Background: Patient safety was one of the most important issues that arisen in health care management many studies were done at different cities to evaluate healthcare safety goals, the development of a checklist might help in improving the safety culture Purpose: Our work aimed to Measure the patient satisfaction at CCU, and assess the patient safety culture at CCU and finally develop Patient safety Checklist to improve performance Method: Our study was carried out in an adult Cardiac Critical care unit (CCU) at Tanta University hospital using the following Tools 1. Safety Culture Survey Assessment tool 2. Designed safety checklist 3. Patient Satisfaction Questionnaire (PSQ) It included the following phases o Assessment of the safety culture o Development of the checklist o Evaluation of the checklist Results Study results claim that safety culture are poor in CCU especially for involvement of staff in decision making, and the absent of Safety rules and procedure which not supported from top management. But the new established safety checklist arise the safety awareness among the CCU staff. Most of patients complaining of waiting time, insurance coverage, care services, availability resources and perfection. Furthermore many physicians skills need more training to "be careful with patient's complain, Explaining the diagnosis and treatment strategies with patients, be good listener's, and Explain the medical terms". Finally, patients feel insecure for all medical problems.