safety culture and ongoing measurement of its progress in achieving the desired cultural shift are required.
A number of health care organizations have surveyed themselves to benchmark their culture-of-safety status (Pizzi et al., 2001), using a variety of surveys and checklists that assess the attitudes and perceptions of workers (Cooper, 2000; Pizzi et al., 2001; Spath, 2000). The Agency for Healthcare Research and Quality and the federal government’s Quality Interagency Coordination Task Force are developing a public-domain instrument for assessing issues of patient safety, medical error, and event reporting as they relate to an organization’s safety culture. This instrument—the Hospital Survey on Patient Safety—is in the final stages of testing and validation and is scheduled to be available in the public domain in early in 2004. It will allow health care institutions to understand the varying safety cultures within their own institutions, how staff view the commission of errors and error reporting, and the extent to which staff perceives the institution to be a safe place for patients.2
By themselves, however, surveys of the safety climate (i.e., the aggregation of individuals’ attitudes and perceptions about safety) within organizations are believed to be inadequate in evaluating the extent to which a culture of safety has been created (Cooper, 2000). While appraisal of the products or outcomes of the safety culture in operating organizations is a challenge, measurable indicators of the culture’s effectiveness are viewed as essential (Cooper, 2000; Spath, 2000).
Although measuring the incidence rate of accidents and other adverse safety-related events as patient safety indicators may appear straightforward, it has serious drawbacks. Negative indicators can be demoralizing to employees, as well as misleading. Reported numbers of errors can decline for reasons having little to do with safety, such as underreporting resulting from other organizational incentives (e.g., production incentives) (Cooper, 2000).
In contrast, positive measures of the observable degree of effort expended by organizational members have been identified as a more effective approach to measuring the degree to which an organization has implemented a safety culture. These measures include the degree to which organi-