# Unraveling Patient Safety Culture Trends in U.S. Hospital Settings: A Yearly Retrospective Analysis
## 3 Results
### Patient Safety Culture Overview  
Figure 2 shows the overall PSC in U.S. hospital settings, combining data from 2013 to 2020. These aggregated data capture the general perceptions of healthcare workers regarding safety policies, practices, and organizational priorities in healthcare settings. Because culture is a group characteristic, each hospital contributes equally to the overall averages. Figure 2 presents the overall PSC score, calculated as the average of PSC dimensions over time, highlighting the average positive response percentages (APR%) at the hospital level. The overall PSC rate in U.S. hospital settings averaged 65% across the years studied. Areas of strength, with the highest average positive response rates, were Teamwork Within Units (82%) and Supervisor/Manager Expectations and Actions Promoting Patient Safety (79%). Organizational Learning--Continuous Improvement and Management Support for Patient Safety also showed relatively strong scores (72%). Conversely, areas needing improvement, with the lowest average positive response rates, included Nonpunitive Response to Error (47%) and Handoffs and Transitions (48%). Staffing (54%) was identified as an area approaching the lower end of performance. The two outcome dimensions--reported error frequency and safety grade (Figure 3A,B)--provide insight into error reporting behaviors and perceptions of workplace safety. Over the years, the majority of respondents (55%) reported no errors in the past 12 months; 26% reported 1-2 errors; 12% reported 3-5; 4% reported 6-10; 2% reported 11-20; and 1% reported 21 or more errors. Figure 1: Annual distribution of surveys, valid responses, and response rate. Note: \(p\)-values were obtained using ANOVA to compare the means across different years. Regarding safety grades, 34% rated their work area as excellent, 43% as very good, 18% as acceptable, 4% as poor, and 1% as failing, indicating predominantly positive perceptions of workplace safety. Figure 3: The average percentage of responses across years for event reporting and safety grade. Figure 2: Overall dimension-level average percentage of positive responses across years. * 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. Table 2 presents percentile assessments, offering hospitals a valuable benchmarking tool for performance improvement. Comparing their results to a larger database enables hospitals to assess their relative standing, identify strengths, and pinpoint areas for enhancement. This, in turn, allows hospitals to set realistic goals and focus on targeted interventions to improve their culture of patient safety. Key dimensions, such as Supervisor/Manager Expectations and Actions Promoting Patient Safety (17-98% positive) and Teamwork within Units (26-99%) showed the highest scores, reaching 87% and 88%, respectively, at the 90 th percentile (meaning that 90% of hospitals scored at or below this level, and 10% higher). Furthermore, Management Support for Patient Safety (36-96%) and Organizational Learning (15-93%) also showed positive scores, reaching 83% and 81% at the 90 th percentile. However, Nonpunitive Response to Error and Handoffs and Transitions showed significant score variation, reaching only 58% and 62%, respectively, at the 90 th percentile. These lower 90 th percentile scores indicate that many hospitals struggle with these aspects, highlighting the need for immediate attention. Other dimensions, such as Staffing (66% in the 90 th percentile), showed room for improvement, suggesting that substantial gaps remain in ensuring adequate staffing.