Rural Hospitals (Flex Program)


Promoting a Culture of Safety: Use of the Hospital Survey on Patient Safety Culture in CAHs (Policy Brief #27)

Document Type

Policy Brief

Publication Date



MRHRC, Patient Safety, Critical Access Hospitals


The Institute of Medicine has emphasized the importance of establishing a culture of safety to improve patient care, specifically: developing clear, highly visible patient safety programs that focus organizational attention on safety; using non-punitive systems for reporting and analyzing errors; incorporating well-established safety principles such as standardized and simplified equipment, supplies, and work processes; and establishing proven interdisciplinary team training programs for providers. We sought to investigate the degree to which these elements are present or absent in Critical Access Hospitals.

This brief presents the results of a literature review and a rural patient safety expert panel comprised of representatives from federal and state government and academia.

Key Findings:

  • Establishing a culture of patient safety includes promoting a nonpunitive environment of shared accountablity (a just culture), encouragement to report errors (a reporting culture), and development of a learning culture.
  • Research demonstrates a positive relationship between organizational culture and safety outcomes for both patients and employees.
  • Use of the AHRQ Hospital Survey on Patient Safety Culture has been effective for planning, implementing, and evaluating targeted patient safety interventions in CAHs.


This brief is one in a series of policy briefs identifying and assessing evidence-based patient safety and quality improvement interventions appropriate for use by state Flex Programs and Critical Access Hospitals (CAH)s, and discusses the use of patient safety culture surveys as a means to promote organizational learning and build a culture of safety.

Funding Organization

This study was conducted by the Flex Monitoring Team with funding from the federal Office of Rural Health Policy

Grant Number

PHS Grant No. U27RH01080

policybrief27_patient-safety-culture-cahs.pdf (194 kB)
Promoting a Culture of Safety: Use of the Hospital Survey on Patient Safety Culture in CAHs (Policy Brief #27)