Patient Safety Culture in a Public Tertiary Care Teaching Hospital in Central India: A Cross-Sectional Study Using the Hospital Survey on Patient Safety Culture (HSOPSC) Version 2.0

Background: Patient safety culture is a critical determinant of healthcare quality and is associated with improved clinical outcomes and patient satisfaction. It can be measured using validated survey instruments assessing organizational norms, behaviors, and healthcare professionals’ perceptions related to safety. In public tertiary care teaching hospitals, where high patient volumes, workforce constraints, and training responsibilities coexist, evaluating patient safety culture is particularly important. Standardized tools such as the Hospital Survey on Patient Safety Culture (HSOPSC) Version 2.0 enable identification of strengths, gaps, and context-specific priorities for improvement. Objective: To assess patient safety culture in a public tertiary care teaching hospital in Central India using HSOPSC Version 2.0 and identify strengths and gaps across key safety culture dimensions at unit and hospital levels, including variations across professional groups and clinical departments. Methods: A descriptive cross-sectional study was conducted in accordance with Strengthening the Reporting of Observational Studies in Epidemiology guidelines at a public tertiary care teaching hospital in Central India. Patient safety culture was assessed using HSOPSC Version 2.0 through a mixed-mode (online and paper-based) survey. Doctors, nurses, and technical staff with at least six months of institutional experience were included. Proportionate stratified sampling yielded 414 respondents (response rate: 80%). Data were analyzed using the Agency for Healthcare Research and Quality (AHRQ) HSOPSC 2.0 Data Entry and Analysis Tool. Percent-positive and composite dimension scores were calculated according to AHRQ guidance. Internal consistency was assessed using Cronbach's alpha. One-way analysis of variance was used for comparisons, with p < 0.05 considered statistically significant. Results: A total of 414 healthcare professionals participated (response rate: 80%). Overall, the patient safety culture was moderate. Teamwork (77.54%) and communication about error (76.31%) were identified as strengths, followed by organizational learning-continuous improvement (69.01%), supervisor/clinical leader support (68.58%), and handoffs and information exchange (60.11%), which demonstrated moderate performance. Staffing and work pace (32.25%) was identified as an area of concern, indicating an important system-level challenge, while response to error (50.00%) was at the threshold of the moderate range. Physicians reported significantly more positive perceptions than nurses and residents across several domains (p < 0.05). Significant variation in safety culture scores was also observed across work areas/units. Overall, 84.30% of respondents (n=349) rated patient safety in their work area as good to excellent. Conclusion: This study provides structured evidence on patient safety culture in a public tertiary care teaching hospital in Central India. While strengths in teamwork, communication about error, organizational learning, and clinical leadership support provide a foundation for safe care, persistent system-level challenges, including staffing constraints, workload pressures, care transition gaps, and concerns regarding non-punitive response to error, require focused leadership attention. Targeted, context-specific interventions and sustained organizational commitment are essential to advance safety culture maturity in resource-constrained public healthcare settings.