​Achieving a patient safety focus is a never-ending process, said healthcare risk management consultant Kathryn Wire, JD, MBA, CPPS, CPHRM, FASHRM, at a session on safety culture landmines held October 8, 2018, at the annual conference of the American Society for Health Care Risk Management (ASHRM) in Nashville. Leaders who think that having a quality department is sufficient for their patient safety goals can derail a healthcare organization's efforts to improve its safety culture. "Patient safety is not an achievable state," said Wire. "It's a process and journey, but it's never really finished." To develop a safety culture, Wire recommended an approach called "positive deviance," which focuses on learning what people do to successfully achieve safe practices (instead of over-analyzing what people do when they make mistakes). "It's a method of using the people in your organization who have already solved a problem," said Wire. She told risk managers to be wary of best practices because "what works in one place won't always work in another." Wire also recommended taking the findings from safety culture surveys to ask staff for more input. Using positive deviance, ask staff how the organization "would look if we had 100% positive answers" to the survey, she said. "Look to your own internal experts. You'll identify actionable items to take forward." There's no "silver bullet" to developing a safety culture, she advised attendees, reminding them of the saying, "You eat an elephant one bite at a time." Sharing the podium with Wire, Lee Varner, MS-EMS, CPPS, EMT-P, patient safety director for emergency medical services (EMS), Center for Patient Safety, spoke about developing an EMS safety culture survey. With any safety culture initiative, it is important to engage people, he said, adding, "You need a champion who will see this through so it doesn't become the flavor of the month."