Yet More Evidence that Patient Safety Culture Measures, Measure Nothing

Searching for a patient safety culture measurement ‘tool’ is like a search for the Holy Grail. I think that it is a search for something that does not exist. If safety culture exists, then safety practices should correlate within organisations. They don’t.[1] [2] Meddings, et al. [3] seem slightly surprised by their finding that bloodstream infections improved in many US hospitals with absolutely no change in safety culture. Of course, if you teach ‘safety culture’ to staff then their scores will improve as they have learned the correct answers. But there is little evidence that, absent such a change, improvements in safety are related to a measurable construct of culture.

— Richard Lilford, CLAHRC WM Director


  1. Wilson B, Thornton JG, Hewison J, Lilford RJ, Watt I, Braunholtz D, Robinson M. The Leeds University Maternity Audit Project. Int J Qual Health Care. 2002; 14(3): 175-81.
  2. Jha A, & Pronovost P. Toward a Safer Health Care System. The Critical Need to Improve Measurement. JAMA. 2016; 315(17): 1831-2.
  3. Meddings J, Reichert H, Green MT, et al. Evaluation of the association between Hospital Survey on Patient Safety Culture (HSOPS) measures and catheter-associated infections: results of two national collaboratives. BMJ Qual Saf. 2017; 26: 226-35.

One thought on “Yet More Evidence that Patient Safety Culture Measures, Measure Nothing”

  1. Richard,
    To what extent – for studies relying on self-report measures of safety culture – do we know if the ‘yardstick’ against which patient safety culture is consistent – both between organisations and within organisations over time? Without recent experience across a number of organisations, how would a respondent know if their own organisation has a strong or weak safety culture? Similarly, if improved safety becomes the “norm” then self-reported measurements of culture may not reflect the changes. Do studies using blinded, objective measures of safety culture show the same “nil” results?

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