BC Patient Safety & Quality Council

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Culture Improvement Resources


Culture refers to shared attitudes, beliefs, and patterns of behaviour that determine what is normal or expected, and ultimately determine how a group or organization functions. It’s “the way we do things around here.” In health care, culture includes topics like teamwork, communication, dedication to safety, stress recognition, just culture, and leadership.

A positive culture is associated with better outcomes for patients and a better experience for providers. The Joint Commission identified communication breakdown as the most common factor implicated in adverse events1. Academic evidence shows a correlation between strong teamwork and high quality of care2.  We are beginning to see culture-related interventions improve clinical outcomes and reduce adverse events3.            


Any hospital, unit, or individual can make a difference. Culture is about the way we work, so we can apply a culture lens to everything and anything we do. For example, if there is a scheduled in-service education session you could deliver content on communication or teamwork. If you’re working on clinical changes (catheter insertion to reduce UTIs, antibiotic timing to reduce SSIs, oral care to reduce ventilator-associated pneumonia, to name a few) you could look at the role of culture as part of your improvement plan.

Culture Change Toolbox

The Culture Change Toolbox is a collection of tools and interventions for changing culture. It’s full of ideas, examples, and exercises. For each tool there are tips on how to apply it and a description of which components of culture it helps to improve.

You can also download the Toolbox.

How Does Your Team Communicate?

The Elephant in the Room

More than ever we have recognized the need to address “the elephant in the room” which often is closely connected to culture. Share this newly released video and start talking about How Your Team Communicates!

The Council offers resources for improving teamwork and communication:

  1. General education by understanding what your culture is like and how to take advantage of healthcare as a complex adaptive system,
  2. Team building games and activities that help engage clinical teams and provide an opportunity for interactive coaching,
  3. Shadowing observations and how to provide feedback and mentorship through these observations,
  4. Peer coaching teams to support non-technical skills in the operating room.

Check out the companion resources that we’ve created to go with the video to help your team address some of your “elephants”.

Measurement Resources

  • The Safety Attitudes Questionnaire is a survey that can be used to measure current culture. The University of Texas SAQ is available online.

Observation is another way to assess the current state of teamwork, communication, and other elements of culture:

  1. Disease-Specific Care Certification – National Patient Safety Goals.  Oak Brook Terrace (IL):  The Joint Commission; 2008.  Available from: http//www.jointcommision.org.
  2. Manser, T. 2009. Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiol Scand 53: 143–151.
  3. Neily, J. 2010. Association Between Implementation of a Medical Team Training Program and Surgical Mortality JAMA 304(15): 1693-1700.

At a Glance

Key Contacts:


Danielle Simpson
Leader, Innovation & Engagement

Geoff Schierbeck
Quality Leader