Reporting a Patient Safety Culture in Global Health: Evidence From Sierra Leone.

Aims: To explore the level of patient safety culture in Sierra Leone and identify the factors associated with the patient safety grade and patient safety events reported. Design: A cross-sectional study. Methods: From February to March 2024, we selected staff members from three representative public hospitals of different types in Sierra Leone. Patient safety culture was assessed with the Hospital patient safety culture survey 2.0. Binary logistic regression was employed to determine the influence of sociodemographic characteristics on the patient safety grade and patient safety events reported. The textual responses to the open-ended question were imported into Nvivo 12.0 for thematic analysis. Results: A total of 247 questionnaires was sent out, of which 202 were effectively received. Among 10 safety culture dimensions, three were strength areas with over 75% positive response rate. The other six dimensions ranged from 54.91% to 70.54%. In this study, the highest positive response rate dimension was "Teamwork" (80.83%), and the lowest was "Reporting patient safety event" (49.1%). Item "Staff in this unit work longer hours than is best for patient care", with a positive response rate of 18.09%, ranks last among all items. "Tenure in Unit/Work Area" could effectively predict patient safety events reported. The initial coding of the open-ended responses yielded a framework of four first-level codes and 11 secondary codes. Conclusions: It is acknowledged that this is the first research to be conducted in Sierra Leone about the local patient safety culture. Hospital safety culture in Sierra Leone remains suboptimal overall, with adverse event report representing the most significant issue. Our study also uncovers unique patient safety challenges in resource-limited settings (reliable water and electricity supply, proper sanitation, and adequate staffing), addressing a critical gap in the global patient safety evidence base.