In a culture of safety, people are not merely encouraged to work toward change; they take action when it is needed. Inaction in the face of safety problems is taboo, and eventually the pressure comes from all directions — from peers as well as leaders. There is no room in a culture of safety for those who uselessly point fingers or say, "Safety is not my responsibility, so I’ll file a report and wash my hands of it."

Even so, an organization can improve upon safety only when leaders are visibly committed to change and when they enable staff to openly share safety information. When an organization does not have such a culture, staff members are often unwilling to report adverse events and unsafe conditions because they fear reprisal or believe reporting won’t result in any change.

Senior leaders must drive the culture change by demonstrating their own commitment to safety and providing the resources to achieve results. Their message about safety must be consistent and sustained, as it takes a long time for culture to change. Surveys that measure staff perceptions about the organization's culture regarding safety are often useful tools to assess the presence of a culture of safety.