Patient safety as an ethical interface: alignment between staff safety culture, speaking up climate and inpatient perceptions in Romania: a cross-sectional multi-informant survey.

backgroundPatient safety emerges where clinical risk governance intersects with ethical duties of non-maleficence, respect for autonomy, and institutional accountability. Safety culture surveys and patient-reported experience measures often evolve on separate analytic tracks, leaving uncertainty about how staff-facing metrics translate into patient-facing ethical practices such as disclosure after harm.

methodsWe conducted an exploratory cross-sectional multi-informant survey in an acute-care hospital in Romania. Healthcare workers (defined as physicians, nurses, hospital auxiliary staff, and other clinical/non-clinical personnel involved in care delivery or immediate supervision; n = 104) completed the AHRQ Hospital Survey on Patient Safety Culture version 2.0 and the Speaking Up About Patient Safety Questionnaire, capturing safety culture composites, speaking up behaviour, and psychological safety. Inpatients (n = 101) completed a project-specific, not externally validated structured questionnaire covering perceived safety, communication and information, consent and involvement, confidentiality and complaint mechanisms, coordination and organisational reliability, observed safety practices, and experiences of incident communication. We conducted exploratory analyses including composite means, percent positive scores, internal consistency estimates, and examined ward-level associations.

resultsStaff composites peaked for teamwork (mean 3.84/5; 74.3% positive) and communication about error (3.74/5; 70.8% positive), while staffing and work pace (2.74/5; 29.3% positive), response to error (31.7% positive), and hospital management support (34.0% positive) showed marked compression. Patients rated coordination and organisation (mean 3.67/5) and consent and involvement (3.60/5) higher than communication and information (3.42/5). Eleven patients (10.9%) perceived a safety incident; among them, ratings for apology, explanation and follow-up clustered at the lower end of the scale (mean 1.73/5). Ward-level overall safety culture scores showed negligible associations with patient global safety, perceived safety and recommendation. Exploratory ward-group analyses suggested that patient-rated coordination aligned more closely with handoffs and information exchange than with global safety culture measures. Other cross-level associations were inconsistent and were interpreted cautiously because of broad clinical-area aggregation and limited between-group variation. Favourable speaking up climate correlated with overall safety culture (r = 0.484, p < 0.001) and management support (r = 0.547, p < 0.001).

conclusionsIn this setting, patient-perceived safety aligned more closely with interface processes than with global culture scores, and incident communication surfaced as a salient ethical deficit. Strategies integrating psychological safety, management responsiveness, and structured disclosure practices warrant prospective evaluation as potential ways to advance moral accountability and risk governance. Given the cross-sectional, single-site design and modest sample size, these associations should be interpreted as exploratory and non-causal.

trial registrationNot applicable.