Qual Saf Health Care 19:e20 doi:10.1136/qshc.2008.029793   •
Original research  Multilayered approach to patient safety
culture    1. Pia Oedewald   1. VTT, Espoo, Finland   1.
Correspondence to Dr Teemu Reiman, VTT, PO Box 1000, FIN-02044
VTT, Finland; teemu.reiman{at}   • Accepted 11 November 2009   •
Published Online First 19 August 2010   Background The concept
of patient safety culture (PSC) has increasingly been used in
the development of patient safety. However, no theoretical
framework on the nature of the underlying phenomenon has been
created. Multiple characterisations of the key dimensions of PSC
exist, but they yield little theory on patient safety culture or
its relation to patient safety. The authors propose a dynamic
and multilayered construct of patient safety culture and
illustrate the critical dimensions at each layer.  Conclusions
PSC can be defined as the willingness and ability of an
organisation to understand safety as well as the willingness and
ability to act on safety. Patient safety