EXAMINING PATIENT SAFETY CULTURE TRENDS IN U.S. HEALTHCARE THROUGH A MULTI-YEAR ANALYSIS

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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

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