Organizational and Digital Health Factors Associated with Perceived Patient Safety Performance During Electronic Medical Record Implementation in Community Health Centers: A Mixed-Methods Study

Evidence on how organizational and technological factors are associated with perceived patient safety performance in community health centers remains limited in emerging health systems. This study aimed to examine the associations among organizational and technological factors, organizational culture-driven orientation, teamwork climate, and perceived patient safety performance during EMR implementation in community health centers. A sequential explanatory mixed-methods study was conducted across all 18 community health centers in one Indonesian district. The quantitative component employed a cross-sectional survey of 456 healthcare professionals and was analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM), followed by qualitative interviews with 14 purposively selected informants to explain and contextualize the quantitative findings. Innovation-supportive leadership showed the largest standardized associations with organizational culture-driven orientation and teamwork climate (p < 0.001). Organizational culture-driven orientation and teamwork climate were positively associated with perceived patient safety performance, whereas perceived clinical value of EMR was not significantly associated with teamwork climate. These findings highlight the relevance of leadership engagement, organizational culture, and teamwork alongside EMR implementation when understanding perceived patient safety performance in primary healthcare.