Leading a Culture of Safety: A Blueprint for Success

American College of Healthcare Executives and IHI/NPSF Lucian Leape Institute. Leading a Culture of Safety: A Blueprint for Success. Boston, MA: American College of Healthcare Executives and Institute for Healthcare Improvement; 2017.

CultureofSafetyBlueprint_cover_thumbnail.jpgPatient safety experts and researchers have increasingly pointed to the role of organizational culture in the success of patient and workforce safety initiatives.

Yet, creating a culture of safety in health care settings has proven to be a challenging endeavor, and there is a lack of clear actions for organizational leaders to take in developing such a culture.

Leading a Culture of Safety: A Blueprint for Success was developed to bridge this gap in knowledge and resources by providing chief executive officers and other health care leaders with a useful tool for assessing and advancing their organization’s culture of safety. This guide can be used to help determine the current state of an organization’s journey, inform dialogue with the board and leadership team, and help leaders set priorities.

The high-level strategies and practical tactics in the guide are divided into two levels:

  • The foundational level provides basic tactics and strategies essential for the implementation of each domain.
  • The sustaining level provides strategies for spreading and embedding a culture of safety throughout the organization.

Each organization will be at a different place on the spectrum from developing the foundation of a culture of safety to embedding and sustaining these principles. An organization may work on strategies and tactics across the two levels, or may be at various levels of progress across each of the domains.

Whether an organization is just beginning the journey to a culture of safety or is working to sustain its safe culture, this guide can serve as a useful guide to direct efforts and evaluate an organization’s success along the journey to zero harm.



The American College of Healthcare Executives (ACHE) and the IHI/NPSF Lucian Leape Institute collaborated with leaders of progressive health care organizations and globally renowned experts in leadership, safety, and culture to develop this resource. We are grateful to the members of the two roundtable meetings whose insights and perspectives informed this work.​

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