National insights into patient safety culture in Chinese psychiatric hospitals: the role of hospital-level disparities

Background Patient safety culture (PSC) is a critical component of healthcare quality, particularly in psychiatric settings where unique risks exist. In China, research on PSC within mental health institutions remains underdeveloped, and the factors influencing it are poorly understood. Methods This cross-sectional study utilized the Chinese version of the Hospital Survey on Patient Safety Culture (HSOPSC) to assess PSC among 2,524 mental health nurses from multiple Level-2 and Level-3 psychiatric hospitals in China (2021–2023). We specifically examined the impact of hospital level on PSC perceptions. Multivariate regression models were employed to identify predictors of PSC composites. Results The overall positive response rate (PPR) across the 12 PSC dimensions was 62.4%, indicating a moderate culture. Strengths were “Teamwork Within Units” (PPR = 83.3%) and “Organizational Learning” (PPR = 82.8%), while critical areas for improvement were “Nonpunitive Response to Error” (PPR = 46.6%) and “Staffing” (PPR = 43.3%). Regression analyses revealed that hospital level was a significant predictor of PSC outcomes, alongside years of experience and daily overtime hours ( P 0.05). Conclusions This pioneering national study reveals that the PSC landscape in Chinese psychiatric hospitals is characterized by specific strengths but also critical weaknesses, significantly influenced by hospital level. The findings compel a move away from one-size-fits-all approaches. We recommend stratified interventions: foundational support for Level-2 hospitals and advanced quality initiatives for Level-3 hospitals, with universal prioritization of addressing staffing shortages and fostering a nonpunitive “Just Culture”.