AUSTIN, Texas — Sometimes when an organization has a special culture, you can just sort of sense it, hanging in the air like a puff of smoke. But what are the key attributes that make those organizational makeups so unique?

During the just-concluded National Patient Safety Congress on Friday, culture was a word seemingly on every speaker's tongue. As we touched on in our video interview with the foundation CEO last week, any organization can make one-time gains in improving patient safety. But it takes a strong culture, starting at the top with the chief executive, to sustain those changes in the long run. Culture, however, can be sort of a squishy, nebulous thing. Allan Frankel, M.D., chief medical officer of consulting firm Safe & Reliable Healthcare, disputed that notion, and looked to provide a little clarity during his closing keynote Friday.

"This is not complicated stuff; we just seem to struggle to get it right," Frankel told attendees, later adding, "Culture is not shapeless; it's not esoteric. It is absolutely measurable and it has distinct components to it."

Those components include everything from teamwork to psychological safety, understanding the relationship between people and the environment, and organizational fairness, all of which have to be intact to succeed, Frankel said. When Frankel walks into an organization to help leaders iron out their cultures, he's measuring how people interact (engagement, teamwork), workflow improvement, organizational values, whether technology is enabling or disabling people from doing their work, and external influences that are hammering away at employees' time (such as competition or reporting requirements).

Just last summer, Frankel evaluated culture at 27 hospitals in Massachusetts, did face-to-face interviews with 2,500 employees, and found those metrics to be useful in gauging the organization's culture. Under the "people" category, psychological safety, AKA burnout, in particular, can erode an organization's culture. Frankel noted that more than 30 percent of health care workers are experiencing burnout. And that may have something to do with the 28 percent turnover rate in the industry, and the fact that one in four registered nurses are leaving the profession within one year of training. Thirty-three percent of health care workers plowed through a shift without any breaks, Frankel noted, and 39 percent slept less than five hours in a night. When you're worn out, tired, disillusioned, you're far less likely to speak up when you see a mistake.

"In an environment like this, what do you think the likelihood is that you can bring value in [if you're burned out]? Zilch," Frankel said. "You want improvement to get done on top of this particular cultural milieu? It ain't gonna happen. It just won't. … You have to be culturally healthy in order to create a learning system."

Trust and providing valuable feedback are also critical in any "nimble culture," Frankel said. When all the requisite components come together, he believes that no issue is too difficult for a health care organization to tackle.

"All of the stuff falls into place. The leaders do what they're supposed to, the teams begin behaving the way they should, and improvement begins to land where it should. Then, bang, the process begins to unfold. There's a tipping point. Cultures catapult from mediocrity into excellence when all of the components come together, because only then do they grapple with thorny issues."