Features of a patient safety culture


Dr Sonya Wallbank, National Clinical Advisor to the Culture, Leadership and Engagement Project, describes the features of a safety culture.

The key ingredients for healthcare organisations that want to be safe are: staff who feel psychologically safe; valuing and respecting diversity; a compelling vision; good leadership at all levels; a sense of teamwork; openness and support for learning.

Psychological safety for staff

To work at our best, adapting as the environment requires, we need to feel supported within a compassionate and inclusive environment. Psychological safety operates at the level of the group not the individual, with each individual knowing they will be treated fairly and compassionately by the group if things go wrong or they speak up to stop problems occurring. It means staff do not feel the need to behave defensively to protect themselves and instead opens the space in which they can learn.


Team psychological safety is characterised by a climate of inclusivity, trust and respect, where people feel able to thrive as themselves. Valuing diversity plays a critical role. Recognising how beneficial difference, be it in age, gender, ethnicity, power or diversity of thought, is for team working, communication and performance, is vital. These differences stimulate learning and creativity if harnessed in the right way. Leading collectively through the team enhances the voice of even the least powerful roles and so enhances safety. Working in a deficit-based manner which can undermine, humiliate or at worst discriminate against those who are different, leads to fear and decreases team psychological safety and workplace learning.

Compelling vision

Before leadership can be practised well, there needs to be a vision of what we want to achieve. A good understanding of why we are doing something and where we want to get to pervades the successful system: the vision needs to be explicit, not reliant on assumption. Organisations that emphasise the importance of long-term thinking and strategy and have high aspirations for the teams within encourage pride and positivity in the workplace.

Leadership and teamwork

Compassionate leadership creates psychological safety and encourages team members to pay attention to each other; to develop mutual understanding; to empathise and support each other. Such teams are also highly innovative. The way leadership is practised through the organisation is critical to its success, with clinical leadership being particularly important to safety. Furthermore, feeling part of a team protects individuals against the demands of the organisation they work for and if they have clarity about their role in the team, they are less likely to burn out and more likely to operate in a safe way.

Open to learning

To develop a culture of learning, the system must focus on what needs to change rather than punitive actions. An organisation that identifies, contains and recovers from errors as quickly as possible will be alert to the possibilities of learning and continuous improvement.

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