• S R Gutiérrez Ubeda.
• Centro de Investigaciones y Estudios de la Salud, Managua, Nicaragua. Electronic address: sergioramon74@yahoo.com.
• Rev Calid Asist. 2016 May 1; 31 (3): 173-6.

AbstractEfforts to introduce a safety culture have flourished in a growing number of health care organisations. However, many of these organisational efforts have been incomplete with respect to the manner on how to address the resistance to change offered by the prevailing punitive culture of healthcare organisations. The present article is intended to increase the awareness on three reasons of why an effort is needed to change the punitive culture before introducing the patient safety culture. The first reason is that the culture needs to be investigated and understood. The second reason is that culture is a complex construct, deeply embedded in organisations and their contexts, and thus difficult to change. The third reason is that punitive culture is not compatible with some components of safety culture, thus without removing it there are great possibilities that it would continue to be active and dominant over safety culture. These reasons suggest that, unless planning and executing effective interventions towards replacing punitive culture with safety culture, there is the risk that punitive culture would still prevail. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

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