How to create a safety culture in the healthcare system: the experience of the Tuscany Region

This paper focuses on how to build up a clinical risk management system in healthcare organizations. It is maintained that, to achieve this result, a change in cultural attitudes is needed. It can be obtained by developing adequate tools for risk analysis, which should focus on the peculiarities of the healthcare systems. A no-blame culture should be shared. This culture is based on some basic assumptions. People make mistakes alongside their best skills and good will, sharing adverse events is a learning opportunity, near misses are free lessons and adverse events are often the outcomes of the system.