Aspects of Patient Safety Culture Most Associated With Employees' Overall Rating of Patient Safety and Whether Employees Reported Safety Events: Overall and for Hospitals Predominantly Serving Black Patients.

objectivesCare for black patients in the United States is concentrated in relatively few hospitals-known as black serving hospitals (BSHs). BSHs have high rates of safety events. Yet, it is unknown what aspects of patient safety culture are associated with employee assessments of patient safety or reporting safety events, and whether these patterns differ for hospitals predominantly serving black patients.

methodsWe identified hospitals as BSH if their proportion of admitted black patients exceeded the national average (12.1%). We linked BSH status to the 2021-2022 Hospital Survey on Patient Safety Culture 2.0 (HSOPS) data, identifying 128 BSHs and 243 non-BSHs (with 107,224 and 138,028 HSOPS respondents, respectively). We examined the associations of 10 aspects of patient safety culture with 2 summary measures: employee's overall rating of patient safety and whether employees reported safety events. We fit respondent-level models, overall and stratified by BSH status, controlling for respondent characteristics. We used weights accounting for hospital HSOPS observations and to make results nationally representative. t tests were obtained from a model fully interacted with BSH status to test whether the associations for BSHs and non-BSHs were different.

resultsPositive patient safety ratings were most associated with staffing/work pace, communication openness, management support of safety, and organizational learning-continuous improvement. Reporting any event was most positively associated with response to error and most negatively associated with management support. Patterns were similar for BSHs and non-BSHs, except for 4 associations: stronger positive association of organizational learning-continuous improvement with positive patient safety ratings in BSHs. Stronger negative association of staffing/work pace and communication openness with reporting any event in BSHs. Stronger positive association of communication openness with reporting any events in non-BSHs.

conclusionsKey aspects of creating hospital workplace cultures that engage in identifying events and learning from them to support patient safety differed in BSHs and non-BSHs, warranting further investigation. This knowledge may help mitigate differences in patient safety across hospitals.