Letters Mid Staffs inquiry

Culture change is not easy but not that difficult

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f1365 (Published 05 March 2013) Cite this as: BMJ 2013;346:f1365
  1. Nick Toff, patient safety adviser and airline pilot1
  1. 1Cambridge University Hospitals NHS Trust, Cambridge CB2 2QQ, UK
  1. nt{at}toffmail.com

Organisational culture is expressed in shared expectations of which attitudes and behaviours are desirable, acceptable, or tolerable. If standards and expectations are high, we strive to do better; if not, we may bend or change. Unclear, unrealistic, or conflicting demands may result in fear, uncertainty, and erratic outcomes.

Hudson describes how a safety management system was a necessary first …

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