Ever since the eye-opening report of 1999 when we learned that as many as 100,000 deaths occur annually as a result of medical errors, hospitals have tried to shift from a culture of blame to a culture of safety. A culture of safety is believed to encourage greater reporting of errors and near misses and implies attention to numerous interrelated factors such as the following:

* Open communication

* Feedback and communication about error

* Frequency of events reported

* Handoffs and transitions

* Management support for patient safety

* Nonpunitive response to error

* Organizational learning-continuous improvement

* Overall perceptions of patient safety

* Staffing

* Supervisor/manager expectations and actions promoting safety

* Teamwork across units

* Teamwork within units

To assess the degree to which hospitals have achieved a culture of safety, the Agency for Healthcare Research and Quality (AHRQ) conducted a survey of 622 hospitals nationwide.1 They found that teamwork within hospital units and supervisor/manager support for patient safety are areas of strength for most hospitals, but nonpunitive response to errors and patient handoffs continue to be patient safety areas that need improvement. The AHRQ survey also found that most respondents within hospitals (52%) reported no error events in their hospital over the past 12 months. It is likely that this represents underreporting of errors and was identified as an area for improvement for most hospitals.

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