Safe system framework - 1: Patient safety culture

Patient safety culture

This core element is challenging, but crucial. It addresses a commitment to an overall improvement in patient safety: to proritise safety, to ensure leadership and executive accountability and to monitor and measure impact.


Children, families and carers 

  • Patient, parent and family engagement in delivering improvement activities
  • Patient and parent experience/feedback surveys
  • Open and supported disclosure

Clinicians and wider team

  • Patient safety leadership
  • Open and robust communication model, such as routine safety briefings; structured communication for escalation; open disclosure and comprehensive investigations for patient safety incidents
  • Identifying positive case scenarios and ‘learning from excellence’

Service or organisation 

  • Broad leadership for patient safety, such as strategic priorities and goals and executive accountability
  • Deliver improvement in patient safety, such as monitoring progress and driving the execution of plans; Establishing and monitoring explicit system level measures; and building patient safety and improvement knowledge and capability
  • Safe staffing levels, skill mix and resources

Regional, national, networks

  • Leadership for patient safety, such as the provision and clarity of data and evidence for change, recommendations and support for improvement


NHS England Improving Patient Experience

Children and young people's survey (2014) - the first national children’s survey conducted by Care Quality Commission (CQC)

Being Open framework - being open about what happened and discussing patient safety incidents promptly, fully and compassionately 

Duty of Candour regulation - to ensure that providers are open and transparent with people who use services

Manchester Patient Safety Framework (MaPSaF) - a tool to help NHS organisations and healthcare teams assess their progress in developing a safety culture

Reducing term admissions to neonatal units - a programme to reduce harm and reduce separation of mother and baby

How to guide for leadership for safety, Patient Safety First (2008)

Learning from Excellence -  resources and ideas on peer-reported excellence in healthcare

Patient safety in the NHS – NHS Choices website including patient safety data on NHS organisations

Sign up to Safety - a national initiative to help NHS organisations and their staff achieve their patient safety aspirations


A promise to learn – A commitment to act: Improving the Safety of Patients in England (Berwick review, 2013). National Advisory Group on the Safety of Patients in England

National Patient Safety Agency (2004) Seven steps to patient safety

Monitor (2010) Improving patient safety: the role of NHS foundation trust boards