Safety in Healthcare

By Topic: Safety Quality Culture of Safety Just Culture By Collection: Blog Safety

As summer turns to fall and students of all ages return to school, now is the perfect time to revisit the building blocks that create a sustainable culture of safety. No big, yellow school bus necessary—this blog is our classroom. In this six-part blog series, we will explore some of the high-level strategies and practical tactics that are critical for creating safer healthcare environments.

To develop and sustain a culture of safety, it is essential to focus on the following six areas: 

  • Establishing a compelling vision for safety
  • Valuing trust, respect and inclusion
  • Selecting, developing and engaging governing boards
  • Prioritizing safety in the selection and development of leaders
  • Leading and rewarding a just culture
  • Establishing organizational behavior expectations

All six leadership domains are outlined in Leading a Culture of Safety: A Blueprint for Success, a resource ACHE and the Lucian Leape Institute developed by collaborating with leaders of progressive healthcare organizations and globally renowned experts in leadership, safety and culture.

M. Michael Shabot, MD, former executive vice president and chief clinical officer for Memorial Hermann Health System, Houston, advised organizations to implement all six domains and to fully commit to each one in a recent Healthcare Executive article. “These six elements are interlocking,” says Shabot. “You really need all of them to make this work.”

Here, we highlight the importance of establishing a compelling vision for safety.

Tactics for Establishing a Vision

An organization’s vision reflects priorities that, when aligned with its mission, establish a strong foundation for the work of the organization. By embedding a vision for total patient and workforce safety within the organization, healthcare leaders demonstrate that safety is a core value.

Some tactics leaders can use to create a foundation for this imperative include working with leadership teams to develop an aspirational end state (e.g., zero harm) that will be incorporated into the vision; building awareness of the current state through culture surveys, observations and focus groups; including equity of care as part of the vision statement, and conducting training and information sessions for all employees to build buy-in for the vision.

Once leaders have built a solid foundation for their vision, they can sustain this safety imperative by continuously engaging the organization, clinical leaders, and patients and families.

To engage your organization:

  • Clearly articulate your vision to the workforce and the public.
  • Benchmark culture progress and best practices with other similar organizations (e.g., participate in collaboratives, etc.).
  • Develop and implement a recognition program for leaders, clinicians, and the workforce based on growth and adherence to vision.
  • Establish organizational goals that address safety and disparities in care.

To engage clinical leaders:

  • Include physician, nursing and other clinical leaders in development of vision statement and strategic plan.

To engage patients and families:

  • Clearly communicate the vision statement and values to patients.
  • Incorporate patient and family stories, along with statistics, when discussing vision at the Board level.
  • Include patient feedback in the development of vision statement.


Establishing a compelling vision for safety is just the beginning. Your homework is to sign the We Lead For Safety Pledge and take the Culture of Safety Organizational Self-Assessment.