PEER RESPONSES FOR Patient Outcomes and Sustainable Change

Mahsoon, A.N. & Dolansky, M. (2021). Safety culture and systems thinking for predicting safety competence and safety performance among registered nurses in Saudi Arabia: a cross-sectional study.  Journal of Research in Nursing, 26(1-2),19-32. doi:

3. Veronica Montemayor

Reflecting on the “IHI Module PS 203” this week helped me assess the just culture and the safety culture in my organization. As a future DNP leader, these reminders are essential to ensure our staff feels safe and has the materials they need to provide the best quality of care to the patients. Churruca et al. (2022) discussed how they used the Broken Windows Theory (BWT) and assessed the probability that the disorder may be an important construct to consider in hospitals, perpetuating a range of behaviors among staff with potential downstream effects on the quality and safety of care delivered to patients. Through a survey of staff across four hospitals, we identified significant differences between hospitals in staff’s perceptions of physical disorder that were corroborated by themes in qualitative open responses (Churruca et al., 2022). The authors used both quantitative and qualitative analysis for this study. In my organization, I can use quantitative data that reflects incidents where patients were harmed but preventable. The qualitative data may be used to assess the staff’s thoughts on the hospital’s safety culture. We conduct safety surveys every year for the staff and compare the data to the previous year to determine our focus.

To sustain a safety culture, leaders must communicate to reassure the staff that reporting events like near misses benefits future patients and their colleagues. I believe we have come a long way from that feeling that someone must be blamed for errors. Although some incidents may require disciplinary action, this should not be the automatic response. Moureaud et al. (2021) noted that the reporting culture is one that promotes, fosters, and rewards the reporting of errors and events across the spectrum of harm (none to significant harm); for this culture to develop, leaders must support department cultural norms. The authors further noted that these cultural norms include making employees feel psychologically safe to report errors and establishing a culture of error review and follow-up that complies with best practices. The cultural norms listed above are how I will inspire and motivate the staff in my organization toward a journey of zero harm.


Churruca, K., Ellis, L. A., Long, J. C., Pomare, C., Liauw, W., O’Donnell, C. M., & Braithwaite, J. (2022). An exploratory survey study of disorder and its association with safety culture in four hospitals.  BMC Health Services Research22(1), 1–10.

Moureaud, C., Hertig, J. B., & Weber, R. J. (2021). Guidelines for leading a safe medication error reporting culture.  Hospital Pharmacy56(5), 604–609.