Assessing Patient Safety Culture in a Secondary Care Hospital in Saudi Arabia Using the Hospital Survey on Patient Safety Culture Tool: A Cross-Sectional Study

BACKGROUND: A positive patient safety culture (PSC) is integral to reducing preventable harm and improving healthcare outcomes. In many low- and middle-income countries, there is a lack of structured measurement of PSC, hindering the identification of systemic weaknesses. This study assessed PSC in a secondary care public hospital in Riyadh, Saudi Arabia, using the Hospital Survey on Patient Safety Culture (HSOPSC) tool, with the aim of identifying strengths, weaknesses, and predictors of a robust safety culture. LOCAL PROBLEM: PSC remains under-assessed in Saudi secondary care hospitals, with inadequate systems for event reporting and weak staffing policies. METHODS: A cross-sectional study using the bilingual (Arabic/English) HSOPSC Version 1.0 was conducted in a 200-bed secondary hospital. All eligible staff were surveyed electronically. Statistical analysis included descriptive statistics, Cronbach's alpha for internal consistency, Spearman correlation, and multiple linear regression to identify predictors of overall safety culture. Kruskal-Wallis tests compared scores across professional roles. INTERVENTION: Survey dissemination was supported by departmental champions and aimed to build a baseline for future safety initiatives. RESULTS: Of 1,084 eligible staff, 613 completed the survey (57% response). Teamwork within units (85%) and frequency of events reported (85%) scored highest; staffing (43%) and communication openness (57%) were weakest. Regression identified non-punitive response to error, event reporting frequency, and communication openness as the strongest predictors of overall PSC (p < 0.001). Nurses reported significantly lower scores than physicians (p < 0.001). CONCLUSIONS: The study highlights strong internal collaboration but emphasises the need for improved staffing and transparency. These results form the basis for targeted quality improvement aligned with national healthcare goals.