[Variability in patient safety culture at Brazilian hospitals: influence of contextual factors].

Patient safety is a strategic challenge for the Brazilian Unified National Health System (SUS) and a priority for hospital quality. This study describes the variation in safety culture among Brazilian hospitals and analyzes whether structural and organizational factors may explain part of these differences. A cross-sectional study was conducted with data collected in 2021 from 42,038 healthcare providers working at 304 public and private hospitals distributed throughout all regions of the country. Safety culture was measured based on the proportion of positive answers to 42 statements of the Hospital Survey on Patient Safety Culture, which is an international questionnaire developed by the U.S. Agency for Health Research and Quality and adapted to the Brazilian context. The variables of interest were geographic location, type of management, and hospital size, which were analyzed using multivariate linear regression with resampling (bootstrap). Considerable variation was found among hospitals for the 12 dimensions of safety culture analyzed. Two dimensions were considered strengths (average of more than 75% positive responses), while one was identified as a weakness (average of less than 50%). The statistical model explained 37% of the variation. The main associated factors were location in the Northeast region, indirect public management, small institutional size, and teaching-hospital status. In conclusion, patient safety culture varies significantly among hospitals in the country and is related to structural characteristics that could be the target of public policies and management strategies. The present findings strengthen initiatives such as the Brazilian National Patient Safety Program and offer practical support for decision-making within the SUS.