Developing a Culture of Safety


“Culture,” in its simplest form, consists of the attitudes, beliefs, and perceptions of a collective group of people. It shapes their behaviors, decisions, and choices and is, therefore, a complicated but highly influential component of the safety equation. 

Individual agencies tend to develop their own subcultures; and this can result from a distance, unique shared experiences, or just variations in management style. Unfortunately, these variations can lead to the breakdown of the organization’s overall mission, vision, and values that can lead to medical errors. 

The Journey to Building a Safe Culture


Does your staff fear they will be punished for mistakes? Or do they believe your organization will fairly evaluate your systems and treat staff justly?Just Culture Algorithm EMS

Patient and provider safety is important, but how do we establish a culture that encourages open reporting of adverse events and risky situations, yet holds people accountable in a just manner?  The challenge lies in distinguishing between a system that might create risks, or human error which may result in a bad outcome, and reckless behavior that intentionally puts lives or organizations at risk.

The Center for Patient Safety is able to customize education for your leaders and staff after a culture assessment that is specifically designed for your organization based on the results from your assessment.




Culture change is a transformative process. Just as sailors would not begin a voyage without a map and navigation tools, culture change requires planning and direction. 

EMS Patient Safety Journey Map


It’s estimated between 250,000 and 440,000 patients in the U.S. die every year from medical errors. The wide margins are mostly due to not having a reliable way to measure all deaths that tie back to a medical error, so we must rely on estimates. The exact number is not as important as the people being harmed and dying of medical errors. We have the resources to reduce those numbers! Check out our offerings below for more information on educational opportunities. 

HubSpot Video


As you continue on your journey, participating with a PSO can help. Many states around the nation do not provide adequate confidentiality, or peer review protections for EMS services and providers. A solution to overcome this barrier comes to you via participation with a Patient Safety Organization (PSO). As a PSO, the Center for Patient Safety offers federal-based confidentiality protection for your safety and quality improvement work. 

“EMS agencies can become members of PSOs and not only achieve protection of their own processes but also benefit from the collective knowledge and understanding provided by the PSO and its members.” – The National Association of Emergency Medical Technicians (NAEMT)

Key PSO Points:

  • improve the culture of safety
  • improve organizational sustainability
  • reduce preventable harm
  • legally protect some of your most sensitive quality and safety work
  • learn from aggregate industry data on clinical errors and causal factors
  • protect conversations and work sessions with your peers (including collaboration with other community providers to improve, for example, care transitions)



The links between organizational culture, safety, and quality are nothing new. Many industries have generated high-reliability outcomes by addressing culture change. Having a benchmark that leaders can use to provide perspective on the health of their safety culture is a valuable component of improving culture.

The Center for Patient Safety seeks to improve deficits through the use of an assessment process that includes a survey with a quantifiable snapshot in time of your safety culture. The snapshot allows you to:

  • Identify and leverage organizational strengths
  • Find opportunities for improvement
  • Understand how they compare to others
  • Learn how to prioritize next steps

The Center for Patient Safety has developed the ONLY Culture Survey specifically customized for First Responders that aligns with the surveys designed by AHRQ for other areas in healthcare.



Learn how to enhance patient safety culture leading to improved patient outcomes. This 7-part virtual webinar series includes:

  • Patient Safety Culture
  • Leadership and Patient Safety Planning
  • Human Factors and the Science of Patient Safety
  • Just Culture and Reporting
  • Measurement and Assessment
  • Process and Quality Improvement
  • Becoming a Highly Reliable Organization

A resource library provides the recorded sessions, slides, tools, forms, and references. A discussion board keeps participants connected and engaged. The curriculum may be customized to meet your needs. 

Designed for Single Organizations



Before training begins, the Center will:

  • Provide a Culture Assessment and readiness self-assessment tool to identify current strengths and weaknesses
  • Consult with staff to evaluate the results and integrate them into the program
  • If the staff has recently completed a safety culture assessment, CPS will also incorporate your results into the Just Culture readiness assessment and training

The training:

  • Introductory leadership webinar (60 minutes, virtual-only) explains the foundation of a just culture/shared accountability and the critical role of leaders in its implementation. CPS provides one or two live presentations with the opportunity for questions, and a recording for those who cannot attend. This session incorporates a short discussion of issues identified in the self-assessment, so the leaders understand any unique challenges. It provides a more theoretical review of just culture/shared accountability principles and goals and how they can serve an organization’s objectives.
  • Training for managers. This three-hour training will provide a working, more practical understanding of the principles of a just culture and how to apply them in the supervisor/manager setting. It is designed to create competence at a working level. In a “flat” organization where leadership may also supervise, this session is also recommended for leaders. It is the foundation for Champions, who will receive additional training. It can include front-line staff, or they can be educated via the optional recorded program described below.
  • Champion Training. This two-hour session provides further theoretical understanding for a few selected individuals who will support the supervisors and managers. Assuming this is a small group, it should be either added to the site visit for manager training or conducted virtually later. The Champions will provide support to other staff and liaison with CPS as needed.
  • Front-Line staff training. If needed, CPS will produce a brief video introduction of shared accountability for front-line staff which can be incorporated into organizational learning management.

       CPS works with clients to develop meaningful follow-up programs to support the implementation.

       Option A: Fully online/virtual OR Option B: In-person

Designed for Associated Agencies or Regional Groups




  • One-hour overview of just culture/shared accountability principles
  • Provided by CPS - mandatory attendance before training in Phase 2

This one-hour webinar will introduce leaders to key concepts of just culture/shared accountability in the context of their leadership role. At least one senior leader in each participating organization must attend this program which will deepen their understanding of key principles and their critical role in the success of the program. It will also describe the multi-faceted benefits of robust just culture/shared accountability implementation

The training for managers and supervisors can be provided either online by CPS or via The Just Culture Company’s online courses.

Six 30-minute monthly webinars will be offered to assist participants with learning and just culture implementation. 

Topics In Past Collaboratives Included:

  • Just Culture and Patient Safety Culture Review – A robust patient safety culture is imperative to implementing a just culture. Participants will learn the necessary components to improve culture, thus supporting the implementation of a successful and sustainable program.
  • Process Improvement Methodology - The primary goal of process improvement is to improve patient outcomes. Shared accountability plays a vital role in creating a culture where providers feel “safe” in sharing opportunities for improvement without punishment. This program will teach participants how to implement a standardized improvement methodology, including metrics for sustainability.
  • Quality Improvement Overview - Achieving sustained QI requires commitment from the entire organization, particularly from top-level management. In the United States, there has been an evolution from quality assurance, where the emphasis was on inspection and punishment for medical errors (the “bad apple” theory) to QI, where we ask, “How did the system fail to support the worker involved in an error?"
  • Importance of Reporting - The deep analysis that leads to improvement relies on the free flow of information about the mistakes, challenges, and concerns facing front-line staff. This program emphasizes the importance of reporting events, near misses, and safety concerns; it also discusses tools to improve reporting.
  • Peer Review and Human Resources in a Just Culture Environment - Peer review, or the evaluation of care provided by staff, and human resource management are essential parts to establishing quality and safety. How can an organization conduct investigations and take action as needed in an environment with shared accountability, which involves looking at the system and the people? This program looks at the “people” side.
  • Root Cause Analysis Overview - This program looks at the system component of just culture/shared accountability. You will learn what makes an investigation robust, enabling you to focus on the right things as part of your action plans.
  • Sharing Lessons Learned and Celebrations - Collaborative improvement projects help all participants improve by learning from each other. This segment highlights participants who have great accomplishments to share. CPS will explore the group’s improvements, and everyone can experience a proud moment!

The collaborative also offers: 

  • Development of measurements to track progress
  • Weekly discussion board – As a team, we will have question and answer sessions to facilitate learning and discussion on our specified topics. Participants will be expected to answer questions and also respond to team members' posts to facilitate discussions.
  • Relevant data-gathering with feedback for all participants – Participants will be expected to gather agreed-upon metrics which will be trended and analyzed by CPS staff. Each organization is provided feedback relative to its metrics.


How do you handle challenging times?ProtectStaff

Today's healthcare workforce is facing a multitude of challenges. Most health care providers adjust well to the multitude of demands encountered during a traumatic clinical event or challenging times. Providers often have strong emotional defenses that carry them through and let them “get the job done.” Yet sometimes the emotional aftershock (or stress reaction) can be difficult. Signs and symptoms of this emotional aftershock may last a few days, a few weeks, a few months, or longer.


Request More Info!

Our team is happy to respond to requests for more information. Simply provide us with a few details about the challenge you're experiencing, or what program(s) you think would be helpful, and we'll prepare a plan that fits your needs.  


“The culture of an organization will either deter or drive the organization’s ability to accomplish its mission.  In EMS we discuss safety in our leadership huddles, attend safety seminars and safety presentations at conferences, but the most profound insight into our culture of safety can be achieved through introspection.  At Cox Health EMS, our use of the EMS patient safety culture survey has been crucial in understanding how our staff view safety and our efforts to improve it.  The information learned has been invaluable to our ability to enhance the safety of our organization for staff and patients.”

Mark Alexander CoxHealth EMS