Safety Culture in Health Care

It is widely recognized that human factors play a crucial role for safety in modern workplaces, not only in hightech, human-machine operation domains (e.g., Bryant, 1991; Amalberti, 1998; Hollnagel, 1998) such as aviation, maritime, and nuclear power plants, but also in health care (Kohn et al., 1999). The recognition that operational safety (and patient safety in health care) depends on our abilities to control human error does not mean that efforts should be directed exclusively to the psychological mechanisms underlying human error. Rather, effective safety management should be directed at factors that are conducive to human failure (Rasmussen, 1986)-in particular factors that are within the direct control of the organization. Thus, organizational factors have long been acknowledged to be of critical importance for safety in human-machine system operations (Griffiths, 1985; Reason, 1993), and in Reason’s thesis it has been pointed out that organizational problems are frequently latent causal factors that contribute or even lead to the occurrence of human error made by frontline personnel and has become part of the industry standard in this field (Reason, 1997). Indeed, the majority of contributing causes to major accidents may be attributed to the organizations themselves (ibid.). For example, it has been reported that 40% of incidents in the Dutch steel industry were caused by organizational failures (van Vuuren, 2000). Similarly, based on studies in aviation and maritime operations, it has been suggested that the quality and safety, by which the operators accomplish their tasks, are affected not only by their professional and technical competence and skills, but also by their attitudes to and perceptions of their job roles, their organization, and management (Helmreich and Merritt, 1998).