Table 4.

Safety culture themes

Theme	Definition	Example item	No. studies/surveys used in (%)
(1) Leadership	Leadership and their support and commitment to safety.	My supervisor often discusses safe work practices with me. (HSCS)	Total*	85 (77.3)
			Quantitative†	66 (78.6)
			Qualitative‡	4 (33.3)
			Mixed methods§	15 (78.9)
(2) Perceptions of safety	Perceptions of how safe the organisation is.	Please give your unit an overall grade on patient safety. (MSI)	Total*	65 (59.1)
			Quantitative†	41 (48.8)
			Qualitative‡	7 (58.3)
			Mixed methods§	17 (89.4)
(3) Teamwork and collaboration	Working together as a team and coordination of care among staff.	I enjoy working as part of a team. (ORMAQ)	Total*	61 (55.5)
			Quantitative†	41 (48.8)
			Qualitative‡	4 (33.3)
			Mixed methods§	16 (84.2)
(4) Safety systems	Systems, procedures and processes exist that facilitate patient safety (eg, rewards, reporting systems).	Things ‘fall between the cracks’ when transferring patients from one unit to another. (HSOPS)	Total*	58 (52.7)
			Quantitative†	40 (47.6)
			Qualitative‡	4 (33.3)
			Mixed methods§	14 (73.7)
(5) Prioritisation of safety	Shared belief, behaviours and norms in which staff in the work area prioritise and value safety.	Patient safety is never sacrificed to get more work done. (HSOPS)	Total*	59 (53.6)
			Quantitative†	42 (50)
			Qualitative‡	2 (16.7)
			Mixed methods§	15 (78.9)
(6) Resources and constraints	Resources for safety including staffing, equipment, lack of time and training.	My unit provides training on teamwork in order to improve patient care performance and safety. (PSCHO)	Total*	58 (52.7)
			Quantitative†	43 (51.2)
			Qualitative‡	1 (8.3)
			Mixed methods§	14 (73.7)
(7) Reporting and just culture	Willingness to report and a culture that does not assign blame.	Staff feel like their mistakes are held against them. (HSOPS)	Total*	54 (49.1)
			Quantitative†	37 (44)
			Qualitative‡	2 (16.7)
			Mixed methods§	15 (78.9)
(8) Openness	Open communication, staff feeling comfortable to express their issues or concerns and question behaviours.	In this clinical area, it is difficult to discuss errors. (SAQ)	Total*	54 (49.1)
			Quantitative†	35 (41.7)
			Qualitative‡	4 (33.3)
			Mixed methods§	15 (78.9)
(9) Learning and improvement	A focus on learning from mistakes, responding to, and improving systems.	When errors happen, we discuss how we could have prevented them. (SOS)	Total*	51 (46.4)
			Quantitative†	34 (40.5)
			Qualitative‡	3 (25)
			Mixed methods§	14 (73.7)
(10) Awareness of human limits	Awareness of individual ability to be safe and how that can be limited by various factors (eg, fatigue).	I am less effective at work when fatigued. (SAQ)	Total*	24 (21.8)
			Quantitative†	16 (19)
			Qualitative‡	3 (25)
			Mixed methods§	5 (26.3)
(11) Well-being	Job satisfaction, burnout and other psychosocial factors.	Morale in this clinical area is high. (SAQ)	Total*	17 (15.5)
			Quantitative†	10 (11.9)
			Qualitative‡	1 (8.3)
			Mixed methods§	6 (31.6)
Other	New, emerging themes and those unable to be classified elsewhere. Includes: flexibility, monitoring, personal values, patient and family involvement.	It is important that my competence be acknowledged by others. (ORMAQ)	Total*	30 (27.3)
			Quantitative†	16 (19)
			Qualitative‡	6 (50)
			Mixed methods§	8 (42.1)

*% of total calculated on n=110. Insufficient detail on five surveys and four surveys were counted in the mixed methods studies because they were single-use and developed by the authors.

†% of total calculated on n=84.

‡% of total calculated on n=12.

§% of total calculated on n=19.

HSCS, Hospital Safety Culture Survey; HSOPS, Hospital Survey on Patient Safety Culture; MSI, Modified Stanford Instrument; ORMAQ, Operating Room Management Attitudes Questionnaire; PSCHO, Patient Safety Climate in Healthcare Organisations survey; SAQ, Safety Attitude Questionnaire; SOS, Safety Organising Scale.