Innovative Approaches for Safety Culture Improvement in Healthcare Systems

Improvements in patient safety have been achieved over the last twenty years, yet challenges remain in relation to safety culture, including the belief among healthcare professionals that blame is still part of their culture. This Special Issue presents papers that explore innovative approaches to understanding and developing safety culture in healthcare. The papers included within demonstrate the importance of taking a systems perspective when considering safety culture, including understanding culture as both an emergent property of systems and something that shapes systems, and as something that can improve patient and staff safety. Three case studies are presented in this Special Issue in relation to understanding and improving the safety culture in an intensive care unit, a nursing home, and in an obstetrics and gynecology department. Four papers present different ways to facilitate safety culture, including the importance of the patient's voice in understanding safety; the need for psychological safety among healthcare professionals to speak up for safety and a joint problem-solving orientation towards addressing problems when they are raised; the role of informal communication between healthcare professionals in joint sensemaking for safety and breaking the silence around safety; and the importance of informed consent for patients. Two perspectives in relation to just culture are presented, including one on the unique challenges of operationalizing just culture in residential care settings and a second on enabling organizational conditions for restorative just culture.