Most previous work on organizational safety climate focused on worker safety in manufacturing industries and passenger safety in the airline industry. There is an extensive literature in manufacturing industries outlining several key factors that affect the rate of worker injury. Dominant among these are supervisory systems and behaviors, including the individual supervisor’s attitudes, actions, expectations, and communications; inclusion of safety in the supervisor’s position responsibilities; involvement of senior management and workers in safety issues; and the attitudes and behaviors of the workers themselves as influenced by the system [7, 8].

Over the last two decades there has been increasing emphasis and interest in studying, measuring, and improving patient safety. Clearly, there is a big difference between the safety of patients and the safety of workers, as patient’s outcomes are largely out of their control. As such, the safety climate of an organization or hospital unit that results from the attitudes and behaviors of healthcare workers functions as a surrogate for a patient’s individual safety. Therefore, patient safety mostly resembles passenger safety, which is why healthcare leaders have turned to the aviation industry for guidance and examples on how to measure and change safety climate.

Since the Institute of Medicine (IOM) recommended that healthcare organizations show enhance their patient safety culture, there have been many surveys developed to measure safety climate in healthcare organizations [9]. A recent systematic review of the available surveys over a dozen safety climate surveys being used in health care settings [10]. These range from surveys designed for teams to complete together (i.e., Strategies for Leadership: An Organizational Approach to Patient Safety (SLOAPS)) to surveys focusing on individual hospital units (i.e., Safety Attitudes Questionnaire (SAQ)). The currently available surveys measuring safety climate in the healthcare setting vary considerably with regard to their general characteristics, dimensions covered, and the psychometrics performed in their development. Further, the IOM challenged providers to not only measure their safety climates, but to improve them with the ultimate goal of improving patient outcomes. However, few safety climate survey results have been directly compared to patient outcomes. Rather, these are generally used to compare safety climates between and within institutions. Therefore, it remains vital to the improvement of patient safety that we continue to study the association between climate survey scores and patient outcomes. Taking for granted the association between these two measures may result in significantly misguided investments.

Understanding and measuring safety culture can be difficult. The idea behind studying an organization’s safety culture is to place a finer point on the statement, “That’s how things are done around here.” As mentioned earlier, qualitative methods are traditionally used to study culture. Several qualitative methods have been used to measure safety culture, including interviews, focus groups, audits, and expert ratings. Many who study safety culture have generally rejected quantitative methods such as questionnaires as an inappropriate means of data collection. However, a hybrid approach has been employed in some studies where qualitative methods are used to investigate safety culture, and quantitative methods are subsequently developed on the basis of those results [11]. The concern with questionnaires is the results are open to misinterpretation and researcher-bias unless some form of follow up is conducted with respondents. Surveys that attempt to elucidate the current state of safety culture may thus misguide administrators and managers resulting in reactionary changes for a so-called “quick fix,” with little regard for long-term solutions. Therefore, it remains difficult to study safety culture in isolation from safety climate for the reasons described above. The casual use of the term culture in lieu of climate in the literature creates confusion. Thus, most of the research into culture may actually be providing further insight in to safety climate. Ultimately, the study of safety culture in surgery and healthcare as a whole remains a wide open field fertile for further research.