Transforming safety culture in health care from the inside out

The health care workforce continues to face key challenges that affect its ability to deliver day-to-day care, including high rates of burnout, a rise in workplace violence and persistent staff shortages. These challenges have a wide-reaching impact on the safety and emotional well-being of both patients and health care workers. The link between provider well-being and patient safety is no longer abstract — organizational culture directly contributes to outcomes.

To enhance the patient experience and address shortcomings in patient safety, hospitals and health systems need to look inward to build a strong organizational culture that can provide resources and support staff as they grapple with industry issues. Building a supportive, fair and accountable culture fosters safety, resilience and a better patient experience.

The role of a ‘fair and accountable culture’ and peer support

The influence of an organization’s culture extends beyond just establishing a support system internally. A strong safety culture impacts how health care workers carry out their responsibilities and interact with patients — it can affect everything from bedside manner to patient communication to care outcomes. Meaningful, safer patient interactions directly impact patient trust, affecting overall performance and revenue. But these interactions are challenging to achieve when our health care workforce is experiencing intense levels of emotional exhaustion or working in environments where staff feel scared to speak up regarding safety incidents. While physician burnout rates have seen improvement in recent years since their peak in 2021, this group remains at a higher risk for burnout relative to other U.S. workers.

Building a “fair and accountable culture” where health care workers feel supported and empowered to report medical harm events and errors benefits everyone in the ecosystem of a hospital or health system. While patients aren’t directly aware of operational changes, they can feel a strong culture through the delivery of high-quality care and meaningful interactions that make them feel seen and heard. This patient experience starts with clear pathways for communication that reinforce a focus on safety, backed by comprehensive solutions for reporting and resources designed to foster peer support. Resources like the Communication and Optimal Resolution (CANDOR) toolkit help organizations respond transparently and empathetically after harm events, supporting both patients and providers.

A case study in culture creation

When you walk into a hospital and interact with staff in any capacity, you’re immediately impacted by the culture, no matter who you are. A strong culture is more than just a supplemental benefit for health care workers; it’s a measurable lever for performance and outcomes that can have a direct impact on an organization’s care quality. Technology plays a critical role in unlocking the insights needed to assess an organization’s safety culture, while also reducing the documentation demands for clinicians. By leveraging the right solutions, health systems can identify areas for improvement and build actionable plans to strengthen key cultural elements such as peer support and communication, ultimately enhancing clinician support.

USA Health’s journey to building a just culture

USA Health, an academic health system that serves patients across southern Alabama, recognized a crucial need to ensure that commitment to patient safety and “a fair and accountable culture” resonated throughout the whole health system, all the way down to the patient level. Across its three hospitals, USA Health had two separate medical teams with different structures, processes, cultures, and ways of measuring quality and safety. The health system needed a sound process to standardize quality and safety measures, remove variability from patient care and objectively assess provider performance.

Through a discovery process with RLDatix, USA Health exposed technological gaps that uncovered opportunities for change around personnel, culture and training. This assessment helped the health system’s leaders and frontline staff identify where improvements were most urgently needed.

Armed with these findings, USA Health is now focused on raising its standard of care with a connected, scalable approach to provider performance and patient safety. By moving beyond subjective impressions to data-driven insights for assessment, the health system aims to enable continuous improvement for its providers and the organization. With a focus on strengthening its safety culture and aligning quality measures, USA Health can mitigate safety risks not just by reacting faster but by preventing harm in the first place.

Automated review

One of the most significant advancements was the rollout of a nondiscretionary case review process. Previously, the system’s hospitals individually managed peer and case reviews. Now, when certain safety triggers occur, a case review is automatically initiated using consistent, systemwide standards. This approach produces outcomes data that leaders can use to identify training needs, gaps in equipment or tools, and other systemic issues. Automating case review also minimizes the nonclinical workload and emotional strain on clinicians who were previously responsible for navigating complex, discretionary processes.

For example, USA Health now has the ability to connect staff’s observations to broader safety outcomes in real time. If data show an elevated number of procedure delays, leaders can trace whether the cause is related to issues like equipment readiness or scheduling workflows. With these insights, they can implement targeted adjustments to reduce disruptions and improve both patient safety and provider efficiency.

Providing physicians with support, not scrutiny

For physicians, it’s important to keep in mind that these technologies serve to shine a light on systemic flaws that often leave clinicians unfairly blamed for harm events. By surfacing all contributing factors, organizations can protect providers from being unfairly blamed and help them deliver safe and effective care.

Equally important, these technologies help reduce the administrative and emotional burden placed on physicians. By minimizing documentation and clarifying contributing factors automatically, clinicians can help raise the standard of care without the added stress of navigating reporting requirements.

These improvements also result in tangible benefits for physicians. By reducing preventable safety events and building a culture of transparency, health systems can strengthen their reputation and bring in more patients. Outpatient and ambulatory clinics can then serve as entry points, driving patients into the hospital for elective procedures and specialty care. In parallel, a culture that prioritizes safety and accountability helps physicians build and protect their personal brands while giving them a seat at the table for organizational decision-making.

An imperative element in today’s health care climate

With the state of today’s health care workforce and patient trust, establishing a strong culture of safety is no longer optional — it’s essential for organizations to thrive. The first crucial step for health care leadership is to thoroughly assess their current culture and leverage advanced solutions to make measurable progress. Collaboration across the industry is key to implementing innovative technology that can holistically support an organization's initiatives to improve safety for both patients and providers.

Timothy McDonald, M.D., J.D., is the chief patient safety and risk officer for RLDatix and a professor of law at Loyola University - Chicago. He is a Harvard-trained anesthesiologist, pediatrician, licensed attorney, patient safety/medical liability specialist and author. As the chief patient safety and risk officer for RLDatix, Tim has taken his passion for shattering the wall of silence in health care and infused it into software to better support organizations who are on their journey to more compassionate honesty.

Michael Chang, M.D., is the chief medical officer for USA Health, where he is responsible for leading clinical, quality and safety initiatives that support the performance and practice standards across USA Health. He develops and executes systemwide initiatives to improve access and processes to the existing system, and he also coordinates the development of new services. As a key member of the executive team, he works closely with both the academic practices and external practices to ensure the quality, safety and efficiency of care delivery.