[Safety culture as a core element of surgical patient safety]

Safety culture is considered a key factor for sustainable patient safety. It encompasses the shared values, attitudes and behaviors of an organization in dealing with risks, errors and responsibility. In highly complex clinical systems adverse events rarely result from individual failure alone but typically arise from the interaction of structural, organizational and communicative factors. An effective safety culture therefore relies on systemic thinking, transparent communication, a nonpunitive approach to errors, the active promotion of speak-up behavior and psychological safety. The discrepancy between formal procedures (work as imagined) and everyday practice (work as done) highlights that safety can only be achieved when standards are designed to reflect real-world conditions and are regularly reviewed. Tools such as checklists are effective only within an environment characterized by psychological safety. Staff surveys, feedback systems, interprofessional training and committed leadership are key levers for continuously measuring, developing and sustainably embedding safety culture. Safety culture is not a one-time initiative but an ongoing organizational development process.