The Use of Red Rules in Patient Safety Culture

This article examines the use of Red Rules in hospital patient safety culture. The purpose of this study is to explore the effects of Red Rules on hospital staff perceptions of safety, frequency of events reported, number of events reported, and staff perceptions of non-punitive response by management. A survey was conducted among hospitals that completed the U.S. Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture during the years 2007 to 2011. A sample of hospitals who implemented Red Rules were compared with a similar group who did not. Contrary to expectations, this study did not find statistically significant differences between the study group (Red Rules) and the comparison group (Non-Red Rules). In the absence of evidence on the use of Red Rules, some hospital leaders have elected not to use them, assuming that they are inconsistent with a just culture and with improving patient safety. The results do not provide support for this belief. Used within a commitment-based management style as a communication tool to support staff in following safety rules rather than as a disciplinary tool in a control-based environment, Red Rules can be part of a comprehensive strategy to improve patient safety.