Iceberg - Hidden Danger And Global Warming Concept

Safety Culture versus Safety Climate

Safety Culture versus Safety Climate – what is the difference? Safety culture has been described as an organization’s value regarding safety and the degree to which staff take ownership for safety. It reflects the “shared beliefs, values, attitudes and customs with regards to workplace safety” (Wolters Kluwer, 2017, para 3) and incorporation of safety thinking into everyday practices. For example, a positive safety culture exists when staff demonstrates safety behaviors when leadership is not present to enforce them, such as conducting time-outs, pre-procedure briefings, or debriefings. In addition, it develops slowly over time (Wolters Kluwer, 2017).

Safety climate represents the current temperature in the room with regard to safety at a specific point in time. It is a snapshot of staff perceptions of processes and behaviors that reflect safety culture and prioritization to safety within the organization. Examples of safety climate features include reporting, speaking up, communication, teamwork, management support/commitment to safety, and safety behaviors (Flin, 2006). These can be impacted by recent safety events or conditions such as short staffing. Using the iceberg analogy, safety climate is represented by the tip of the iceberg (visible features), and culture by what lies underneath the surface. 

Assessment of Safety Climate

Safety climate can be assessed through various surveys, including the Safety Attitudes Questionnaire and the Hospital Survey on Patient Safety Culture (Pettker & Grobman, 2015). Climate surveys can be helpful in assessing strengths and weaknesses. Interventions can then be targeted to specific areas of opportunity. They can also be helpful in raising staff awareness of safety, evaluating trends, and benchmarking against other hospitals. The Hospital Survey on Patient Safety Culture is a validated survey tool that was developed by the Agency for Healthcare Research and Quality (AHRQ) and released for public use in 2004. The survey 2.0 version includes questions around the following topics:

  • Staff working effectively together
  • Respectful behavior 
  • Regular review of processes to improve patient safety including evaluation of changes to determine if they are working well
  • Staff empowerment to speak up when there is a concern for patient safety, including to those of higher authority (Agency for Healthcare Research and Quality, n.d.).

Why is this important? 

Developing, reinforcing, and maintaining a positive culture of safety can lead to better patient outcomes and reduced safety events. A multifaceted approach is required to improve patient safety, including building a culture of safety over time and periodically assessing the safety climate through surveys. Assessment of the safety climate can help to further raise awareness of safety, provide information to then target interventions for improvement, and provide data for benchmarking and trends. 

*If this article interests you, you may also enjoy my book titled: Obstetric and Neonatal Quality and Safety (C-ONQS) Study Guide: A Practical Resource for Perinatal Nurses, available on amazon: Amazon_obneonatalstudyguide


Agency for Healthcare Research and Quality (n.d.) Hospital Survey on Patient Safety Culture. 

Retrieved from

Flin, R. (2006). Measuring safety climate in health care. Quality and Safety in Health Care, 15(2), 109-115. doi:10.1136/qshc.2005.014761

Pettker, C. M., & Grobman, W. A. (2015). Obstetric Safety and Quality. Obstetrics & Gynecology, 126(1), 196-206. doi:10.1097/aog.0000000000000918

Safety Culture & Safety Climate: Knowing the Difference. (n.d.). Retrieved from

Copyright by Jeanette Zocco MSN, RNC-OB, C-EFM, C-ONQS

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