Patient safety culture across hospital tiers in China: a cross-sectional survey of healthcare professionals

PSC perceptions varied systematically across hospital tiers in Chongqing. These differences appear to coexist with variations in organisational context, workforce composition, and institutional characteristics across tiers. By applying an organisational ecosystem perspective, this study offers an additional framework for interpreting PSC variation within tiered healthcare systems. The findings highlight the potential value of tier-sensitive approaches to patient safety improvement and may inform safety strategies in other health systems with similar structural arrangements.