mitment is needed from all organizational leaders—governing boards and clinical leaders as well as management.

Words alone are an ineffective leadership tool. Leadership commitment must be expressed through actions observable to employees (Carnino, undated; Spath, 2000). Boards of directors can demonstrate this commitment by regular and close oversight of patient safety in the institutions they oversee (IOM, 2000). Leadership actions that management can take include the following:

  • Undergoing formal training to gain an understanding of safety culture concepts and practices (Carnino, undated).

  • Ensuring that safety is addressed as a priority in the strategic plans of the organization (Carnino, undated; Shrivastava, 1992).

  • Having facility-wide patient safety policies and procedures that delineate clear plans for supervisor responsibility and accountability and enable each employee to explain how his or her performance affects patient safety (Spath, 2000).

  • Regularly reviewing the safety policies of the organization to ensure their adequacy for current and anticipated circumstances (Carnino, undated).

  • Including safety as a priority item on the agenda for meetings (Carnino, undated).

  • Encouraging employees to have a questioning attitude on safety issues (Carnino, undated).

  • Having personal objectives for directly improving aspects of safety in managers’ areas of responsibility (Carnino, undated).

  • Monitoring safety trends to ensure that safety objectives are being achieved (Carnino, undated; Spath, 2000).

  • Taking a genuine interest in safety improvements and recognizing those who achieve them—not restricting interest to situations in which there is a safety problem (Carnino, undated).

  • Reviewing the safety status of the organization on a periodic (e.g., yearly) basis and identifying short- and long-term safety objectives (Pizzi et al., 2001; Spath, 2000).

Finally, leadership’s commitment to safety is evidenced by a willingness to direct resources for improved safety, as reflected in the organization’s budget (Pizzi et al., 2001; Shrivastava, 1992).

All Employees Empowered and Engaged in Ongoing Vigilance

Organizations with higher rates of accidents tend to believe that managers and system designers will anticipate potential problems in production

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