Comprehensive unit-based safety program in practice: high reliability organising, patient safety and organisational human factors in Victoria’s public healthcare system – a qualitative study

Purpose – This study aims to explore organisational human factors in implementing and evaluating the Comprehensive Unit-based Safety Program (CUSP) as part of a high reliability organisations (HROs) framework for improving patient safety in a public hospital setting in Victoria, Australia. Design/methodology/approach – A qualitative study using semi-structured interviews with 15 participants from seven CUSPs was conducted. Participants represented diverse clinical and non-clinical roles, selected based on program maturity and availability. Data were collected between August 2022 and March 2023, with thematic analysis using deductive and inductive coding. Reflexive practices, including transcript verification and peer debriefing, ensured rigour. Findings – CUSP emerged as vital for fostering leadership, accountability, teamwork and psychological safety – pillars of a robust safety culture. Thematic analysis revealed three core themes: HRO Principles, Organisational Human Factors and Quality and Safety. CUSP’s integration of timely, actionable safety data enhanced teamwork, flattened hierarchies and drove collaborative improvements in patient safety. By blending technical and adaptive elements, the program cultivated a proactive safety culture. These findings emphasise embedding human factors and leadership into safety programs while identifying a need for further research into CUSP’s scalability and long-term impact. Practical implications – CUSP’s adaptable, data-driven approach can embed patient safety into organisational practices. Healthcare organisations can leverage this study’s insights to prioritise leadership, promote psychological safety and ensure data accessibility for staff. Originality/value – To the best of the authors’ knowledge, this is the first Australian study to examine CUSP within a HRO context, highlighting how leadership and teamwork underpin safety program success in public healthcare.