Leading a culture of safety

Putting Culture on TrialBlog post by Richard Corder

“Culture is how organizations ‘do things’.” – Robbie Katanga

“We are what we repeatedly do.” – Aristotle

Culture is consistent, observable patterns of behavior in organizations. At the beginning of the year I wrote a blog about a local (north of Boston, MA) supermarket chain that had reinstated their president after staff walked off the job.

One of the most striking parts of the story was the reference to his culture. When the former president returned, he brought with him a set of standards, expected behaviors and way of doing things that clearly fostered loyalty, joy and camaraderie. This is one of many stories that demonstrate that culture is not an abstract concept that is difficult to grasp – it is something that is real and impacts people’s actions.

In the work to improve patient and provider safety in healthcare the word ‘culture’ gets used frequently. In fact if you want to prompt vigorous debate, just start talking about the culture within a hospital or health system and watch what happens. Soon you’ll be neck deep in all sorts of good, bad and ugly. It is far too easy to blame the culture within healthcare for our safety woes. It is as if the culture is an amorphous “thing” that has some control over us. It rolls off the tongue as part of our standard vernacular, and is often the go-to response to much of what ails us:

Q: “Why are some of your operating rooms using surgical checklists and others not?”

A: “That’s just the way we do things here, it’s our culture…”

Q: “What stopped you from speaking up when you saw your senior colleague acting in that rude, disrespectful manner?”

A: “That’s the culture on this team, keep your mouth shut and your head down…”

It strikes me that we cite or state culture as the root-cause of the problem because it creates the impression that fixing or changing it is nigh on impossible. That to tackle, change or create a new culture is a myth so complicated that we best not even try…

The Market Basket story annihilated that myth.

Putting Culture on Trial

Two weeks ago on June 5th my CRICO colleagues and I hosted a one day symposium to further explore the idea of culture. Together we took a critical look at how we “do things” as healthcare leaders, how we lead, which is in fact our culture. The variation we tolerate, the difficult conversations we either are not trained to have or refuse to have, the level of confusion we permit and the decisions we fail to make – create our culture.

We are culture.

Colin Hung wrote a blog that summarized the day we put “culture on trial” – we concluded that culture is not to blame, it is neither guilty nor innocent. As healthcare leaders we are in a position to take action, to model open communication and to celebrate people speaking up when something doesn’t look or sound right.

Looking in the mirror

If anyone is to blame, if anyone is guilty – surely they are staring back from the mirror.

Healthy, safe, just, open healthcare cultures are leader led by individuals that are just that – healthy (and smart), safe, just and open.

Safe hospitals are led (at all levels) by people who are willing to demonstrate their own commitment through their words, their actions and their comfort with being a little vulnerable and a lot of transparent.

Leading and promoting a safe, enjoyable, rewarding and well-resourced environment for care givers is a commitment to be personally accountable to achieving this as job #1. This demands a level of clarity and commitment that acknowledges that our behaviors, actions, words and commitments (what we repeatedly do) are how our culture manifests, grows and lives.

Please join me on June 23rd 2015 as I guest host the weekly #hcldr chat at 8:30pm ET (for your local time click here). Together we will continue the #CRICO15 conversation and discuss patient safety (#ptsafety), leadership and culture:

  • T1 What can healthcare leaders do to create a stronger #ptsafety culture?
  • T2 What aspects of #ptsafety culture have improved in the past 3 years? What have not?
  • T3 The business world have some great stories of leader-led cultures – Southwest Airlines, Zappos, Apple, Nike, Disney. Why is it that we are only now waking up to this fact in healthcare? How can we accelerate it?
  • T4 Who “owns” culture in your healthcare organization? Who should?


“Culture and Love – Safety Leadership Lessons from a Supermarket Chain”, Richard Corder, Richard Corder Blog, January 6 2015, https://rhlcorder.wordpress.com/2015/01/06/culture-and-love-safety-leadership-lessons-from-a-supermarket-chain/, accessed June 19 2015

“Market Basket deal closes book on family feud”, Casey Ross and Beth Healy, Boston Globe, December 12 2014, http://www.bostonglobe.com/business/2014/12/12/demoulas-closes-deal-buy-market-basket/AXcJOLvTuttlxqo2qb2e6O/story.html, accessed June 19 2015

“Grassroots Change + Personal Accountability in Healthcare”, Richard Corder, Richard Corder Blog, March 20 2015, https://rhlcorder.wordpress.com/2015/03/20/grassroots-change-personal-accountability-in-healthcare-2/, accessed June 19 2015

“Putting Organizational Culture on Trial”, Colin Hung, Crico Blog, June 12 2015, https://www.rmf.harvard.edu/Blog/2015/June/Putting-Patient-Safety-Culture-on-Trial, accessed June 19 2015

“Safety Culture”, Agency for Healthcare Research and Quality, http://psnet.ahrq.gov/primer.aspx?primerID=5, accessed June 19 2015

“Develop a Culture of Safety”, Institute for Healthcare Improvement, http://www.ihi.org/resources/Pages/Changes/DevelopaCultureofSafety.aspx, accessed June 19 2015

“Through the Eyes of the Workforce: Creating Joy, Meaning and Safer Health Care”, Lucien Leape Institute, 2013, http://www.npsf.org/?page=throughtheeyes, accessed June 19 2015

“Flying High on Accountability”, Linda Galindo, Linda Galindo Blog, http://lindagalindo.com/flying-high-on-accountability/, accessed June 19 2015

“Delivering a Collective Leadership Strategy for Health Care”, Eckert et al, Center for Creative Leadership, 2014, http://insights.ccl.org/wp-content/uploads/2015/04/DeliveringCollectiveLeadership.pdf, accessed June 19 2015

“Educate the Young…Emerging Trends in Quality and Safety”, David Mayer MD, Medical Quality Presentation, February 20 2013, http://www.acmq.org/natlconf/2013/presentations/Mayer%20-%20MQ2013%20Slide%20Presentation.pdf, accessed June 19 2015

Image Credit

Putting Culture on Trial – Colin Hung


  1. […] safety continues to improve only marginally [see our HCLDR discussion with Richard Corder on Leading a Culture of Safety], more and more people will seek alternatives to […]

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