Teamwork and Safety Culture


In A Nutshell:

Measurement of team safety culture is a core element of our patient safety work. The Improvement Academy uses a validated tool developed by University of Texas within a framework of systematic team-level data collection and analysis. Electronic data capture will provide a means of measuring/benchmarking team culture across the region.

“In the end, culture will trump rules, standards and control strategies every single time, and achieving a vastly safer NHS will depend far more on major cultural change than on a new regulatory regime.”

Don Berwick, 2013

Whenever the Improvement Academy is involved in supporting teams to improve quality and safety, we encourage that team to start with a team culture survey. The 33 question validated questionnaire, developed by the University of Texas, is both a diagnostic and an intervention to improve culture. This has now been adapted for use in many different healthcare settings. Since 2013, we have worked with over 400 teams, analysing over 10,000 individual surveys across over 40 organisations.

Why is it important to measure team working and safety culture?

  • Disharmony within any team is a distraction and means that the team won’t be in an optimal position.
  • A highly dysfunctional culture where there are disparate scores amongst the team groups – whilst rare – is a strong indicator of clinical risk.
  • When there are very different perceptions and individuals who are not happy, there is always a ‘price to be paid’ in terms of safety.


When there are very different perceptions and individuals who are not happy, there is a always a ‘price to be paid’ in terms of safety.


What does a sound safety culture look and feel like?

  • Every member of the team, regardless of their role and professional group, feels valued.
  • Everybody also feels like they can speak up if they feel worried about a patient (Psychological Safety).


What does research tell us?

  • Safety Culture “lives” at team level and therefore has to be measured there.
  • A team that works together is a safe team.
  • The degree to which nursing input is positively received, particularly by doctors, correlates with patient outcomes.
  • Commonly, doctors will believe that the team works really well together but other team members often don’t agree.


What’s the Improvement Academy’s observation and theory?

  • We’ve surveyed hundreds of teams over many years and, without exception, teams tell us they find the survey helpful.
  • When teams are equipped with insight into how they work as a team and how safe they perceive their care to be, they feel empowered to take action where necessary.
  • The process of measuring, analysing and giving the team their results is an intervention in itself.
  • The majority of the elements of the survey are within the gift of the team to improve.

Contact Information

Alison Lovatt

Vicky Padgett

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