Nurses' Perceptions of Patient Safety Culture in Saudi Arabia

Abstract

Background:

Patient safety culture is a fundamental component of healthcare quality and patient safety. Nurses play a central role in promoting patient safety through their involvement in patient care. Evidence from Gulf Cooperation Council (GCC) countries remains fragmented, with limited quantitative synthesis. This dissertation investigated nurses' perceptions of patient safety culture in GCC hospitals and within a Saudi hospital using the Hospital Survey on Patient Safety Culture (HSOPSC) within Donabedian's Quality Framework.

Methods:

A multi-method research design comprised a systematic review, a cross-sectional study completed with findings reported in three manuscripts, and a meta-analysis. The cross-sectional study was conducted among frontline nurses at Hail General Hospital, Saudi Arabia. Correlation and regression analyses examined relationships between patient safety culture dimensions and patient safety outcomes, while comparative analyses evaluated differences between HSOPSC versions. A meta-analysis generated pooled estimates of HSOPSC composite scores across GCC hospitals.

Results:

Across all dissertation components, teamwork and organizational learning consistently emerged as strengths of patient safety culture, whereas staffing, response to error, and care transitions remained persistent challenges. Both HSOPSC versions demonstrated satisfactory overall reliability and identified significant associations between patient safety culture dimensions and patient safety outcomes. Communication, teamwork, organizational learning, leadership support, and responses to error were key process-level factors associated with safety perceptions and reporting behaviours. Comparison of HSOPSC versions demonstrated conceptual continuity, while revisions in survey design may influence nurses' evaluations of patient safety culture. The meta-analysis confirmed similar patterns across GCC hospitals.

Conclusion:

This dissertation advances understanding of patient safety culture among nurses in GCC hospitals and provides evidence regarding the assessment of patient safety culture using HSOPSC versions. Guided by the Donabedian's Quality Framework, the findings highlight the importance of communication, teamwork, organizational learning, leadership support, and safe reporting environments in improving patient safety outcomes. The findings support routine patient safety culture assessment, workforce and leadership development, and the promotion of learning-oriented, nonpunitive cultures to improve healthcare quality.