The trajectory of patient safety culture: a comparative analysis of Iranian healthcare workers’ perspectives during and post-COVID-19 pandemic

BACKGROUND: The COVID-19 pandemic significantly impacted patient safety culture in hospitals. Patient safety culture is a critical factor in determining hospitals' ability to manage and reduce patient risks. This study aimed to examine the perceived patient safety culture among healthcare workers (HCWs) in Iran during and after the COVID-19 pandemic. METHODS: This descriptive study included HCWs as the study population. A census sampling method was employed at a hospital in southeastern Iran. Data were collected using a demographic questionnaire and the Hospital Survey on Patient Safety Culture (HSOPSC), administered at two time points: initially in 2020 (during the Covid-19 pandemic) and again in 2023 (two different time periods). A total of 316 HCWs from a public hospital serving as a COVID-19 medical center participated in the initial phase (in 2020). In 2023 after the pandemic, 320 HCWs from the same hospital were included in the follow-up assessment. Data analysis was performed using IBM SPSS Statistics version 22.0 to calculate means, standard deviations, frequencies, and percentages. Bivariate analysis using one-way ANOVA and t-tests examined the correlations between demographic/professional variables and HSOPSC dimensions. RESULTS: The majority of participants in both 2020 and 2023 were female (77% vs. 73%), and most were nurses (72.46% vs. 75.93%). The overall safety culture scores were 44.06 in 2020 and 50.07 in 2023. The average positive response rate for patient safety culture was below 50% in 2020 (indicating a low safety culture) and exceeded 50% in 2023. In 2023, mean scores were significantly higher than in 2020 for Dimension 1 (Frequency of Event Reporting: 3.40 vs. 3.09), Dimension 5 (Teamwork Within Units: 3.69 vs. 3.44), and Dimension 10 (Hospital Management Support for Patient Safety: 3.29 vs. 3.00) (p < 0.001). CONCLUSION: A strong patient safety culture can enhance patient safety and the quality of healthcare services. Therefore, hospital management should focus on strengthening all dimensions of patient safety culture by providing advocacy programs, soft skills (non-technical, cognitive and interpersonal), and support interventions based on sharing information and experiences, mentoring and peer-to-peer exchange to ensure safe patient care. Future research could investigate the factors that influence patient safety culture.