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September • 18 • 2023

Fostering a Culture of Patient Safety Through Healthcare Leadership


By Coverys Risk Management 



Leadership plays a pivotal role in the development of a culture of patient safety. This can benefit both patients and providers.

Medical errors are alarmingly common. They can cause both patient harm and caregiver distress. By fostering a culture of patient safety, healthcare leaders can reduce the occurrence of medical errors.

Safety Must Be the Priority

Unsafe practices don’t always stem from a lack of care. Sometimes, mistakes are made despite the best intentions. One nurse’s error serves as a prime example and a cautionary tale. The nurse was delivering medications at night and didn’t want to turn on the light because it would wake up the patients. After administering medication to the second patient in a two-patient room, she realized she had mixed up the medications. She immediately called a physician to ensure the patients were safe. Fortunately, the patients were fine; however, the stress she experienced as a result caused her to consider leaving the profession.

Medical Errors Are a Leading Cause of Death

More than two decades ago, the Institute of Medicine released a report showing that between 44,000 and 98,000 people die every year due to medical errors. More recent research from Johns Hopkins University School of Medicine indicates that medical errors result in 251,000 deaths annually in the U.S. Medical errors are not mentioned on death certificates and therefore don’t make the CDC’s list of the most-common causes of death. However, based on these figures, medical errors could be the third-leading cause of death.

Since not all medical errors result in death, the total number of errors is even greater than the numbers above. The Institute for Healthcare Improvement found that 21% of Americans have experienced a medical error while receiving care. An additional 31% report that someone whose care they were closely involved with experienced a medical error.

Medical Errors Have Second Victims

Medical errors don’t just harm patients—they also harm healthcare providers. These providers are often called second victims.

According to Harrison and Wu, providers who witness or contribute to adverse events can experience anxiety, depression, sleep disturbances, and other psychological effects. These effects can disrupt their personal and professional lives and interfere with their ability to deliver high-quality and safe care. One survey found that 76% of physicians who had been involved in an adverse event experienced personal or professional distress for which they required support.

The Financial Impact of Medical Errors

Medical errors can be costly. According to Rodziewicz, Houseman, and Hipskind, estimates of the cost of medical errors range from $4 billion to $20 billion a year. In addition to requiring more care—and therefore generating more expenses—medical errors can result in malpractice lawsuits. Most malpractice claims against hospitals are related to surgical errors, whereas most malpractice claims involving outpatient care are related to missed or late diagnoses.

The Role of Leadership in Patient Safety

Albert Bandura coined the term “collective efficacy” to describe “a group’s shared belief in its conjoint capability to organize and execute the courses of action required to produce given levels of attainment.” According to the Power of Collective Efficacy, research since has shown that this concept applies in many areas. In short, when teams have a shared belief in their ability to achieve their goals, they are more effective in accomplishing these goals.

In healthcare settings, patient safety is the goal. Healthcare leaders play a pivotal role in achieving the collective efficacy needed to support that goal.

A Study in Patient Safety

A study of patient safety was conducted in an academic healthcare system consisting of five hospitals, multiple clinics, inpatient and outpatient behavioral health centers, and a Level I trauma center. It had more than 15,000 employees. The healthcare system’s website identified safe patient care delivery to avoid medical errors and the associated harm as the ultimate goal of the organization.

The research participants were the individuals who worked in the patient safety department, including the executive vice president, vice president, director, manager, and patient safety specialists. Each was surveyed regarding the role of leadership in patient safety culture. Findings from the survey were compared with data from the organization’s patient-safety-related documents, such as policies, organizational charts, and website content. These findings were then compared to prior research and literature on patient safety.

One of the research questions asked: “How does a leader ensure consistency in policies, practices, and protocols to create a patient safety culture?” The following points stood out in the responses:
  • Understanding. Leaders are committed to being knowledgeable about the content within the policies, practices, and protocols. They use data and direct observations to focus on individual areas of responsibility, raise awareness, and highlight opportunities for improvement.
  • Communication. Leaders interact with staff and communicate in creative and engaging ways to spread the message of safety as a priority.
  • Exhibiting patient safety behaviors. Leaders’ communication and behaviors align with patient safety principles. They hold staff accountable in a consistent and objective manner.
Another question asked: “What attitudes, beliefs, and collective efficacy are needed to produce patient safety culture?” Three elements stood out in the responses:
  • Attitude. Leaders respond to errors in a human and empathetic way. They provide compassion and emotional support.
  • Beliefs. Leaders believe that every staff member is accountable and that measures of accountability should be fair and equitable.
  • Collective efficacy. Leaders build connections and trust with their team. They encourage communication and collaboration.
One survey respondent said, “Leaders who tell stories with examples of their vulnerability to elicit a response that ‘Oh my God, that could have been me’ and no one is ‘perfect’ display an attitude of connection.” Another respondent explained how leaders can use observations of deviations from best practices to provide nonjudgmental coaching instead of berating the healthcare provider. This turns the situation into a positive learning opportunity.

A third question asked: “What leadership characteristics are needed to create patient safety culture?” Four characteristics stood out as essential:
  • Alignment. Leaders need to get team members on board with the mission by motivating them, articulating expectations, and getting everyone excited.
  • Trust. Leaders need to connect with staff and show interest and empathy.
  • Learning. Leaders need to articulate why patient safety is important. They should possess integrity, be able to model desired behaviors, and come from a real-world bedside background.
  • Support. Leaders need to be approachable, supportive, and willing to listen.

Achieving Organizational Change

To achieve the organizational change needed to develop a patient safety culture, individuals within the organization need to embrace change and invest in the development of new skills. Consistency is also key. If employees see a mismatch between written policy and the actual behavior of leaders, they may be confused as to what is expected of them.

It’s important to:
  • Offer coaching and leadership training to help leaders learn effective methods.
  • Provide opportunities for leadership to practice their new skills and receive feedback.
Although it requires ongoing effort, developing a culture of patient safety is a worthwhile goal that can prevent patient harm, avoid provider distress, and reduce costs.
This article is based, in part, on a Coverys’ presentation “Leadership Behaviors, Attitudes, and Characteristics to Support a Culture of Safety,” presented by Susan L. Montminy, EdD, MPA, BSN, RN, FASHRM, CPHRM, CPPS.

Copyrighted. No legal or medical advice intended. This post includes general risk management guidelines. Such materials are for informational purposes only and may not reflect the most current legal or medical developments. These informational materials are not intended, and must not be taken, as legal or medical advice on any particular set of facts or circumstances. 


  • Risk Management & Patient Safety