# Unraveling Patient Safety Culture Trends in U.S. Hospital Settings: A Yearly Retrospective Analysis
## 1 Introduction  
Patient safety culture (PSC) has gained significant attention in healthcare research, as the safety of patients is increasingly recognized as a vital element of high-quality healthcare. The Institute of Medicine (IOM) emphasizes patient safety as a fundamental component in improving healthcare quality, noting that enhancing hospital safety is crucial for overall care improvement [1]. A strong patient safety culture is essential for reducing medical errors, improving patient outcomes, and creating a supportive environment for healthcareprofessionals. This aligns with the international patient safety goals set by the World Health Organization [2], which provide a framework for addressing critical safety issues in healthcare settings.  
Safety culture in general refers to the collective beliefs, attitudes, and behaviors within an organization that shape its approach to safety management [3]. In healthcare, PSC specifically focuses on minimizing harm and ensuring that safety practices are effectively integrated into daily care processes [4]. PSC encompasses multiple dimensions, including leadership commitment, communication, teamwork, and continuous learning, all of which contribute to a culture where patient safety is prioritized. While PSC is often discussed alongside healthcare quality, it is distinct in its focus on risk prevention and harm reduction [5; 6].  
To assess PSC, various instruments have been developed [7], with the Hospital Survey on Patient Safety Culture (HSOPSC) being one of the most widely adopted tools. Developed by the Agency for Healthcare Research and Quality (AHRQ) in collaboration with the Quality Interagency Coordination Task Force, the HSOPSC measures hospital staff's perceptions of safety culture [8]. The first version of the HSOPSC (1.0), introduced in 2004, includes 42 items across 12 dimensions, assessing factors such as organizational learning, teamwork, supervisor support, and nonpunitive responses to error [8]. These dimensions offer insights into the hospital's safety culture and guide safety improvements.  
Tracking trends in PSC is essential for evaluating the effectiveness of safety interventions and measuring long-term improvements in healthcare settings. Understanding these changes allows hospitals to assess the impact of safety initiatives and identify areas needing attention [9]. However, there is a lack of research analyzing PSC trends over time, leaving a gap in understanding the improvement and sustainability of patient safety culture over time.  
This research aims to address that by examining trends in PSC within U.S. hospitals using the HSOPSC 1.0 database. It will track key PSC dimensions over time to assess changes, focusing on both strong and weak areas. By analyzing these trends, this study should identify and evaluate the critical dimensions that contribute to fostering a positive patient safety culture and the potential areas for improvement. Ultimately, this research seeks to provide a comprehensive understanding of the state of PSC and offer insights into its year-by-year evolution within U.S. hospitals.