Assessment of patient safety culture among nurses in Djibouti: a multicentric study

Patient safety is a cornerstone of healthcare quality, yet it persists as a critical global challenge. In Djibouti, data on safety culture are scarce. This study aimed to assess the patient safety culture among nurses in the country’s principal public referral hospitals. A multicentre cross-sectional study was conducted in four of Djibouti’s main public hospitals using the validated French version of the Hospital Survey on Patient Safety Culture (HSOPSC). A total of 239 nurses from four hospitals participated. Data were analysed using descriptive statistics, with dimensions classified based on predefined positive response rate thresholds. The overall perception of patient safety was low, with only 37% of nurses rating it as “acceptable” and 38% as “poor.” Teamwork within units was a relative strength (50% positive responses). In contrast, critical weaknesses were identified in non-punitive response to error (26%), staffing (24%), communication openness (31%), and management support for patient safety (35%). These deficits manifested operationally: 87% reported no adverse events in the past year, suggesting severe under-reporting. This first multicentre assessment reveals a patient safety culture in urgent need of strengthening in Djibouti’s major hospitals. While teamwork provides a foundation, systemic interventions are required to build managerial commitment, ensure adequate staffing, and foster a just, open, and reporting-oriented culture to sustainably improve patient safety.