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The mission of TJC is to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value (TJC, 2018a, 2018b, 2018c). Founded in 1951, TJC uses the Donabedian conceptual framework of structure, process, and outcomes to assess an organization. TJC (March 1, 2017) identified 11 leader expectations for developing a safety culture, as outlined in Table 4.7. These expectations are very appropriate for nurse leaders in every level of an organization.

Table 4.7 Joint Commission Expectations for Leaders in Developing a Safety Culture

Create a transparent, non‐punitive approach to reporting and learning from adverse events, close calls, and unsafe conditions.Establish clear, just, and transparent risk‐based processes for recognizing and separating human error and error arising from poorly designed systems from unsafe or reckless actions that are blameworthy.Adopt and model appropriate behaviors and champion efforts to eradicate intimidating behaviors.Establish, enforce, and communicate to all team members the policies that support safety culture and the reporting of adverse events, close calls, and unsafe conditions.Recognize team members who report adverse events and close calls, who identify unsafe conditions, or have good suggestions for safety improvements.Establish an organizational baseline measure on safety culture performance using the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture or another tool, such as the Safety Attitudes Questionnaire.Analyze safety culture survey results from across the organization to find opportunities for quality and safety improvement.Develop and implement unit‐based quality and safety improvement initiatives designed to improve the culture of safety.Embed safety culture team training into quality improvement projects and organizational processes to strengthen safety systems.Proactively assess system strength and vulnerabilities and prioritize them for enhancement or improvement.Repeat organizational assessment of safety culture every 18 to 24 months to review progress and sustain improvement.

Source: The Joint Commission. (2018b). 2019 Hospital National Patient Safety Goals. Retrieved from www.jointcommission.org/assets/1/6/2019_HAP_NPSGs_final.pdf.