JAKARTA – A comprehensive evaluation of patient safety culture at a secondary care facility in Riyadh has uncovered significant insights into healthcare quality practices in Saudi Arabia, revealing both commendable collaborative practices and critical systemic weaknesses that require immediate attention.

Study Overview and Context

Researchers conducted an extensive cross-sectional assessment involving 613 healthcare professionals across multiple disciplines at a 200-bed public hospital in Riyadh. The investigation utilized the Hospital Survey on Patient Safety Culture (HSOPSC) tool, a globally recognized instrument developed by the Agency for Healthcare Research and Quality, marking one of the first comprehensive safety culture evaluations in Saudi secondary care settings.

The study aligns with Saudi Arabia’s Vision 2030 National Transformation Programme, which prioritizes healthcare quality enhancement, transparency, and accountability throughout the Kingdom’s medical system. Despite recent reforms and modernization efforts, preventable medical errors continue to pose significant challenges, with many healthcare environments characterized by insufficient incident reporting and workforce constraints.

Critical Findings: Mixed Results

The assessment revealed a paradoxical situation within the hospital’s safety environment. While approximately 79% of respondents rated their unit’s overall patient safety as excellent or very good, concerning patterns emerged regarding actual reporting behaviors and systemic practices.

Areas of Excellence

The evaluation identified several domains where the facility demonstrated strong performance:

Collaborative Environment: Internal teamwork received the highest rating at 85% positive response, indicating robust cooperation among staff within individual units. Healthcare workers consistently reported mutual support, respectful treatment, and coordinated efforts during high-pressure situations.

Learning and Feedback Mechanisms: Organizational learning and continuous improvement scored 77% positive, while feedback and communication about errors reached 80%. These results suggest that when incidents occur, the hospital effectively discusses preventive measures and implements corrective actions.

Incident Reporting Frequency: Paradoxically, 85% of respondents indicated that errors caught before reaching patients were reported, suggesting awareness of reporting protocols.

Critical Weaknesses

Despite these strengths, the study revealed three domains scoring below acceptable thresholds:

Staffing Adequacy: The most concerning finding, with only 43% positive response, revealed severe workforce shortages. Many healthcare workers reported working in “crisis mode,” attempting to accomplish excessive tasks rapidly, with insufficient personnel to manage workload demands safely.

Communication Openness: Scoring just 57% positive, this dimension highlighted significant barriers to upward communication. Staff members, particularly those in junior positions, expressed reluctance to question decisions made by authority figures or speak freely about concerns that might affect patient care.

Non-Punitive Response to Error: At 59% positive, this finding indicated persistent fear of blame. Many respondents felt their mistakes would be held against them personally, and incident reports were perceived as staff write-ups rather than problem identification tools.

The Reporting Paradox

A striking contradiction emerged from the data: despite high overall safety ratings, 43% of participants reported zero safety events during the preceding year, while only 5% documented twenty or more incidents. This substantial reporting gap suggests systemic underreporting, potentially linked to concerns about blame or uncertainty regarding reporting procedures.

International research indicates that healthcare facilities typically experience numerous near-misses and minor incidents that provide valuable learning opportunities. The low reporting rates observed in this study suggest many such events go undocumented, representing lost opportunities for system improvement.

Professional Role Disparities

Statistical analysis revealed significant differences in safety culture perceptions among professional groups. Nurses consistently reported lower safety culture scores compared to physicians, a pattern attributed to heavier workloads, limited decision-making autonomy, and weaker managerial support.

These disparities reflect broader hierarchical dynamics within healthcare systems, where nursing staff often possess greater exposure to frontline safety risks but limited authority to address underlying problems. The gap between physician and nurse perceptions underscores the need for role-specific interventions addressing workload distribution, empowerment, and communication channels.

Predictive Factors for Safety Culture

Advanced statistical modeling identified three primary factors accounting for 79% of variance in overall safety culture scores:

1. Frequency of Event Reporting: Organizations where staff regularly document incidents demonstrate stronger safety cultures
2. Non-Punitive Response to Error: Environments free from blame foster greater transparency and learning
3. Communication Openness: Systems enabling staff to voice concerns without fear support sustained safety improvement

These findings emphasize that sustainable safety transformation depends more heavily on cultural and behavioral factors than on technological solutions or procedural compliance alone.

International Context and Comparisons

The Saudi findings mirror patterns observed globally. United States healthcare facilities demonstrate similar profiles, with strong internal teamwork (82% positive) but weak non-punitive cultures (47% positive). Even well-resourced Western healthcare systems struggle with blame-related barriers to incident reporting, suggesting these challenges transcend resource availability.

Research from neighboring Gulf states—Kuwait, Lebanon, and Oman—revealed comparable trends: excellent intra-unit collaboration coupled with deficiencies in communication openness, staffing adequacy, and blame-free reporting. These consistent regional patterns indicate shared cultural and organizational dynamics affecting patient safety across Middle Eastern healthcare systems.

Workforce Implications

Inadequate staffing, identified as the lowest-scoring dimension, carries serious implications for patient outcomes and staff wellbeing. International evidence consistently links insufficient nurse-to-patient ratios with increased mortality rates, infection prevalence, and reduced job satisfaction. Chronic understaffing undermines team resilience, inhibits organizational learning from incidents, and accelerates workforce turnover.

The staffing crisis also intersects with communication barriers. Overwhelmed staff working under extreme pressure possess limited capacity to engage in reflective practice, participate in safety discussions, or report incidents comprehensively. This creates a negative feedback loop where inadequate resources compound cultural barriers to safety.

Recommendations for Improvement

Based on these findings, researchers proposed a comprehensive improvement strategy centered on three priorities:

Cultivating Non-Punitive Environments: Healthcare facilities must clearly distinguish between human error, risky behavior, and negligence while encouraging and rewarding error reporting. Leadership should visibly demonstrate that incident documentation leads to system improvement rather than individual punishment.

Enhancing Communication Channels: Organizations should implement structured mechanisms enabling staff at all levels to voice safety concerns without fear of repercussion. This includes regular safety huddles, anonymous reporting systems, leadership walkarounds, and debriefing protocols that flatten traditional hierarchies.

Optimizing Workforce Planning: Staffing levels must align with patient acuity and workload demands, with frontline clinicians actively involved in workforce planning decisions. This ensures both feasibility and staff engagement in safety initiatives.

Strategic Implementation

Hospital leadership has developed a targeted quality improvement roadmap incorporating several initiatives:

• Department-specific feedback sessions discussing safety performance
• Regular safety huddles integrating real-time incident discussion
• Integration of safety culture metrics into organizational performance dashboards
• Leadership safety walkarounds demonstrating visible commitment
• Annual re-administration of the HSOPSC tool to monitor progress

These actions aim to embed continuous learning and transparent feedback mechanisms within governance processes, aligning with World Health Organization frameworks emphasizing patient safety as a core healthcare quality element.

Broader Healthcare Context

The study’s findings carry significant implications for Saudi Arabia’s healthcare transformation efforts. As the Kingdom advances toward its Vision 2030 objectives, establishing robust safety cultures becomes essential for achieving world-class healthcare delivery. While technological modernization and infrastructure development remain important, this research demonstrates that cultural and behavioral transformation represents an equally critical pathway.

Patient safety culture cannot be legislated into existence; it must be cultivated through systematic measurement, genuine engagement, and consistent reinforcement. In hierarchical healthcare systems where communication between senior and junior staff often faces constraints, structured safety assessments can uncover subtle yet significant barriers to optimal care.

Looking Forward

This comprehensive evaluation establishes a crucial baseline for ongoing safety improvement efforts within Saudi secondary care. By identifying specific domains requiring intervention while acknowledging existing strengths, healthcare leaders can design targeted strategies addressing the most pressing challenges.

The study demonstrates that even facilities with strong collaborative foundations face persistent cultural barriers related to blame, communication, and resource allocation. Addressing these challenges requires sustained commitment from leadership, investment in workforce development, and willingness to transform traditional power dynamics that inhibit open dialogue about safety concerns.

As Saudi Arabia continues modernizing its healthcare system, systematic attention to safety culture alongside technological advancement will prove essential for achieving sustainable improvements in patient outcomes and healthcare professional satisfaction.

Original Article:

Cure Us. (2025, December 8). 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.  Retrieved from https://www.cureus.com/articles/433894-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?score_article=true#!/