Multilevel Analysis of Individual, Organizational, and Regional Factors Associated With Patient Safety Culture: A Cross-Sectional Study of Maternal and Child Health Institutions in China

The aim of this study was to assess patient safety culture (PSC) in maternal and child health (MCH) institutions in China and its individual, organizational, and regional variations. METHODS: Using the PSC survey for MCH institutions (PSCS-MCHI), 2021 valid respondents from 25 participating institutions were investigated in three regions (Beijing, Zhejiang, and Jiangxi) of China. Patient safety culture and its subscale scores (1–5) and factors associated with PSC as revealed by multilevel modeling. RESULTS: The respondents had an average PSC score of 3.55 (SD = 0.35), with subscale scores ranging between 2.46 (“staffing and workload”) and 4.02 (“work commitment”). There were limited regional differences in PSC: a three-level regression model was only confirmed for the subscale “staff empowerment” (P = 0.006). However, significant organizational variations in PSC were evident: a two-level regression model was assumed for the PSC scale and nine subscales (P < 0.001). The fixed-effect models showed that male respondents, frontline workers, those who were in their mid-career (11–20 y), overloaded (≥9 hours), and had a masters or higher degree reported worse PSC. Frontline workers were less positive than managers in ratings on “managerial response to risks” (−0.11 [−0.20 to −0.02]), “management support” (−0.18 [−0.28 to −0.07]), and “staff empowerment” (−0.23[−0.35 to −0.11]). CONCLUSIONS: Patient safety culture in MCH institutions is shaped by organizational and individual characteristics. We observed a gap in perceived PSC between frontline worker, who are less positive, and managers. Actions for improving PSC should consider interventions on organizational management (such as appropriate staffing and workload management) and engagement of frontline workers in the development of management and training activities.