# Unraveling Patient Safety Culture Trends in U.S. Hospital Settings: A Yearly Retrospective Analysis
## 3 Results
### Annual Changes in Patient Safety Culture
In contrast, D9 (Staffing) declined (mean dropping from 3.53 to 3.29, \(p\) = 0.009), and D10 (Management Support for Patient Safety) also decreased (mean from 3.86 to 3.72, \(p\) = 0.007). Persistent challenges in D12 (Handoffs and Transitions) highlighted areas needing improvement, as it remained weak with no statistically significant change observed. Many PSC dimensions showed statistically significant changes over time (Table 4), likely due to the large sample size affecting the one-way ANOVA results. D1 (Overall Perceptions of Patient Safety), D9 (Staffing), and D10 (Management Support for Patient Safety) declined in positive responses and increased in negative responses (\(p\) < 0.05). D1's positive responses dropped from 70% (2013) to 64% (2020), while the negative responses rose from 13% to 18%. D9 and D10 also showed declines. D6 and D7 showed improvement. D6's neutral responses decreased from 23% to 21%, and the positive responses increased from 64% to 66%. D7's neutral responses declined from 22% to 21%, and the positive responses increased from 69% to 70% (0.23% change, \(p\) = 0.115). The boxplot (Figure 6) illustrates the consistency and variability of the 12 PSC dimensions across the observed years. Some dimensions showed remarkable stability. For instance, D5 consistently achieved high percentages of positive response, and D3 exhibited similar, though less pronounced, consistency. D12 showed the greatest variability, reflecting significant perceptual divergence. At the year level, 2020 displayed the highest overall consistency across the 12 dimensions. However, outliers were notable in earlier years (2014-2017 and 2019), indicated by the (O) symbol, with some hospitals reporting exceptionally high or low percentages of positive responses. Some hospitals reported perceptions exceeding outlier values, representing extreme deviations, indicated by the (\(\star\)) symbol. A more detailed view of the year-by-year variation for each dimension is provided in Figure S1 in the Supplementary Material. Figure 7 presents the distribution of safety grades and reported events. In Part A, the percentage of \"Excellent\" grades increased slightly from 32% (2013) to 36% (2019) before decreasing to 34% (2020) (\(p\) = 0.003). The \"Very Good\" grades consistently declined from 47% (2013) to 40% (2020) (\(p\) < 0.001). The \"Acceptable\" grades remained relatively stable (17-20%, \(p\) = 0.134). The \"Poor\" grades increased from 2% (2013) to 5% (2020) (\(p\) = 0.038). The \"Failing\" grades remained constant at 1% (\(p\) = 0.354). Part B of Figure 7 reveals that the proportion of respondents reporting \"No events\" varied between 52% and 58%, with a statistically significant downward trend (\(p<0.001\)). Reports with \"1-2\" events ranged from 23% to 27%, and reports with \"3-5\" events varied between 11% and 14%. The \"6-10\" events remained between 4% and 5%, while the \"11-20\" events increased from 1% to 4% (all \(p<0.001\)). The \"21+\" events remained constant at 1% (\(p=0.465\)). Fluctuations and increases are observed in positive event reporting (42-48%, avg. 45%). However, a decrease in worker perception of their work area over time can be recognized from positive safety grades (74-79%, avg. 77%) from 2013 to 2020, as shown in Figure 8. This indicates varying trends in reporting practices and workers' perceptions of safety within their work units or departments over time. Figure 6: Boxplot analysis of 12 PSC dimensions across years. 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 \(\geq 75\%\)). (O) indicates outlier hospitals; (\(\bigstar\)) indicates hospitals with extreme deviations beyond the outlier range.