This quote hit me the first time I read it, partly because it's uncomfortably true. As leaders in healthcare, our influence is felt in ways we don't always see. It's a significant responsibility, and honestly, it's one I'm still learning how to navigate every day. It's not just about what we say in team meetings or post on a bulletin board; it's about what we walk past, what we reinforce (intentionally or not), and what we prioritize on the busiest days. The culture, especially the safety culture, is a direct reflection of what you do, what you prioritize, and, crucially, what you allow. Your actions cast a long shadow; within that shadow, your teams learn what truly matters.

The core message seems simple, yet living it is complex: as healthcare leaders, your actions—far more than your words—shape your organization's safety culture. When you consistently model the safe, communicative, and supportive behaviours you want to see, you implicitly give your team permission to do the same. Your actions are never more critical than when fostering psychological safety – that feeling of trust that allows someone to speak up without fear.

Building this kind of safety leadership isn't about following a perfect formula; there isn't one. It isn't about abstract theories; it's about the daily, tangible, and often challenging ways you lead. It's about understanding that building a robust culture of safety—where both caregivers and those they care for thrive—is a continuous journey, not a destination. It always starts with looking in the mirror and acknowledging that we are all works in progress.

The ripple effect: How your actions shape everything

People mirror what they see. I've watched teams take cues from their leaders—whether it's how they respond to a near-miss or how they handle a high-stress day.

• Modelling matters, imperfectly: When leaders consistently try to prioritize safety checks, openly discuss near-misses without assigning blame, or even admit when they don't have all the answers or made a mistake, it sets a powerful tone. It signals that safety isn't just a poster on the wall; it's how we strive to operate, even when we stumble.
• Vulnerability builds safety: Psychological safety often begins with a leader's courage to be vulnerable. Sharing a personal learning moment, acknowledging uncertainty, or asking for help doesn't show weakness but strength and humanity. It makes it exponentially safer for team members to voice concerns, share innovative ideas, or admit their own mistakes–knowing that errors are part of the learning process for everyone.
• Walk the talk (consistently, even when it's hard): Safety protocols can't just exist on paper. They come alive in how you run meetings, respond to feedback (especially critical feedback), and genuinely check in on your teams' well-being, not just their task lists. If you champion staff well-being but rush past the human element during stressful periods (and let's be honest, we've all done it), your message becomes diluted, and trust erodes. Rebuilding that trust takes time. Consistent, small gestures accumulate, slowly building that foundation.

Walking the talk isn't about achieving perfection; none of us is perfect, and pretending otherwise doesn't help. It's about modelling accountability when things go wrong, demonstrating curiosity rather than blame, and showing genuine care for the team, especially during setbacks. Culture shifts, often gradually, when leaders are humble enough to admit they are learning too, and bold enough to lead out loud, mistakes and all.

Obvious actions, powerful impact: The foundational practices (and the effort they take)

There are some foundational practices that have helped teams I've worked with feel safer and more supported. These aren't magic bullets; implementing them consistently takes effort and ongoing commitment. Are these visible in your leadership practice?

• Short safety huddles work: They don't have to be long, but they help create a shared rhythm and allow people to surface issues early. Maintaining this routine day after day requires discipline, but the payoff in awareness is often worth it.
  • How can you integrate or strengthen daily safety huddles within your teams, whether in a long-term care setting or coordinating home health visits?
• Protecting psychological safety is non-negotiable (and hard work): I've seen what happens when people don't feel safe to report incidents—mistakes get buried, and risks build up. It takes considerable time and consistent, trustworthy actions to build psychological safety, and unfortunately, only a moment of blame or dismissal to break it. Rebuilding it is even harder.
• Violence prevention must be front and centre: This isn't something we can afford to treat as a side issue anymore, though finding the resources and focus amidst competing priorities is a constant challenge. Whether someone's in a home or out in the community, they deserve to feel safe doing their job, and making that a reality requires persistent effort.
• Provide continuous, relevant safety education: Safety skills require constant reinforcement, especially with high turnover and diverse work settings. Go beyond orientation. Implement regular micro-learning sessions on high-risk areas like de-escalation strategies, safe resident/client handling, infection control, and community violence risks for home health staff. Tailor training to specific roles and risk levels, understanding that effective education is an ongoing investment.

Beyond the obvious: Subtle shifts for big gains

While the fundamentals are crucial, cultivating a mature safety culture often involves trying new approaches and learning as we go. Some less obvious leadership behaviours might accelerate the shift, but they usually require experimentation and adaptation:

• Hand the microphone to frontline "micro-leaders": Empower experienced nurses, care aides, or other trusted team members to lead safety huddles. Micro-leadership builds ownership, speeds up adoption, and leverages expertise where it matters most – at the point of care. It also means trusting others and letting go of some control, which can be a learning curve for leaders.
• Offer immediate emotional debriefs (psychological first aid): After a safety event, clinical error, or workplace violence incident, the immediate aftermath is critical. Facilitating short, supportive debriefs that acknowledge potential trauma, focus on lessons learned (not blame), and offer support can lower burnout and PTSD risk. Getting these debriefs right takes practice and sensitivity.
• Give staff autonomy in unsafe situations (and back them up!): Particularly vital in home health, leaders must empower staff to modify, reschedule, bring a partner, or even abandon a visit if they perceive a safety risk, without fear of reprisal. Trusting your team's judgment, combined with clear escalation pathways, reduces harm. This requires a genuine commitment to supporting their decisions, even when it causes inconvenience.
• Share safety data transparently: Don't keep safety metrics hidden. Share data on injuries and incidents to keep safety in mind and promote improvement opportunities. Exposing your data requires vulnerability, especially when the numbers aren't perfect, but transparency builds trust over time.
• Flatten hierarchy through inclusive rituals: Create intentional opportunities to break down traditional hierarchies. Consider "open-door" forums, skip-level meetings[1], or even reverse-mentoring sessions where frontline staff can share insights and concerns directly with leadership. Inclusive leaders who actively invite dissent and credit ideas boost psychological safety. These methods might initially feel awkward, but they can yield valuable insights.

Weaving safety into the very fabric of your organization (a continuous thread)

Building a truly strong safety culture isn't about one-off programs or ticking boxes—it's about the slow, deliberate work of making safety a core part of how your organization functions every single day. That means embedding it into your values, conversations, and decisions at every level. It's a process, often marked by small steps forward and occasional setbacks. Here's what that ongoing effort looks like in action:

• Demonstrating unwavering, visible commitment: Safety must be a clear priority embedded in the mission, vision, and strategic goals. Visible commitment looks like leaders consistently participating in safety meetings (even when busy), allocating budget for safety (even when tight), reviewing safety metrics (even when unfavourable), and recognizing safe practices. Your sustained presence matters.
• Establishing robust communication systems: People need to feel safe speaking up. Create spaces where team members can share concerns or report issues without fear. That includes everyday conversations and clear, trusted ways to raise issues, whether it's a hazard on the floor or a gap in a policy. Listening non-defensively is key.
• Enforcing clear policies with accountability (justly): Develop, communicate, and consistently implement clear, evidence-based safety policies within a just culture framework. This requires the wisdom to distinguish between human error, at-risk behaviour, and reckless behaviour, focusing on learning first. It's not always easy, but fairness is crucial.

• Actively fostering teamwork: Encourage mutual support, respect, peer checking, and collaboration within and across teams. Teamwork is crucial for coordinating care and essential for maintaining cohesion, especially for dispersed home health teams. Positive relationships build resilience, helping teams navigate the inevitable challenges together.
• Empowering frontline staff: Some of the most powerful safety insights come from those closest to the work. Creating space for those voices—and truly acting on what we hear—is often a work in progress for many organizations, including ours. It means not just asking for input, but also being prepared to share decision-making power.
• Championing proactive risk assessment: Shift from reaction to anticipation. Promote systematic efforts to identify hazards before they cause harm. Implement robust, standardized safety assessments, understanding this requires ongoing vigilance.
• Adopting relational leadership styles: Strong relationships are the foundation of safety. That means leading humanly—listening, supporting, and being willing to admit when we don't know something or made a misstep. None of us has this figured out, and we all have room to grow, but showing up with care and consistency matters.
• Driving organizational learning and resilience: Champion a culture where your team views mistakes as learning opportunities. Actively seek feedback, analyze it rigorously (even when critical), and translate insights into tangible improvements. Celebrate and share successful innovations to foster adaptability.

Your leadership legacy: A journey towards a culture of safety

Building and sustaining a culture where safety is paramount isn't a project with an endpoint; it's an ongoing commitment, a journey we undertake together. It starts with recognizing the profound impact of your leadership shadow, for better or worse. It requires intention, consistency, courage, and perhaps most importantly, a constant willingness to learn, adapt, and admit we don't have all the answers. It's not easy, and progress often comes in small, incremental steps, built through trial, error, and persistent effort.

Ask yourself today:

• What behaviours am I modelling—intentionally or unintentionally?
• When did I last admit a mistake or ask for help in front of my team?
• Is it truly safe for my team to be honest, ask questions, or disagree, even when it's uncomfortable?
• How do we really respond when the team raises safety concerns?
• Are we rewarding the behaviours and the courage it takes to create safety, or just focusing on outcomes?

Your answers to these questions illuminate the path forward. Let's commit to leading by learning from our missteps and patiently building healthcare environments where everyone – caregivers, residents, elders, and clients – feels safe, valued, and protected. Our collective leadership, day by day, makes the difference.

[1] A skip-level meeting is a meeting where a manager or leader meets directly with employees who are two or more levels below them in the organizational hierarchy. Essentially, the leader "skips" the level of the direct manager to connect with their team members. The employee's direct manager does not typically attend this meeting.