Generally, trainees had comparable to more favorable perceptions of patient safety culture compared with staff. They did identify opportunities for improvement though. Hospitals can use perceptions of patient safety culture to complement CLER visit reports to improve patient safety.

Institute of Medicine reports provide evidence of the failings of the healthcare system in the United States and a vision of the required transformation. The Institute for Healthcare Improvement and the Robert Wood Johnson Foundation created the Transforming Care at the Bedside initiative in 2003 to develop and validate a process for transforming care in hospital medical-surgical units. The authors describe Transforming Care at the Bedside as implemented by one of Institute for Healthcare Improvement/Robert Wood Johnson's initial pilot hospitals, including promising outcomes and a model for spreading the initiative.