# Unraveling Patient Safety Culture Trends in U.S. Hospital Settings: A Yearly Retrospective Analysis
## 3 Results
### Annual Changes in Patient Safety Culture
 } \\ \cline{3-11}  & \(\mathrm{APR\%}\) * & \(79\) & \(78\) \(\mathrm{\char 37}\) & \(79\) \(\mathrm{\char 37}\) & \(80\) \(\mathrm{\char 37}\) & \(80\) \(\mathrm{\char 37}\) & \(80\) \(\mathrm{\char 37}\) & \(80\) \(\mathrm{\char 37}\) & \(80\) \(\mathrm{\char 37}\) & \(80\) \(\mathrm{\char 37}\) & \(79\) & \(0.18\) & \(<\)\(001\) \\ \cline{3-11}  & \(\mathrm{ANeR\%}\) * & \(12\) & \(12\) \(\mathrm{\char 37}\) & \(11\) \(\mathrm{\char 37}\) & \(11\) \(\mathrm{\char 37}\) & \(11\) \(\mathrm{\char 37}\) & \(11\) \(\mathrm{\char 37}\) & \(11\) \(\mathrm{\char 37}\) & \(11\) & \(-1.19\) & \(0.097\) \\ \cline{3-11}  & \(\mathrm{ANeR\%}\) * & \(9\) & \(10\) \(\mathrm{\char 37}\) & \(10\) \(\mathrm{\char 37}\) & \(10\) \(\mathrm{\char 37}\) & \(9\) \(\mathrm{\char 37}\) & \(9\) \(\mathrm{\char 37}\) & \(9\) \(\mathrm{\char 37}\) & \(9\) \(\mathrm{\char 37}\) & \(10\) & \(0.16\) & \(<\)\(001\) \\ \hline \multirow{4}{*}{ \begin{tabular}{c} D4: Organizational \\ Learning \\ \end{tabular}  } & \multirow{2}{*}{Mean (SD)} & \(3.84\) & \(3.81\) \(\mathrm{\char 37}\) & \(3.83\) & \(3.81\) & \(3.83\) & \(3.80\) & \(3.82\) & \(3.81\) & \(3.82\) & \multirow{2}{*}{ \begin{tabular}{c} **-0.01** \\ **0.2** \\ \end{tabular}  } & \multirow{2}{*}{\ \begin{tabular}{c} **-0.01** \\ **0.1** \\ \end{tabular}  } & \multirow{2}{*}{
\begin{tabular}{c} **-0.02** \\ **0. \begin{table}
\begin{tabular}{c c c c c c c c c c c c c} \hline \hline \multirow{2}{*}{**Dimensions PSC**} & \multirow{2}{*}{**Measure**} & \multirow{2}{*}{**2013**} & \multirow{2}{*}{**2014**} & \multirow{2}{*}{**2015**} & \multirow{2}{*}{**2016**} & \multirow  
As shown in Figure 4, D5 (Teamwork within Units) and D3 (Supervisor/Manager Expectations and Actions Promoting Patient Safety) consistently remained strengths. Most other dimensions fluctuated within the moderate range (between 50% and 75%), exhibiting both improvements and declines over time. D9 (Staffing) transitioned from a neutral to a weak area, while D12 (Handoffs and Transitions) remained weak, showing a continuous decline. D8 (Nonpunitive Response to Error) initially improved, peaking in 2018 when it moved out of the weak category, but later regressed. Figure 4: Trends in APR% across the 12 PSC dimensions over time. Note: the red dotted line represents the threshold for areas of weakness (composite scores \(<\) 50%). The green dotted line represents the threshold for areas of strength (composite scores \(\geq\) 75%). 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. Figure 5: Trends in the overall PSC scores over time. Overall PSC scores (Figure 5), calculated as the average of all dimensions each year, declined from 67% in 2013 to 64% in 2020. Although the scores fluctuated around 65% for most years, a notable drop occurred in 2020. From 2013 to 2020, the PSC dimensions showed mixed trends (Table 4). D1 (Overall Perceptions of Patient Safety) remained stable (mean \(\approx\) 3.68 \(\pm\) 0.2, \(p\) = 0.391). D2 (Frequency of Events Reported) improved, with the mean increasing from 3.85 to 3.91 (\(p\) < 0.001) and the APR% rising from 67% to 68%. D3 (Supervisor/Manager Expectations and Actions Promoting Patient Safety) remained high, with a mean of \(\approx\)4.01 \(\pm\) 0.2 and the APR% increasing from 79% to 80% (\(p\) < 0.001). D4 (Organizational Learning) and D5 (Teamwork within Units) remained stable, with the APR% around 72% and 82%, respectively. D6 (Communication Openness) showed significant improvement, with the mean increasing from 3.70 to 3.81 (\(p\) < 0.001), and the same trend was observed in D7 (Feedback and Communication about Error) (mean rising from 3.89 to 3.95, \(p\) = 0.007).