Nurse Perceptions: The Relationship Between Patient Safety Culture, Error Reporting and Patient Safety in U.S. Hospitals

Date of Award


Document Type


Degree Name

Doctor of Healthcare Administration (DHA)

Committee Chair

Dale Gooden

Committee Member

Jesse Florang

Committee Member

Shawishi Haynes


Purpose: Preventable medical errors resulted in about 400,000 annual deaths in U.S. hospitals (Thornton et al., 2017) and cost the U.S. economy about $20 billion annually (Rodziewicz & Hipskind, 2020). Meanwhile, nurses continued embracing patient care and safety. However, limited research existed associating nurses’ perceptions of safety culture with error reporting and patient safety outcomes (Han, Kim, & Seo, 2020). This study aimed to fill that literature gap, advance nurses’ roles, and improve care quality. Framework: Self-determination theory (SDT) and Donabedian’s Model guided this research. Method: This was a quantitative, cross-sectional correlation design study using bivariate, multivariate, and logistic regression analysis for multi-level modeling with 90,016 nurse participants. Ethical approval came from Franklin University Institutional Review Board. Data: Secondary, de-identified SOPS® data for the analysis was provided by the SOPS Database, funded by U.S. Agency for Healthcare Research and Quality (AHRQ) and administered by Westat under Contract Number HHSP233201500026I / HHSP23337004T. This study analyzed collected data (i.e., 2015 to 2017) from 565 U.S. hospitals that voluntarily submitted their HSOPSC data to the 2018 comparative dataset. Findings: Data findings for unit-level aggregation identified PSC composite Feedback and communication about errors with the most statistically significant positive association with Overall frequency of events reported. PSC composite Teamwork within unit had the greater odds for an increase in Number of events reported. PSC composite Staffing produced a higher, statistically significant positive association with Overall perceptions of patient safety. Furthermore, Organizational learning – continuous improvement produced the higher odds of increasing Patient safety grade. Hospital-level aggregation revealed that Management support for patient safety had the most positive, significant effect across three outcome measures: Overall frequency of events reported, Overall perceptions of patient safety, and Patient safety grades. Regrettably, PSC composite measures failed to demonstrate a significant, positive association for Number of events reported at hospital-level aggregation. Lastly, data findings confirmed a statistically significant positive association between Frequency of events reported and Overall perceptions of patient safety. Conclusion: Multiple PSC composite measures demonstrated a statistically significant positive association with response variables for unit-level aggregation, while Management support for patient safety provided the most impact for hospital-level aggregation. However, unit leaders focused on specific PSC composites measures might see an immediate impact.