Ellis, L.A.Falkland, E.Hibbert, P.Wiig, S.Ree, E.Schultz, T.J.Pirone, C.Braithwaite, J.2023-08-182023-08-182023Frontiers in Public Health, 2023; 11:1-62296-25652296-2565https://hdl.handle.net/2440/139189The concept of safety culture in healthcare-a culture that enables staff and patients to be free from harm-is characterized by complexity, multifacetedness, and indefinability. Over the years, disparate and unclear definitions have resulted in a proliferation of measurement tools, with lack of consensus on how safety culture can be best measured and improved. A growing challenge is also achieving sufficient response rates, due to "survey fatigue," with the need for survey optimisation never being more acute. In this paper, we discuss key challenges and complexities in safety culture assessment relating to definition, tools, dimensionality and response rates. The aim is to prompt critical reflection on these issues and point to possible solutions and areas for future research.en© 2023 Ellis, Falkland, Hibbert, Wiig, Ree, Schultz, Pirone and Braithwaite. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.safety culture; safety climate; patient safety; survey; healthcare benchmarkingHumansSafety ManagementOrganizational CultureDelivery of Health CareSurveys and QuestionnairesJournal article10.3389/fpubh.2023.12175422023-08-18649587