Between Leadership Expectations and Error Reporting: Contradictions in Patient Safety Culture in an Iranian Hospital

Background: A safety culture is a foundational determinant of patient safety in healthcare settings, and its deficiency has been consistently linked to increased risks of adverse events and suboptimal care delivery. This study examines the current state of patient safety culture (PSC) through the perspectives of frontline hospital staff, identifying both key strengths and critical areas for improvement within the organizational environment.Methods: In this descriptive cross-sectional study, ۳۱۶ staff working in Ali Ibn-e Abitaleb hospital, Rafsanjan were selected. The study employed the Hospital Survey on Patient Safety Culture (HSOPSC) a validated instrument measuring ۱۲ composite domains to collect data, which were subsequently analyzed using one-way ANOVA and Kruskal-Wallis tests in SPSS software.Results: Results showed a relatively strong perception of leadership support for safety (۷۶.۸۵%), but critically low scores in non-punitive response to errors (۱۶.۸۲%), staffing (۱۸.۳۵%), and error reporting (۳۹.۲۳%). Communication and feedback about errors (۴۴.۶۳%), communication openness (۳۹.۴۷%), frequency of events reported (۳۹.۲۳%), management support for patient safety (۳۴.۴۷%), teamwork across units (۳۳.۴۷%) were among the weaknesses of PSC. Notably, a punitive culture and staffing were strongly associated with suppressed incident reporting, revealing a critical failure in organizational level occupational health and safety (OHS) controls. The aggregate score for PSC was observed to be suboptimal (۴۴.۷۶%), necessitating subsequent enhancement.Conclusions: Overall PSC is poor and requires hospital manager’s attention. The punitive culture at workplace, the staffing, management support for staff and teamwork across units are the most important issues that should be considered in this hospital. Therefore, the safety culture can be promoted, the risks threating patients can be reduced, and ultimately the health care quality can be improved. These findings underscore the need for OHS interventions targeting punitive workplace norms, staffing adequacy, and inter-unit collaboration to foster a just culture and improve patient outcomes.Background: A safety culture is a foundational determinant of patient safety in healthcare settings, and its deficiency has been consistently linked to increased risks of adverse events and suboptimal care delivery. This study examines the current state of patient safety culture (PSC) through the perspectives of frontline hospital staff, identifying both key strengths and critical areas for improvement within the organizational environment. Methods: In this descriptive cross-sectional study, ۳۱۶ staff working in Ali Ibn-e Abitaleb hospital, Rafsanjan were selected. The study employed the Hospital Survey on Patient Safety Culture (HSOPSC) a validated instrument measuring ۱۲ composite domains to collect data, which were subsequently analyzed using one-way ANOVA and Kruskal-Wallis tests in SPSS software. Results: Results showed a relatively strong perception of leadership support for safety (۷۶.۸۵%), but critically low scores in non-punitive response to errors (۱۶.۸۲%), staffing (۱۸.۳۵%), and error reporting (۳۹.۲۳%). Communication and feedback about errors (۴۴.۶۳%), communication openness (۳۹.۴۷%), frequency of events reported (۳۹.۲۳%), management support for patient safety (۳۴.۴۷%), teamwork across units (۳۳.۴۷%) were among the weaknesses of PSC. Notably, a punitive culture and staffing were strongly associated with suppressed incident reporting, revealing a critical failure in organizational level occupational health and safety (OHS) controls. The aggregate score for PSC was observed to be suboptimal (۴۴.۷۶%), necessitating subsequent enhancement. Conclusions: Overall PSC is poor and requires hospital manager’s attention. The punitive culture at workplace, the staffing, management support for staff and teamwork across units are the most important issues that should be considered in this hospital. Therefore, the safety culture can be promoted, the risks threating patients can be reduced, and ultimately the health care quality can be improved. These findings underscore the need for OHS interventions targeting punitive workplace norms, staffing adequacy, and inter-unit collaboration to foster a just culture and improve patient outcomes.

کلیدواژه ها:

Safety culture ، Patient safety ، Hospitals ، Staff perspective