Staff willingness to report threats to patient safety is critical to preventing errors and improving safety and is an indicator of an organization’s safety culture. The authors discuss studies exploring what factors influence whistleblowing, organizational responses, and implications for practice or policy. The authors concluded that the existing literature focuses on the decision to speak up. There is limited evidence discussing organizational responses or systems-level changes, yet these actions influence whether the patient safety threats are addressed and if future events will be reported.

Psychological safety empowers staff to speak up about problems. This commentary highlights how senior managers can help ensure that departmental-level conditions facilitate the reporting of concerns. The authors call for organizations and managers to encourage speaking up and to respond appropriately.

Organizational acceptance of accountability for failures and implementation of solutions are critical to improve safety. This review explores the impact of investigations focused at the individual, practice, and system levels. The authors describe design and operational failings at each level that enable purposeful or accidental patient harm.

Hospital leadership oversight is thought to be critical for advancing patient safety initiatives. This narrative review synthesized 122 studies examining the role of hospital board oversight in fostering safety practices. Investigators found that high-performing hospitals are more likely to have skilled board members and standardized board processes compared with low-performing hospitals, highlighting the value of effective and committed leadership that prioritizes quality and safety improvement. However, more research is needed to determine optimal hospital governance. A past AHRQ WebM&M interview discussed the role of leadership and medical administration in patient safety.

In three British hospitals, poor teamwork between physicians and nurses impaired efforts to improve the quality of postoperative pain management due to both parties' reluctance to step outside their perceived professional boundaries.