EXAMINING PATIENT SAFETY CULTURE TRENDS IN U.S. HEALTHCARE THROUGH A MULTI-YEAR ANALYSIS
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Date
2026
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Saudi Digital Library
Abstract
Patient Safety Culture (PSC) is recognized as a cornerstone of healthcare quality and a key determinant
of patient outcomes. Despite the Institute of Medicine’s early calls to establish safety-oriented systems,
evidence on the long-term stability of PSC in U.S. hospitals has remained limited. This dissertation
addresses this gap through a multi-year evaluation of PSC using the Hospital Survey on Patient Safety
Culture (HSOPSC v1.0) and advanced statistical methods. Drawing on one of the largest national
datasets—comprising over 993,000 healthcare providers from 1,601 U.S. hospitals across three survey
cycles (2013–2020)—the study employed a longitudinal repeated cross-sectional design. Analyses
combined descriptive statistics, second-order factor modeling, and Partial Least Squares Structural
Equation Modeling (PLS-SEM) with multi-group analysis to capture temporal trends, determinants, and
outcomes of PSC. Findings showed that overall PSC scores averaged 65% across years, with strengths in
“Supervisor/Manager Expectations” and “Teamwork within Units,” and persistent weaknesses in
“Nonpunitive Response to Error” and “Handoffs and Transitions.” PSC declined slightly over time, with
regional and institutional variations: smaller, non-teaching, and Southern/Central hospitals reported
higher PSC. Hospital size and region exerted inconsistent effects, while workforce factors—such as staff
role, tenure, and patient contact—were stronger and more stable predictors of PSC outcomes. Importantly,
PSC demonstrated robust predictive power, explaining 56.7% of the variance in overall safety perceptions
and 23.2% in error reporting frequency. The dissertation provides rare longitudinal evidence confirming
PSC as a dynamic, multidimensional construct. While PSC’s influence on safety outcomes has
strengthened over time, sustaining improvements remains challenging, particularly in fostering blame-free
reporting, ensuring adequate staffing, and improving care transitions. Practical implications highlight
leadership commitment, nonpunitive systems, and workforce-centered strategies, alongside
interprofessional education to embed safety in daily practice. Collectively, the findings offer actionable
insights for policy, leadership, and training, while advancing methodological rigor in PSC research.
Description
This dissertation by Hassan Alabdullah (2026) at the University of Central Florida examines longitudinal trends in Patient Safety Culture (PSC) across U.S. hospitals. Recognizing PSC as a cornerstone of healthcare quality, the study addresses the limited evidence on its long-term stability despite early calls for safety reform by the Institute of Medicine.
Using data from over 993,000 healthcare providers across 1,601 U.S. hospitals (2013–2020), the research applies a longitudinal repeated cross-sectional design based on the Hospital Survey on Patient Safety Culture (HSOPSC v1.0). Advanced statistical techniques—including second-order factor modeling and Partial Least Squares Structural Equation Modeling (PLS-SEM) with multi-group analysis—were used to assess trends, determinants, and outcomes of PSC over time.
Findings indicate that overall PSC averaged 65%, with strengths in supervisor expectations and teamwork within units, but persistent weaknesses in nonpunitive response to error and handoffs/transitions. PSC showed a slight decline over time, with variation by hospital size, teaching status, and geographic region. Workforce characteristics (e.g., role, tenure, patient contact) were more consistent predictors of PSC outcomes than institutional factors. Importantly, PSC strongly predicted safety outcomes, explaining 56.7% of variance in overall safety perceptions and 23.2% in error reporting frequency.
Overall, the dissertation provides rare large-scale longitudinal evidence that PSC is dynamic and multidimensional. It highlights the importance of leadership commitment, blame-free reporting systems, staffing adequacy, and workforce-centered strategies to sustain safety improvements in U.S. hospitals.
Keywords
patient safety culture, Hospital Survey on Patient Safety Culture, HSOPSC, Hospital, U.S., longitudinal, partial least squares structural equation modeling, PLS-SEM, multi-group analysis, MGA
Citation
Alabdullah, H. (2026). Examining patient safety culture trends in U.S. healthcare through a multi-year analysis (Publication No. 1000) [Doctoral dissertation, University of Central Florida]. STARS. https://stars.library.ucf.edu/cgi/preview.cgi?article=1000&context=gradstudies_etd_2026
