# Unraveling Patient Safety Culture Trends in U.S. Hospital Settings: A Yearly Retrospective Analysis
## 4 Discussion  
Healthcare systems worldwide face the challenge of improving PSC [15]. Assessing PSC helps identify safety strengths, weaknesses, and areas for improvement within organizations [8; 16; 17], fostering supportive environments for staff to implement safety  
Figure 10: The number of hospitals that showed a 5% change in PSC dimensions, safety grade, and reporting events. PSC dimensions: D1: Overall Perceptions of Patient Safety; D2: Frequency of Events Reported; D3: Supervisor/Manager Expectations and Actions Promoting Patient Safety; D4: Organizational Learning; D5: Teamwork within Units; D6: Communication Openness; D7: Feedback and Communication about Error; D8: Nonpunitive Response to Error; D9: Staffing; D10: Management Support for Patient Safety; D11: Teamwork across Units; and D12: Handoffs and Transitions. Safety grades: Grade A indicates excellent, B indicates very good, C indicates acceptable, D indicates poor, and E indicates failing. measures effectively [18; 19]. This study analyzed trends in PSC within U.S. hospitals from 2013 to 2020, using participant data from the HSOPSC 1.0 survey, which was developed and managed by the AHRQ. The longitudinal analysis presented the development of PSC over time, revealing persistent strengths, concerning declines, and the influence of various hospital characteristics on the results of the PSC survey. Regarding survey processing, the overall survey distribution and response numbers remained relatively stable across participating hospitals, but the likelihood of hospital staff responding to surveys improved significantly over time. This could indicate a growing interest in PSC or improvements in survey engagement processes at U.S. hospitals. Additionally, this study showed that the overall perception of healthcare workers regarding PSC was moderate throughout this study's timeframe, ranging from 64.2% to 66.5%, with an average score of approximately 65%. This indicates that while some improvements were observed, there is still a need for continued efforts to enhance safety culture across U.S. hospitals. When analyzing the dimensions of safety culture, clear sustainable strengths were noted in areas such as \"Supervisor/Manager Expectations and Actions Promoting Patient Safety\" and \"Teamwork within Units\", with \"Organizational Learning\" approaching classification as an area of strength. These dimensions demonstrated good perception, indicating that they are key areas that can be built upon to further enhance safety culture. Strong scores in Organizational Learning reflect a commitment to learning from mistakes and improving practices [20]. Meanwhile, effective collaboration improves communication and decision-making, contributing to better patient safety outcomes [21; 22]. On the other hand, other dimensions, such as \"Nonpunitive Response to Error\" and \"Handoffs and Transitions\", consistently showed noticeable weaknesses, requiring urgent interventions. These areas fall short of the Institute of Medicine's recommendations to foster a strong, blame-free culture that learns from mistakes to prevent harm [1]. The participating U.S. hospitals generally exhibit stronger perceptions of PSC dimensions compared to hospitals from other continents [23]. However, comparable strengths and weaknesses in PSC are also evident, particularly in some dimensions, both globally [23] and locally [24]. Specifically, they demonstrate strengths in supervisor and manager support for patient safety and teamwork within units, while showing weaknesses in fostering a blame-free environment and ensuring effective handoffs and transitions. The fear of reporting errors significantly hinders open communication and prevents proactive safety improvements [25; 26]. Critically, insufficient staffing compromises patient care quality and safety by increasing the likelihood of errors [27; 28; 29].