Intentionally foster communities and cultures that promote respect, inclusion, belonging, psychological safety, compassion, collaboration, and shared responsibility for wellbeing.

Culture: At-a-Glance

What is this strategic direction about?
Fostering safe, inclusive, supportive, and health-promoting cultures across learning and work environments.

Why does it matter?
Culture shapes how people feel a sense of belonging within their working and learning environments.

What will I do here?
Learn how your institution can foster connection and advance a culture of wellbeing, safety, and belonging for all.

What you’ll find in this section

Overview: Why Culture Matters
Key Components of Health-Promoting Culture
Putting Health-Promoting Culture into Practice
Case Studies
Explore Your Role in Health-Promoting Culture
Tools and Resources

Overview

Why Culture Matters

Culture shapes how people experience learning, work, leadership, relationships, and care within our institutions. It influences what behaviours are rewarded, what concerns feel safe to raise, how people treat one another, and whether individuals feel valued, supported, and included. Culture is reflected not only in formal policies and structures, but also in everyday interactions, teaching practices, team dynamics, and the often-unspoken norms that define “how things are done.”

Historically, the culture of medicine has been shaped by beliefs that prioritized endurance, hierarchy, perfectionism, and self-sacrifice. Although many institutions are actively advancing wellbeing, equity, inclusion, and psychological safety, remnants of these cultural norms continue to influence learning and working environments. Misalignment between institutional values, everyday behaviours, and rewarded practices can contribute to distress, burnout, inequities, mistreatment, and barriers to help-seeking.

So how do we begin to change ingrained cultures?

Creating health-promoting cultures requires intentional action across leadership, systems, policies, education, relationships, and environments. It involves reinforcing behaviours that support wellbeing, respect, inclusion, and belonging while addressing practices that undermine psychological safety and equity. Sustainable culture change also requires alignment between institutional values, accountability processes, reward structures, and daily experiences across the community.

Health-promoting cultures support engagement, collaboration, learning, professional fulfillment, and quality patient care. While leadership and organizational systems are important drivers of change, culture is also shaped through everyday interactions, peer norms, and informal learning environments. Meaningful change therefore requires both institutional commitment and collective participation across all levels of the organization.

This section focuses on practical approaches that help institutions foster connected, sustainable, and supportive communities grounded in compassion, respect, relational leadership, equity, and collective wellbeing.

The Culture of Academic Medicine Initiative resource collection includes tools, publications, and practical resources related to ppc safety, organizational culture, wellbeing, and health-promoting learning environments.

How Culture Connects to Other Strategic Directions in the Okanagan Charter

Culture influences how policies are experienced, how spaces are used, whether people seek support, and how individuals learn and grow. Culture is both shaped by and shapes every other Strategic Direction.

Policy

Policies help establish expectations and accountability, but culture influences how those policies are interpreted and enacted in practice.

Spaces

Physical, social, and virtual environments can reinforce or challenge cultural norms, relationships, inclusion, and belonging.

Personal Development

Reflection, communication, mentorship, leadership, and professional identity formation contribute to healthier and more supportive cultures.

Health Services

Cultures that reduce stigma and encourage help-seeking can improve access to support and strengthen wellbeing across the community.

Continuous Quality Improvement & Evaluation

Feedback, evaluation, and organizational learning help institutions understand cultural strengths, identify challenges, and monitor progress over time.

Key Components of Effective Health-Promoting Culture

Health-promoting cultures are fostered through relationships, leadership, systems, policies, teaching practices, and everyday interactions that support wellbeing, inclusion, psychological safety, collaboration, and meaningful connection across learning and working environments. While every institution will have unique priorities and contexts, several core components consistently contribute to healthier and more supportive cultures.

Together, these components represent the foundational conditions of a health-promoting culture and provide a lens for reflection, assessment, and action. They are often interconnected and mutually reinforcing, with progress in one area often strengthening progress across others.

Psychological Safety and Respect

People are more likely to learn, collaborate, ask questions, seek support, and provide feedback when they feel psychologically safe and respected. Health-promoting cultures foster respectful communication, curiosity, inclusion, and accountability while actively addressing mistreatment, discrimination, harassment, and harmful power dynamics.

This may include respectful feedback practices, psychologically safe reporting pathways, inclusive communication, and clear expectations for professional behaviour.

Equity, Inclusion, and Belonging

Health-promoting cultures create environments where diverse identities, experiences, perspectives, and ways of knowing are respected and valued. Individuals experience fairness, accessibility, cultural safety, meaningful inclusion, and a sense of belonging within learning and work environments.

This may include accessible environments, culturally safe practices, inclusive policies, and intentional efforts to reduce barriers and inequities.

Connection, Community, & Relational Leadership

Supportive cultures are strengthened through positive relationships, mentorship, collaboration, transparency, and compassionate leadership. Leaders, educators, and colleagues help shape culture through everyday interactions, role modeling, allyship, and shared responsibility for community wellbeing.

This may include mentorship, peer support, collaborative leadership practices, recognition of contributions, and responding constructively to harmful or exclusionary behaviours.

Growth-Oriented Learning and Support

Educational and workplace cultures influence professional identity formation, confidence, wellbeing, and help-seeking behaviours. Health-promoting cultures support reflective learning, psychologically safe supervision, constructive feedback, mentorship, coaching, and accessible wellbeing supports that encourage growth rather than fear or shame.

This may include coaching-based feedback, reflective practice, learner-centered supervision, mentorship opportunities, and visible wellbeing supports.

Reflection, Accountability, & Continuous Improvement

Sustaining culture change requires ongoing reflection, feedback, transparency, and accountability. Health-promoting cultures use data, lived experience, dialogue, and continuous quality improvement processes to identify strengths, address gaps, and guide meaningful organizational change.

This may include culture surveys, focus groups, feedback mechanisms, transparent reporting, and continuous quality improvement initiatives.

Putting Health-Promoting Culture into Practice

Improving culture requires coordinated action across leadership, systems, teaching, relationships, supports, environments, and continuous improvement efforts. The following domains provide practical areas where institutions can strengthen and sustain health-promoting cultures across their organizations.

Together, these domains can support implementation planning, organizational reflection, and application of the concepts explored throughout this Strategic Direction.

Domains of Action for Advancing Culture

Leadership and Governance

Signal the Commitment

Leadership behaviours strongly influence organizational culture. Leaders help shape whether people feel psychologically safe, valued, included, and supported. Visible commitment, relational leadership, and accountability help align institutional values with everyday experiences.

Potential strategies may include:

Publicly endorse and operationalize the principles of the Okanagan Charter within organizational priorities and strategic plans.
Integrate health-promotion, wellbeing, EDIA, and culture goals into strategic planning, accreditation processes, and program review.
Establish cross-portfolio leadership or governance groups to coordinate culture and wellbeing initiatives.
Include culture, wellbeing, respect, and equity indicators within leadership accountability and performance review processes.
Recognize and reward leadership practices that foster collaboration, inclusion, psychological safety, mentorship, and community-building.
Engage learners, faculty, staff, and communities in decision-making and improvement efforts.

Visible leadership behaviors such as transparency, relationship-building, and prioritizing wellbeing can strongly influence organizational culture and trust.

Policies and Systems

Create Structures That Support People

Policies and organizational systems communicate institutional priorities and shape daily experiences. Supportive structures can foster fairness, safety, accessibility, and trust, while poorly designed systems may reinforce inequities, stigma, or unnecessary stress.

Potential strategies may include:

Review policies through wellbeing, accessibility, equity, Indigenous, anti-racism, and cultural safety lenses.
Establish and uphold clear approaches to harassment, discrimination, mistreatment, and unsafe learning or working environments.
Create psychologically safe reporting pathways with transparent follow-up and accountability processes.
Simplify processes related to accommodations, conflict resolution, leave, and learner or faculty supports.
Embed principles of psychological health and safety within organizational policies and practices.
Design systems that reduce avoidable administrative burden and support sustainable workloads.
Ensure policies align institutional values with expected and rewarded behaviours.

Focus first on high-impact processes that strongly influence day-to-day experiences, such as reporting pathways, accommodations, workload expectations, and communication practices.

Teaching and Learning

Embed Wellbeing, Respect, and Inclusion into Education

Educational environments shape professional identity formation, help-seeking behaviours, team dynamics, and perceptions of psychological safety. Supportive learning cultures promote curiosity, growth, reflection, and compassionate practice.

Potential strategies may include:

Provide faculty development on trauma-informed teaching, psychologically safe supervision, culturally safe practice, coaching-based feedback, and inclusive pedagogy.
Replace shame-based or fear-based educational practices with supportive, growth-oriented approaches.
Integrate wellbeing, relational practice, health promotion, equity, and professionalism throughout curricula.
Normalize reflective practice, feedback literacy, peer support, and psychological safety as core educational competencies.
Create and support mentorship, peer-support, and coaching programs across learner and faculty groups.
Promote leadership development focused on healthy teams, conflict resolution, communication, and relational leadership.

Examine both formal curriculum and the hidden curriculum to understand how everyday teaching practices, role modeling, and feedback reinforce psychological safety, inclusion, curiosity, and growth, and where they may unintentionally reinforce fear, hierarchy, or shame.

Culture and Relationships

Build Communities Where People Feel They Belong

Everyday interactions influence whether individuals feel respected, connected, included, and psychologically safe. Intentionally fostering kindness, compassion, collaboration, and belonging helps strengthen healthy professional communities.

Potential strategies include:

Develop shared behavioural expectations that articulate respectful, inclusive, and collaborative interactions.
Recognise and celebrate contributions to wellbeing, inclusion, kindness, mentorship, and community-building.
Encourage allyship and active responses to harmful, exclusionary, or disrespectful behaviours.
Foster opportunities for connection across clinical, academic, research, and administrative groups to reduce silos and foster collaboration.
Celebrate diverse cultures, identities, experiences, and perspectives through events, storytelling, and community engagement.
Promote sustainable work and learning practices that support healthy boundaries, recovery, and manageable workloads.

Encourage individuals at all levels to model allyship, address harmful or exclusionary behaviours, and reinforce respectful, inclusive interactions in everyday learning and work environments. Small actions, including speaking up, checking in, and supporting colleagues, can meaningfully influence culture over time.

Health-Promoting Programs and Supports

Provide Supports that Meet Real Needs

Accessible and responsive supports reinforce cultures where wellbeing and help-seeking are normalized, encouraged, and stigma-free. Programs should reflect the diverse and evolving needs of learners, faculty, and staff.

Potential strategies include:

Create visible and accessible pathways to mental health, occupational health, wellness, coaching, peer-support, and crisis supports.
Offer population-specific supports that reflect the needs of diverse learners, faculty, and staff communities.
Develop peer-led initiatives such as wellbeing advocacy, affinity groups, mentorship programs, and peer coaching.
Provide opportunities for reflection, debriefing, and emotional processing following stressful or difficult experiences.
Support grassroots wellbeing, inclusion, and community-building initiatives through grants, innovation funding, or protected time.

Partner with learners, faculty, staff, and equity-deserving groups to identify gaps and co-design programs that reduce stigma and promote meaningful engagement.

Environments and Spaces

Support Culture Through Physical and Social Environments

Physical and social environments influence how safe, connected, supported, and valued people feel within medical communities. Supportive environments reinforce broader cultural goals related to wellbeing, inclusion, accessibility, and belonging.

Potential strategies include:

Provide accessible, inclusive, and welcoming spaces that support learning, connection, rest, reflection, and recovery.
Increase access to quiet rooms, lactation spaces, reflection rooms, and restorative spaces for learners, faculty, and staff.
Foster environments that support collaboration, community-building, and psychological safety.
Ensure physical environments reflect principles of accessibility, cultural safety, sustainability, and inclusion.
Align environmental design with broader organizational efforts to create compassionate and health-promoting cultures.

Small environmental improvements, such as quiet spaces, natural light, inclusive signage, or comfortable gathering areas, can meaningfully influence culture and wellbeing.

Reflection, Measurement, and Continuous Improvement

Track Progress and Sustain Change

Meaningful culture change requires ongoing reflection, transparency, accountability, and adaptation. Continuous improvement processes help organizations identify strengths, understand gaps, and monitor progress over time.

Potential strategies include:

Conduct regular assessments of culture, wellbeing, inclusion, psychological safety, and learning environments.
Use pulse surveys, focus groups, feedback sessions, and qualitative storytelling to understand experiences across communities.
Share findings transparently alongside identified actions and progress updates.
Monitor indicators related to wellbeing, equity, mistreatment, inclusion, engagement, and sustainability.
Evaluate initiatives to determine effectiveness, scalability, and areas for improvement.
Embed continuous quality improvement (CQI) approaches that support iterative learning, responsiveness, and long-term culture change.

Start with a small number of meaningful indicators and feedback mechanisms that communities can realistically act on. Sharing results and follow-up actions transparently helps build trust and sustain engagement.

Case Studies

The following case studies provide opportunities to explore how health-promoting culture principles can be applied to real-world challenges and organizational scenarios.

Case Study #1: “Off-Service Residents Feeling Like Second-Rate Learners”

Case Study #2: “Research Pressure and Hazardous Lab Culture”

These examples are not intended to prescribe a single solution. Rather, they are designed to support dialogue, identify opportunities for change, and help institutions apply health-promoting principles within their own unique contexts.

Case Study #1

Off-Service Residents Feeling Like “Second-Rate Learners”

The Scenario

Leo is a first-year pathology resident completing an off-service rotation on a busy inpatient unit. Although eager to learn, he quickly feels out of place and undervalued. Teaching and feedback are primarily directed toward core service residents, while off-service residents are often assigned additional administrative tasks or heavier call responsibilities.

During rotation evaluations, off-service residents repeatedly report feeling “invisible,” excluded from meaningful learning opportunities, and valued more for service support than education. Despite recurring feedback, these concerns have become normalized within the rotation culture. Many learners hesitate to speak up for fear of being labelled “not a team player.”

The Challenge

This case highlights how hidden curriculum, hierarchy, and competing service pressures can unintentionally create inequitable learning environments. When off-service residents are treated primarily as workforce support rather than learners, it can reinforce harmful cultural messages about belonging, value, and professional identity.

The issue extends beyond individual interactions and reflects broader cultural and structural challenges related to workload, supervision, inclusion, psychological safety, and accountability within medical education.

Why This Matters in Health-Promoting Culture

Supportive learning environments are essential for learner wellbeing, psychological safety, equitable education, and professional development. When learners consistently feel excluded, undervalued, or unable to advocate for their needs, it can negatively affect confidence, engagement, learning, and trust in the educational environment.

This case also demonstrates how the hidden curriculum can reinforce inequities when efficiency and service pressures unintentionally prioritize workload over learning and inclusion.

Where This Case Fits in Health-Promoting Culture

Psychological Safety and Respect: Learners may feel unable to speak up or advocate for their needs.

Equity, Inclusion, and Belonging: Off-service residents experience exclusion and inequitable learning opportunities.

Connection, Community, and Relational Leadership: Team culture and leadership behaviours influence inclusion and support.

Growth-Oriented Learning and Support: Service pressures may undermine learner-centered teaching and feedback.

Reflection, Accountability, and Continuous Improvement: Recurring concerns require ongoing review, dialogue, and action.

Guided Reflection Questions

Individual Reflection

What hidden messages about belonging, hierarchy, or value are being communicated in this environment?
How might these experiences affect learning, wellbeing, confidence, or professional identity?
What behaviours or assumptions may be reinforcing the problem?
What factors might make learners hesitant to speak up or ask for support?

Team and Leadership Reflection

How are workload expectations, supervision practices, and team culture influencing off-service learner experiences?
What changes could improve inclusion, equitable learning opportunities, and psychological safety?
How are recurring concerns identified, discussed, and acted upon within the program or institution?
Who has the greatest ability to influence culture in this environment, and how might they model allyship or intervene when inequities occur?

Apply This Case to Your Context

Reflect on how learners are integrated into clinical, research, academic, or administrative environments within your own institution:

Are some learners or groups unintentionally excluded from meaningful learning opportunities?
How are expectations communicated and modeled within teams?
What aspects of the hidden curriculum may reinforce hierarchy or inequity?
How comfortable do learners feel speaking up about concerns or unmet learning needs?
What systems exist to monitor and respond to recurring cultural concerns?

From Insight to Action - Tangible Solutions

Leadership and Governance

Clearly communicate expectations for equitable teaching, supervision, and workload distribution across all learner groups.
Reinforce that all learners are valued members of the educational environment, regardless of specialty or rotation status.
Recognize and support leaders, faculty, and residents who model inclusive and learner-centered practices.

Policies and Systems

Review rotation policies and expectations to ensure service demands do not override core educational requirements.
Establish transparent processes for reporting and addressing inequitable learning experiences.
Monitor rotation evaluations for recurring patterns related to exclusion, workload inequities, or psychological safety concerns.

Teaching and Learning

Encourage faculty and senior residents to routinely discuss learning goals with all learners, including off-service residents.
Promote equitable access to teaching opportunities, case discussions, procedural experiences, and feedback.
Provide faculty development on hidden curriculum, psychologically safe supervision, inclusive teaching, and coaching-based feedback.

Culture and Relationships

Foster team cultures that intentionally welcome and include all learners.
Encourage allyship and active responses to exclusionary or dismissive behaviours.
Model respectful communication, inclusive introductions, and shared responsibility for supporting learner wellbeing and belonging.

Health-Promoting Programs and Supports

Ensure learners can access confidential wellbeing, mentorship, coaching, and learner support services.
Provide opportunities for learners to discuss challenges related to workload, supervision, or belonging.
Offer mentorship or peer-support opportunities for learners navigating unfamiliar or high-pressure environments.

Reflection, Measurement, and Continuous Improvement

Collect and review feedback from off-service and core residents separately to identify recurring inequities.
Use focus groups, pulse surveys, or facilitated discussions to better understand learner experiences.
Include learners in rotation review, quality improvement, and culture change efforts.

Key Takeaway

Off-service inequities are often normalized within clinical learning environments, but small relational, structural, and organizational changes can significantly improve belonging, psychological safety, and equitable learning experiences for all learners.

Case Study #2

Research Pressure and Hazardous Lab Culture

The Scenario

Dr. Wong leads a translational research lab within a Faculty of Medicine. Following delays caused by equipment repairs and reagent shortages, the lab faces growing pressure to produce results for an upcoming grant milestone.

As timelines tighten, some trainees and staff feel encouraged (implicitly or explicitly) to skip routine safety practices to maintain productivity. Junior team members hesitate to raise concerns because they fear being viewed as slowing progress or jeopardizing funding success. After a recent near-miss involving a laboratory spill, several staff quietly questioned whether ongoing time pressures contributed to the incident.

The Challenge

This case highlights how funding pressures, productivity expectations, hierarchy, and normalized workplace behaviours can unintentionally contribute to unsafe research environments. Although formal safety procedures exist, the day-to-day culture of the lab may communicate that efficiency and output are prioritized over physical and psychological safety and wellbeing.

Why This Matters in Health-Promoting Culture

Research environments shape wellbeing, psychological safety, mentorship experiences, and research integrity. When individuals feel unsafe speaking up about concerns, harmful shortcuts and unsafe norms may become normalized over time.

This case also demonstrates how organizational pressures and incentive structures can influence behaviour within academic environments. Sustainable research excellence depends not only on productivity, but also on cultures that prioritize safety, inclusion, accountability, and supportive leadership.

Where This Case Fits in Health-Promoting Culture

Psychological Safety and Respect: Junior staff may feel unable to raise safety concerns or question unsafe practices.

Equity, Inclusion, and Belonging: Power dynamics and hierarchy may affect whose concerns are heard or valued.

Connection, Community, and Relational Leadership: Mentorship, leadership behaviour, and team culture influence trust and accountability.

Growth-Oriented Learning and Support: Trainees require supportive supervision, safe learning environments, and mentorship that prioritizes both wellbeing and research integrity.

Reflection, Accountability, and Continuous Improvement: Near-misses and recurring pressures require ongoing dialogue, review, and systems-level improvement.

Guided Reflection Questions

Individual Reflection

What hidden messages about productivity, safety, or success are being communicated in this environment?
How might time pressures and hierarchy influence decision-making or willingness to speak up?
What behaviours, norms, or assumptions may be reinforcing unsafe practices?

Team and Leadership Reflection

How are productivity expectations, mentorship practices, and team culture influencing psychological safety and physical safety behaviours?
What changes could help staff and trainees feel safer raising concerns or asking for support?
How are near-misses, workload pressures, and recurring safety concerns identified, discussed, and addressed within the lab or institution?
Who has the greatest ability to influence culture in this environment, and how might they model allyship, accountability, and safe leadership practices?

Apply This Case to Your Context

Reflect on the learning, research, clinical, or workplace environments within your own institution:

Do productivity pressures unintentionally encourage harmful shortcuts or unsafe practices?
How comfortable do trainees, staff, or faculty feel raising concerns about safety, workload, or wellbeing?
What hidden curriculum messages exist around productivity, success, or asking for help?
How are leaders and supervisors modeling psychological safety, accountability, and supportive mentorship?
What systems are in place to identify, review, and respond to recurring concerns or near-misses?

From Insight to Action - Tangible Solutions

Leadership and Governance

Reinforce institutional expectations that safety, wellbeing, and research integrity are non-negotiable priorities.
Support leaders and supervisors in modeling psychologically safe, transparent, and supportive leadership practices.
Recognize mentorship and leadership behaviours that foster safe, inclusive, and sustainable research environments.

Policies and Systems

Establish clear expectations that productivity goals must not override documented safety procedures.
Develop transparent and psychologically safe reporting pathways for safety concerns and near-misses.
Review workload expectations, staffing pressures, equipment maintenance processes, and operational barriers that may contribute to unsafe practices.

Teaching and Learning

Provide ongoing education on laboratory safety, research integrity, psychological safety, and ethical leadership.
Support mentorship practices that encourage reflection, open dialogue, and safe questioning.
Promote onboarding and supervision practices that clearly communicate expectations related to safety, inclusion, and respectful team culture.

Culture and Relationships

Foster team cultures where individuals feel safe raising concerns, asking questions, and discussing mistakes or near-misses.
Encourage allyship and active responses to unsafe or exclusionary behaviours.
Create regular opportunities for team reflection, check-ins, and supportive discussion around workload, stress, and safety pressures.

Health-Promoting Programs and Supports

Ensure staff and trainees have access to confidential occupational health, mental health, and employee assistance supports.
Provide mentorship, coaching, or peer-support opportunities for individuals experiencing stress, moral distress, or burnout.
Encourage proactive check-ins and support following stressful events or near-misses.

Reflection, Measurement, and Continuous Improvement

Track and review near-misses, safety concerns, equipment downtime, workload pressures, and staff experiences over time.
Use pulse surveys, facilitated dialogue, or focus groups to better understand lab culture and psychological safety.
Engage staff and trainees in continuous quality improvement initiatives related to safety, wellbeing, and research culture.

Key Takeaway

Research excellence and safety are not competing priorities. Supportive leadership, psychologically safe environments, and strong accountability structures help create research cultures where safety, wellbeing, integrity, and innovation can be sustained together.

Exploring Your Role in Health-Promoting Culture

Culture is shaped through everyday interactions, behaviours, decisions, and relationships. While leadership and organizational systems play important roles, culture is also influenced by how individuals communicate, collaborate, teach, learn, and support one another.

This section explores how different roles contribute to creating respectful, inclusive, psychologically safe, and health-promoting cultures.

Reflect on Your Role

How do your everyday actions contribute to psychological safety, inclusion, and respect?

How do you respond when harmful, exclusionary, or unsafe behaviours occur?

What is one small change you could make to help strengthen a more health-promoting culture within your environment?

Every role contributes by modelling behaviours and relationships that influence belonging, inclusion, trust, and wellbeing.

Senior Leadership & Governance

Senior leaders help shape institutional priorities, resource allocation, accountability structures, and organizational culture. Their actions and decisions strongly influence whether health-promotion, wellbeing, psychological safety, and inclusion are treated as core institutional values.