Skip to main content

Changing the Culture of Patient Safety: Leadership's Role in Health Care Quality Improvement

Buy Article:

$12.00 plus tax (Refund Policy)


Background: For two decades health care workers have been struggling, with varying degrees of success, to use the principles of continuous quality improvement (CQI) to improve the quality of patient care. The Institute of Medicine report To Err Is Human prompted most hospitals to turn their attention to the pandemic of medical errors and to the realization that without changing the culture of blame, and thus releasing an avalanche of information, major improvement would not be possible. This article describes one community hospital's approach to changing its organizational culture and the critical role of leadership in that transformation.

The realities: The places to look for trouble when diagnosing organizational problems are purpose, structure, rewards, helpful mechanisms, relationships, and leadership. Hospitals are professional bureaucracies in that the real power resides with clinical staff. Improvement requires that effective relationships be built within the executive suite. Relationship and team building must be part of the organizational culture. Quality improvement will not occur unless it is clearly aligned with the organization's core objectives.

Conclusions: Managing the five realities is essential to creating a suitable environment for sustaining clinical or more general CQI efforts within health care organizations. This is particularly crucial if the basic culture of the organization is to be changed. All five realities must be addressed on a continual basis, which takes time, and positive outcomes can be expected only over a longer rather than shorter time frame.

Document Type: Research Article

Publication date: 2003-07-01

More about this publication?
  • The Joint Commission Journal on Quality and Patient Safety will be published by Elsevier beginning in 2017! For readers who receive access to the journal through their institutions, the journal can now be found on ScienceDirect ( For librarians looking to subscribe to the journal for their institutions please contact your Elsevier Account Manager or visit for more information. All other readers, please visit to subscribe to the journal or to claim your access for an existing subscription.
  • Editorial Board
  • Information for Authors
  • Subscribe to this Title
  • Information for Advertisers
  • Reprints and Permissions
  • Index
  • Ingenta Connect is not responsible for the content or availability of external websites
  • Access Key
  • Free content
  • Partial Free content
  • New content
  • Open access content
  • Partial Open access content
  • Subscribed content
  • Partial Subscribed content
  • Free trial content
Cookie Policy
Cookie Policy
Ingenta Connect website makes use of cookies so as to keep track of data that you have filled in. I am Happy with this Find out more