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This paper will introduce healthcare professionals to a theory regarding why 100% compliance with patient safety initiatives, while extremely important, might not be possible. We explain that patient safety initiatives in healthcare systems are promoted to change a systematic culture, specifically (in this paper) in the operating room, when steps being taken are addressing the climate, not the culture. We also discuss the evidence-based reasons why changing culture is very challenging, if even do-able. Understanding the difference between climate and culture is key to bringing about an overall transformation in institutional behaviors.