Two Contrasting Organizations
Organizational Culture
What Do We Mean By a Culture of Safety?
The Culture of Healthcare Organizations
What Makes a Culture of Safety?


Semantically we tend to view accountability as culpability, where someone is “held accountable” or “found to be accountable” and therefore “guilty” or “to blame”. This negative connotation tends to work against the goals of openness and teamwork in an organization. What is it we intend to accomplish through accountability, and what does this mean to an organization focused on maintaining a culture of safety?

Accountability is a means of ensuring that personnel are aware of their responsibility to maintaining safety. It must begin at the highest levels of the organization, and extend down to the teams and individuals. It is a means to ensure that the team knows the shared responsibility of safety, both of the patient/customer and one another.

There is need for balance between personal responsibility to safety and the responsibility of the entire organization to promote an environment where the individual is protected and systems are in place for reporting and review of events. Also, the goals of reviews are focused on learning and system improvement, not assigning blame to the individual.

Promoting individual accountability for safety communicates a positive message about the organization's commitment to a culture of safety. In order for this to be an effective tool, all levels in the organization must comply. An organization can promote individual accountability for safe practices in many ways, such as:

  • Incorporate an assessment of compliance with safety practices into annual performance evaluations.
  • Evaluate managers’ and supervisors’ ability and methods of communicating safety concerns to their employees.
  • Have staff sign an agreement to promote a safe healthcare environment. This should be incorporated into hiring procedures and rolled out as part of an organization-wide emphasis on safety and a culture of safety.

Thought Question:
An example from the airline industry: A newly hired employee was towing baggage carts and took a corner too sharply, causing the last baggage cart in the train to collide and damage a piece of equipment used for loading aircraft.

What would you, as supervisor to this employee, have done?


What if the employee had received the training?


Under what circumstances might disciplinary action be warranted?


Can you think of similar examples where this could apply in healthcare?



Index Previous Next

Questions about this website, please email: CFM_Webmaster@mc.duke.edu
© 2016 Department of Community and Family Medicine, Duke University School of Medicine. All Rights Reserved.