Safety rests at the core of healthcare's mission and purpose, fundamentally shaping both employee and patient experiences. Perceptyx research has repeatedly demonstrated clear relationships between employee experience, patient experience, and safety outcomes — making safety culture improvement a necessary focus for healthcare organizations.
Healthcare leaders increasingly recognize that safety isn't just about protocols and procedures. Rather, it emerges from the complex interplay between organizational culture, employee engagement, and operational systems. Understanding these relationships helps organizations make more effective improvements to their safety programs.
Organizations need evidence-based approaches to enhance their safety cultures, recognizing that the stakes are too high and important to rely on simple anecdotes or gut instincts. This search for proven methods led our Center for Workforce Transformation to conduct a comprehensive analysis of approximately 1,500 healthcare workers, providing a reflective sample of industry perceptions.
Understanding Safety Advocacy
Safety advocacy — when employees willingly recommend their organization as a good place to receive care — strongly correlates with patient perceptions of care quality and their willingness to recommend a healthcare facility to those they care about. Our research identifies several key drivers of safety advocacy that organizations can target for improvement.
Training
Training emerges as a top driver of safety advocacy, particularly crucial given the rapid pace and level of change consistently occurring within healthcare environments. Employees who indicated they received adequate training for their job were much more likely to indicate their organization is a safe place to receive care. Of the more than 800 who said they had the training they needed, almost no one (less than 1%) thought their facility was an unsafe place to receive care. This is a striking contrast to those who felt there were gaps in their training. Of those, 40% were unwilling to recommend their organization as a safe place to receive care.
When new technologies and advances are introduced within an organization, upskilling employees to work effectively and safely with these new systems and processes is paramount. Organizations that prioritize the identification of strategic learning needs as it relates to safety will better position their workforce to provide safe, high-quality care. Take it a step further by evaluating the effectiveness of training programs — such as reactions from the training, learning outcomes achieved, behavior change, or business impact — to ensure your training programs provide the greatest value to employees and the larger organization.
Teamwork
Team dynamics play another especially important role. Historically, teams within healthcare tend to have exceptionally positive working relationships with their immediate team members, even more so than in other industries. Our data shows that these supportive team member relationships positively contribute to safety outcomes. Nearly 50% of healthcare workers on teams with poor collaboration and insufficient helping behaviors, especially during times of high workload, were unwilling to recommend their organization as a safe place to receive care; however, when teamwork is strong, 90% of those healthcare workers advocate for their organization as a safe place to receive care.
One of the most important factors for high-performance teams is psychological safety. There’s strong evidence-based support that teams with members who are comfortable speaking up, especially as it relates to patient safety concerns, are much more likely to recommend their organization as a safe place to receive care. Developing leader behaviors that support inclusivity and trust will position teams for greater success when it comes to safety outcomes.
Values Alignment
The healthcare workforce is deeply connected to and finds a lot of meaning in the purpose and mission of their work. Based on this strong commitment to their field, it’s important for healthcare workers to observe authentic alignment between organizational actions and stated values. In addition, when healthcare workers find strong alignment between their own values and those of the organization, more than 9 in 10 of those workers are willing to recommend their organization as a safe place to receive care.
This workforce population is particularly attuned to misalignments in this area, and it’s not uncommon to hear statements such as leadership being more financially focused than mission-driven when actions don’t seem to be supporting the values of the organization — which is often “Zero Harm” or safety-related. How leaders communicate decisions and changes can influence workforce perceptions, so leaders need to connect their business decisions back to the mission and vision. Framing leaders' communications through this lens helps reinforce to the workforce that safety remains your organization’s north star.
Belonging
Another important factor is ensuring employees have a strong sense of belonging within the organization. Healthcare workers with a strong sense of belonging are 5.5x as likely to recommend the organization as a safe place to receive care compared with those who do not feel like they belong. Additionally, feeling a strong sense of belonging enhances employees’ engagement and lowers their retention risk. This is especially important to safety outcomes as it’s critical to retain key talent across all types of functions and roles, clinical or non-clinical, to support a safer work environment and promote a culture that places safety first.
Over the past year, there has been increasing external pressure for organizations, across industries, to scale back or even eliminate their diversity, equity, inclusion, and belonging (DEIB) functions and practices. As a result of these pressures, organizations are in a litmus test moment to see how committed they are to the espoused values of DEIB. Some have responded by altering their language and how they talk about DEIB, while others have decided to walk back their programs and initiatives in this space. This moment serves as an important reminder that organizations that embed DEIB into their systems, compared to a mere functional purpose, are better positioned for providing safe care and fostering a highly engaged workforce.
Critical Group Differences
Our analysis also revealed several important variations in safety advocacy perceptions across different worker groups. The data shows these differences aren't minor variations — they represent significant gaps in safety advocacy that deserve focused attention from healthcare leaders. Understanding these group-specific challenges helps organizations develop more targeted and effective interventions.
These patterns remained consistent across various healthcare settings, suggesting they represent industry-wide challenges rather than organization-specific issues. This consistency makes them particularly valuable for strategic planning.
Impact of Shift Length
The research clearly demonstrates that longer shift length is negatively related to safety perceptions. Employees working longer shifts (12 hours or more) report less favorable safety perceptions (74% favorable) compared to those working standard 8-hour shifts (82% favorable).
Organizations need to recognize these shift-related differences when designing safety initiatives. While 12-hour shifts may offer operational advantages, the data suggests they require specific support structures to maintain strong safety cultures.
Day vs. Night Shift Differences
Night shift workers show less favorable safety perceptions (69% favorable) compared to their day shift counterparts (82% favorable). This 13-percentage-point gap represents one of the largest disparities in safety advocacy across all groups studied.
This difference isn't surprising when considered alongside other challenges faced by overnight staff. As we noted in our recent shift worker research, night shift employees often struggle with various aspects of their work experience, from reduced access to resources and support to feelings of disconnection from the broader organization.
Healthcare organizations need to develop specific strategies for supporting night shift workers. This might include ensuring consistent resource availability across all shifts, maintaining leadership presence during overnight hours, and creating dedicated communication channels for night staff to raise concerns.
Making Safety Culture Sustainable: Lessons from MetroHealth
MetroHealth, a leading Cleveland-based healthcare provider with more than 9,000 employees that has partnered with Perceptyx, serves as a compelling example of how organizations can build lasting safety improvements through employee engagement and data-driven decision-making. By transitioning from traditional safety surveys to a more inclusive approach that encouraged participation from both clinical and non-clinical staff, MetroHealth doubled its response rate from 25% to 55%. They leveraged innovative crowdsourcing solutions that allowed employees to share and vote on safety improvement ideas, generating over 11,000 votes and surfacing key priorities directly from front-line staff.
Critical to MetroHealth's success was a focus on psychological safety and creating a speak-up culture. The organization found that this approach not only validated existing safety concerns but provided concrete data to drive meaningful change. Leadership emphasized the impact of having robust data to support improvement initiatives, noting that with 1,000 participants and 11,000 votes, the evidence for change was compelling. By prioritizing employee feedback and taking action on identified priorities, MetroHealth created a virtuous cycle of engagement and improvement that continues to enhance both employee satisfaction and patient safety outcomes.
The data shows organizations taking this comprehensive approach see better safety outcomes across all measures. This includes higher patient satisfaction scores and improved employee retention rates. By creating an inclusive environment where all staff members feel empowered to contribute ideas and voice concerns, organizations can build a more robust safety culture. MetroHealth's experience demonstrates that when healthcare providers invest in listening to their employees and acting on their feedback, they create lasting positive change in their safety outcomes.
Perceptyx Can Help Your Organization Improve Its Safety Culture
Building a strong safety culture like the one at MetroHealth requires sustained commitment and regular assessment. Perceptyx's comprehensive listening solutions can help organizations develop and maintain effective safety cultures. Our People Insights Platform provides the features and insights needed to track progress and drive meaningful improvements in safety outcomes.
To learn more about how Perceptyx can help strengthen your organization's safety culture, schedule a meeting with a member of our team.