Value Congruence Regarding Patient Safety Among Nurses and Their Managers and Its Association With Patient Safety Behaviors: The Moderating Role of Psychological Safety.

Introduction Securing patient safety is a global concern. Unsafe care can cause preventable adverse events. Nurses play a key role through two types of patient safety behaviors: compliance (mandatory adherence to safety protocols) and participation (voluntary efforts to improve safety). While value congruence with supervisors promotes positive work behaviors, its influence on patient safety behaviors remains unclear. Moreover, a clear link between psychological safety and patient safety outcomes is yet to be established. To fill this gap, the present study examines whether psychological safety moderates the relationships between value congruence regarding patient safety and patient safety behaviors. Objectives To examine the associations between nurses' value congruence with their managers regarding patient safety and both patient safety compliance and participation, and to assess the moderating role of psychological safety in these relationships. Design A cross-sectional, multicenter, self-administered questionnaire survey. Materials and methods The survey was conducted from April to May 2025 among registered nurses working in hospitals across Japan with more than 200 beds. Multivariate regression analyses were employed to examine the relationships among patient safety behaviors, value congruence, and psychological safety. This study was conducted in accordance with the STROBE (STrengthening the Reporting of OBservational Studies in Epidemiology) guidelines. Results In total, 509 nurses at six hospitals were included in the study. Value congruence was associated with patient safety compliance (β=0.347, p<0.001) and participation (β=0.341, p<0.001). The interaction effect of value congruence and psychological safety on patient safety compliance and participation yielded β=0.020 (p<0.630) and β=0.081 (p=0.047), respectively. Conclusions This study introduced the novel concept of value congruence as a contributor to patient safety. Our findings suggest that sharing values and goals related to patient safety can promote both types of patient safety behaviors, and psychological safety plays a key role in fostering voluntary engagement in patient safety practices.