Aim: Speaking up about medical errors is an essential behaviour for nurses in pursuit of their goal of maintaining patient safety. This study was designed to understand how a hospital's culture and climate can impact a nurse's active behaviour in this important health care activity.Background: Research shows that while medical errors happen frequently, there is great variability on whether these errors are reported. As such, organizational culture, climate and commitment as well as employee perceptions associated with the reporting process were investigated to determine their impact on participants' intentions to speak up about medical errors. Methods:Focus groups and one-on-one interviews were used to collect these data and were analysed using content analysis. Results/KeyIssues: Nurses in the hospital perceive and understand both the benefits and barriers to reporting medical errors. Commonly reported benefits include patient safety, promoting education and awareness, and the improvement of internal processes or systems. Barriers include an inefficient reporting system and organizational influences such as perceived consequences and unequal status/position of the individual who made the error and the person reporting the error. Participants are aware that the organization believes that the responsibility to report medical errors falls to everyone. Conclusions: Results indicate that the organization's existing culture does not facilitate the reporting of medical errors and that the organizational climate interferes with the reporting process. Lastly, organizational commitment is not related to the perception of importance given to the reporting of medical errors by the hospital. Implications for Nursing Management: Nurses and nurse managers are an essential part of any hospital. In their role, they can effect change on the organization's culture and climate, but often do not realize the connection between organizational culture and patient safety. Results indicate that promoting organizational commitment to speaking up through the creation of a positive organizational culture can both promote speaking up about medical errors and increase patient safety. K E Y W O R D S organizational culture, patient safety, speaking up | 131 LEVINE Et aL.

lesson plan, and at the conclusion of the intervention. Results: Sixty two participants (49% male/female) with a mean age range of 70-79 y completed the study, and 63% indicated they had at least one chronic condition. Wilcoxon Signed Rank indicated a significant improvement in nutrition knowledge of participants who completed the post intervention test (z = -2.56, P = .01). One-way ANOVA indicated that after the grains lesson plan, the intervention participants (N = 32) intent to change behavior as reported in "I will eat ≥ 3 oz of grain/d next month" was significant, P = .05. Conclusion:There was a significant improvement in knowledge change. Intent to change behavior was significant after the grains intervention, but not after the other five lessons. Some seniors indicated older age > 85 y was a barrier to change since they "made it that far." Designing interventions for seniors needs to be age specific targeting younger seniors for behavior change.