physicians and other clinicians had to be cajoled into adopting good hand hygiene, Krause says, and that reflects the overall lackadaisical attitude toward safety.
“If you ask your family doctor how’s patient safety going at our local hospital, he won’t know what you’re talking about. Literally, he or she will get a funny look on their face and say, ‘What are you talking about?’” he says. “If you say mistakes that kill people in the hospital, or you say it nicer than that, then they’ll say, ‘Oh yeah, yeah, yeah. Like hospital-acquired infections, yeah, yeah. Well, we’re working on that.”
There is a broad understanding in healthcare leadership that culture matters, and it is related to their leadership, Krause says. In the best scenario, top leadership establishes safety as a top priority and encourages that culture throughout the organization, he says.
But Krause says when that does not happen, risk managers still can promote a culture of safety.
“It’s better if it comes from the top, but it doesn’t have to. Organizations can make significant progress by starting in the middle and then going in both directions,” he says. “If you gave leadership a survey and asked about their influence on the culture, and is that part of their responsibility, they’d say yes. But if you then look at the decisions that they make, they miss opportunities to have positive influence left and right.”
They see their role in the culture in the abstract, Krause explains, but they do not act on it in practical ways. When considering any change in operations, leadership will analyze every angle on costs and operational factors but they do not ask how it will affect the organizational culture, he says.
That kind of situation would be an opportunity for a risk manager to step in and remind the top administration about the importance of culture and how it will be affected by the proposed change.
“The risk manager saying, ‘Let’s consider the cultural effect, or the effect of this decision or thing that we’re doing,’ could remind them that that is an important factor also,” Krause says. “That would be great. That would be very beneficial.”
Krause notes that upward communication is a variable that is a very strong predictor of culture. Does information flow up through the organization to the people who make decisions? Upward communication affects perceived organizational support, he explains, which means how people feel about whether they are supported in relation to their objectives.
“If you say to a leader, ‘Let’s improve the culture,’ they’ll say, ‘Sure, but what does that mean?’ You can point them to the variables that predict overall organizational performance, and addressing these variables will improve the culture,” he says. “That’s something that leaders will have a larger appetite for. And you can assess those things with a survey or with interviews.”
A safety culture depends on information flowing up through the organization, Krause explains.
“The people at the bottom know what’s happening. They know that the way this bed is configured, the patient is going to want to get out of it in the middle of the night, and you have a fall risk. That’s a design issue that hasn’t been addressed,” he says. “The nurses know that, but do the people who make the decisions about purchasing that bed know that — what it would take to fix that so that we reduce that risk? That’s upward communication.”
Source
- Thomas R. Krause, PhD, Krause Bell Group, Ojai, CA. Telephone: (888) 859-2661.
Greg Freeman has worked with Relias Media and its predecessor companies since 1989, moving from assistant staff writer to executive editor before becoming a freelance writer. He has been the editor of Healthcare Risk Management since 1992 and provides research and content for other Relias Media products. In addition to his work with Relias Media, Greg provides other freelance writing services and is the author of seven narrative nonfiction books on wartime experiences and other historical events.
Risk managers often hear that patient safety initiatives and other improvement efforts must have support from the top if they are to succeed, but the real key is having an organizational culture that facilitates those goals, according to a leader in culture change.
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