Letter to the Editor by Amy Fagan to Patient Safety Culture: The Nursing Unit Leader’s Role

Creating a Culture of Safety: The Next Steps

May 23, 2012

Response by Amy Fagan to Patient Safety Culture: The Nursing Unit Leader’s Role by Dr. Christine E. Sammer and Dr. Barbara R. James (September 2011)

Dear Editor,

First, I want to thank you for publishing the works of such esteemed and knowledgeable patient safety leaders on the current topic, "Creating a Culture of Safety: The Next Steps." Their research and experience are both exciting and empowering, as we all feel the responsibility of enhancing safety culture within healthcare organizations. I have spent the past several years of my nursing career in a patient safety role, and the last 5 years researching patient safety culture as part of my doctoral dissertation. I agree that this current topic is worthy of crucial discussion and immediate action by the nursing profession.

I was particularly motivated by the article, Patient Safety Culture: The Nursing Unit Leader’s Role, written by Drs. Sammer and James (2011). This article stands alone as a succinct and practical guide to enhancing safety culture for nursing unit leaders. Furthermore, due to its creatively written format, the context is applicable and will appeal to nurses at all levels.

If I could add anything to this exceptional work, it would be to simply expand on a few of the points made by Sammer and James (2011). First, the authors bring forth the importance of utilizing a valid and reliable tool to measure safety culture, one such as the Hospital Survey on Patient Safety Culture (HSOPSC), developed by the Agency for Healthcare Research and Quality (AHRQ). If healthcare organizations opt to utilize the HSOPSC, the organization has the further option to electronically submit its confidential survey results to an annual comparative database. I encourage nurse leaders to share their safety culture data through the database and utilize the annual database results as benchmarks for their own patient safety efforts. Moreover, organizational level safety culture data is currently difficult to access and collect, inhibiting crucial research from progressing. As more organizations participate in the database, it will become a richer repository of safety culture data for researchers pursuing scientific inquiry within this topic.

Sammer and James (2011) also cited teamwork and communication as driving factors related to a patient safety culture. Keeping with the general article theme of practicality, I recommend nursing leaders pursue a formal team training approach to improving teamwork and communication. AHRQ offers an “evidence-based teamwork system to improve communication and teamwork skills among healthcare professionals” known as TeamSTEPPS (AHRQ, n.d.). TeamSTEPPS is a collection of tools and strategies that teach leadership, situation monitoring, mutual support, and communication to all members of the healthcare team. TeamSTEPPS training sessions are offered at no charge, and many of the materials can be downloaded from the website: http://teamstepps.ahrq.gov.

I hope these additional resources are helpful, and again I commend you for fostering the discussion of such an important topic.

Amy Fagan, RN, MPH, PhD(c)
School of Nursing
University of Mississippi Medical Center


Agency for Healthcare Research and Quality. (n.d.). TeamSTEPPS: National implementation. Retrieved from http://teamstepps.ahrq.gov.

Sammer, C., James, B. (2011). Patient safety culture: The nursing unit leader’s role. OJIN: The Online Journal of Issues in Nursing, 16, 3, Manuscript 3. Doi: 10.3912/OJIN.Vol16No03Man03