Analysis of the influencing factors of team safety culture in non-public tertiary general hospitals

Analysis of the influencing factors of team safety culture in non-public tertiary general hospitals | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Analysis of the influencing factors of team safety culture in non-public tertiary general hospitals Qiannan Zhao, Chenxiao Zhu, Ting Li, Jiahui Fu, Huahua Wei, Manyun Zhang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8581892/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 12 You are reading this latest preprint version Abstract Background With the rapid development of non-public tertiary general hospitals in China, the construction of team safety culture has become a priority to narrow the gap with public hospitals in terms of patient safety management, however, the current driving factors have not been identified. To evaluate the current status of team safety culture in a non-public tertiary general hospital and identify key influencing factors, thereby providing a scientific basis for targeted safety culture enhancement. Methods A cross-sectional survey was conducted among 840 medical staff in a non-public tertiary general hospital from June to August 2025. Stratified cluster sampling was adopted, with stratification first performed according to clinical departments, followed by cluster sampling, with each department treated as a sampling cluster. Team safety culture was assessed using the Chinese version of the Hospital Patient Safety Culture Survey Scale, which includes six dimensions and 39 items. One-way analysis of variance was applied for the preliminary comparison of the total mean patient safety culture scores across medical staff with different characteristics. Statistically significant variables from the one-way analysis were included in a multivariate logistic regression model to identify independent factors affecting the perception of patient safety culture. Department type, working tenure, and professional category were taken as the core independent variables, and their impacts on the perception of team patient safety culture were evaluated. Results The overall positive response rate for team safety culture was 66.65%. “Managerial Support for Patient Safety” (77.70%), “Colleague Collaboration” (76.15%), and “Communication” (75.43%) were strengths, whereas “Staff Recognition of Hospital Safety Culture” (58.21%) and “Incident Reporting” (66.47%) were weaknesses. Multivariate analysis identified department as an independent influencing factor. Medical staff in critical care (OR = 0.42), laboratory (OR = 0.25), and platform departments (OR = 0.49) had significantly lower safety culture perception (P < 0.05). Conclusion Team safety culture in the non-public tertiary general hospital is at a moderate level, with marked departmental differences. Future interventions should prioritize fostering a non-punitive reporting environment, improving staffing in high-risk units, and strengthening interdepartmental communication and collaboration to enhance the overall patient safety culture climate. Non-public hospital Patient safety culture Team safety culture Influencing factors Cross-sectional study Introduction Patient safety is the cornerstone of medical quality, and the World Health Organization has consistently emphasized that cultivating a positive patient safety culture is one of the most effective strategies for reducing medical errors and safeguarding patients. Safety culture is defined as “a unified organizational behavior that advances all cultural connotations toward safety” [ 1 ]. This adopted definition is consistent with the World Health Organization (WHO) Patient Safety Framework [ 2 ] and the concepts put forward in the Agency for Healthcare Research and Quality (AHRQ) [ 3 ] Hospital Survey on Patient Safety Culture (HSOPS). Both documents emphasize the sharing of safety values, attitudes, and behaviors among organizations, and they strive to reduce patient risk through systematic improvements. In medical institutions, it is expressed through shared values, attitudes, cognition, and behavioral patterns that collectively minimize the risk of patient harm. In recent years, national policy reforms and the influx of social capital have expanded the role of non-public hospitals within China’s medical service system. Their number and service capacity have increased rapidly, and non-public tertiary general hospitals, in particular, have become an essential force in meeting diverse, higher-level medical needs. However, unlike public hospitals with long-established management systems, non-public hospitals often prioritize hardware investment and market expansion during periods of rapid growth. Studies have shown that non-public hospitals often lack long-term and systematic investment in the development of safety culture due to their pursuit of short-term benefits and market response speed [ 4 ]. As a result, internal development—especially safety culture centered on human factors—tends to lag and may lack systematic structure and depth. Existing research underscores the importance of safety culture cognition. Chen and Li [ 5 ] reported that nurses’ understanding of safety culture directly influences their willingness to report adverse events and affects patient outcomes. Similarly, Qin et al. [ 6 ] found that medical staff in public hospitals frequently exhibit cognitive deficiencies regarding communication openness and the frequency of event reporting. Compared with public hospitals, non-public hospitals face unique organizational dynamics. Their flexible human resource systems may result in higher staff turnover, and although service awareness is strong, operational pressures can be substantial. These conditions pose challenges to cultivating a safety culture characterized by stability, trust, and transparency. However, most of these studies are based on public hospitals, with insufficient attention paid to non-public hospitals, especially in terms of safety culture differentiation at the internal departmental level; as a result, they fail to reveal the special predicaments faced by high-risk departments and supporting departments within the private hospital system [ 7 ]. Moreover, most studies [ 8 , 9 ] have focused on individual-level factors, with insufficient attention paid to department-level safety climate, the role of middle managers, and the mechanisms of inter-departmental collaboration. In addition, conclusions regarding the influencing mechanisms of reporting culture remain inconsistent, particularly the empirical relationship between punitive climates and willingness to report incidents. Further evidence highlights the prevalence of punitive attitudes toward errors. Zhou et al. [ 10 ] found that only 48.8% of nurses in a public tertiary hospital recognized the non-punitive response dimension of patient safety culture, suggesting that a “blame culture” remains widespread. This issue may be more pronounced in non-public hospitals where management systems are still evolving. Moreover, most domestic studies focus on public hospitals, and comprehensive examinations of non-public tertiary hospitals—especially from a team safety culture perspective—remain limited. Given that clinical teams form the operational core of medical practice, the safety culture within and across teams is fundamental to maintaining a robust safety defense system. As non-public hospitals take on more responsibilities in the diagnosis and treatment of critical illness, high-end physical examinations, and specialized characteristic departments, their level of patient safety culture is directly linked to medical quality and patient trust [ 11 ]. Against the backdrop of a growing sensitivity to public opinion around medical safety incidents, the systematic evaluation and improvement of patient safety culture in non-public hospitals have become urgent tasks to ensure their sustainable development and brand building [ 12 ]. Therefore, this study conducts a cross-sectional assessment of team safety culture in non-public tertiary general hospitals and analyzes its key influencing factors. Safety climate theory [ 13 ] emphasizes the perceptual differences in safety priorities among different units within an organization, while the principles of high-reliability organizations (HROs) indicate that high-risk units must be equipped with strong error tolerance and learning mechanisms. As the basic operational units of medical organizations, clinical departments often exhibit differences in their professional nature, risk levels, communication modes, and resource allocation, which in turn affect healthcare professionals' perceptions of safety and their behaviors [ 14 ]. Therefore, an intervention-based perspective at the department level enables more accurate identification of the weak points and priorities for improvement in the construction of patient safety culture. This study hypothesizes that in private tertiary hospitals, department type is an independent factor influencing the perception of team safety culture, and also that the level of safety culture in emergency and critical care departments, clinical laboratories, and platform departments is significantly lower than that of other clinical departments. In the context of non-public tertiary hospitals and from a perspective of refined departmental stratification, this study quantitatively analyzes the perceived disadvantages in patient safety culture among high-risk or supporting departments, including acute and critical care departments, clinical laboratories, and platform departments. It also reveals the structural challenges present in the construction of patient safety culture at the departmental level in non-public hospitals, thereby providing empirical evidence for differentiated interventions. Materials and Methods Subjects The study employed a cluster stratified sampling method to administer a questionnaire to all medical staff in a non-public tertiary general hospital from June to August 2025. The inclusion criteria were: (1) doctors, nurses, and medical technicians on duty during the survey period, and (2) individuals who provided informed consent and voluntarily participated. Exclusion criteria included interns, advanced trainees, and staff engaged in off-site study. The sample size was determined based on an estimated population size of approximately 1,200 individuals. With a confidence level of 95%, a margin of error of 5%, and an expected response rate of 85%, the calculated minimum sample size was 785 [ 15 ]. Of the 900 distributed questionnaires, 840 were returned and deemed valid, yielding an effective response rate of 93.3%. Data collection This study consisted of two components: collection of basic demographic and professional information from medical staff, and an assessment of the hospital’s patient safety culture. The basic information survey included three variables—years of work experience, job category, and departmental affiliation. Department classification was conducted with reference to the actual organizational structure and functional attributes of the hospital. Acute and critical care departments included the emergency department, intensive care unit (ICU), anesthesiology department, and other similar departments; platform departments referred to supportive departments such as the clinical laboratory department, medical imaging department, and pathology department; and the remaining departments were classified based on clinical discipline, including internal medicine, surgery, gynecology, and pediatrics. This classification scheme was primarily based on work risks, work modes, and the intensity of clinical collaboration [ 16 ]. Hospital Survey on Patient Safety Culture (HSOPSC) was compiled by the American research organization Westat for the Agency for Healthcare Research and Quality (AHRQ). It is primarily designed to assess nurses' cognitive level of patient safety culture, and it has demonstrated good reliability (Cronbach’s α = 0.918) and validity [ 17 ]. The Chinese version of Hospital Survey on Patient Safety Culture (HSOPSC) was translated and adapted by Liang [ 18 ], and it has demonstrated good reliability (Cronbach’s α coefficient = 0.837) and validity [ 19 ]. Before the formal survey, a pilot test and item analysis were conducted. Item discrimination analysis, factor loading tests, and reliability assessments revealed that three items—including “I have a very good understanding of the hospital’s safety management policy” and “The department I work in often conducts safety training”—had factor loadings below 0.40. Items were deleted based on a criterion of factor loading < 0.40, which conforms to the commonly used threshold for item discrimination in psychometrics [ 20 ]. Removing these items increased the overall Cronbach’s α coefficient from 0.95 to 0.96, indicating that they contributed minimally to reliability and exhibited overlapping or ambiguous content. To strengthen structural validity and internal consistency, the final instrument retained 39 items across six core dimensions: employees’ recognition of hospital safety culture (8 items), managerial support for patient safety (6 items), colleague collaboration (3 items), safety culture awareness (6 items), communication and exchange (10 items), and reporting of abnormal events (6 items). The dimensions of the revised questionnaire are detailed in Supplementary Table S1 . All items were positively worded and rated using a 5-point Likert scale. The overall Cronbach’s α coefficient was 0.95, with dimension-specific coefficients ranging from 0.78 to 0.95. The Cronbach’s α coefficients for the reliability of each dimension were all higher than the acceptable standard of 0.70, indicating that the scale had good measurement reliability [ 21 ]. After questionnaire recovery, invalid questionnaires with incomplete responses and patterned answers were first excluded. Mean imputation was subsequently adopted to address the missing values of individual items [ 22 ]. The selection of control variables was based on the results of a literature review and univariate analysis, and variables with P < 0.01 were included in the multivariate model. Statistical analysis methods Data were analyzed using Statistical Package for the Social Sciences (version 23.0). Categorical variables were summarized with frequencies and percentages, while continuous variables were presented as mean ± standard deviation. Before model construction, the linear relationship between continuous variables and logit was tested, and multicollinearity was evaluated using the variance inflation factor (VIF) [ 23 ]. The model achieved a satisfactory fit as indicated by the Hosmer–Lemeshow test (P > 0.05). The VIF values of all independent variables were less than 5, suggesting that there was no multicollinearity [ 23 ]. The 95% confidence intervals (95%CI) were reported for all odds ratios (ORs). One-way analysis of variance was used to compare differences in the overall safety culture scores across staff characteristics. The total safety culture score—categorized into high and low groups based on the median—served as the dependent variable. Variables showing statistical significance in univariate analysis were entered as independent variables into a multivariate logistic regression model to identify independent predictors of safety culture cognition. Dichotomization using the median value as the cut-off helped simplify the regression model and improve the interpretability of the results, which is suitable for exploring the directionality and significance of influencing factors. However, this approach may lead to a loss of partial information and a reduction in statistical test power. To compensate for this limitation, this study also reported the results of univariate analysis for continuous variables [ 15 ]. Given the exploratory nature of this study, no correction was made for multiple comparisons; this was taken into account when interpreting the results. The significance level was set at α = 0.05. Results Information of medical staff Among the respondents, 40.5% had 8–12 years of work experience, making this the largest group, followed by those with 3–7 years of experience (21.7%). New staff with less than six months of experience accounted for the smallest proportion (2.3%). Regarding job categories, nurses formed the largest occupational group at 59.0%, followed by doctors (16.9%) and medical assistants (12.5%). Departmental distribution showed that internal medicine had the highest proportion of staff (30.0%), followed by surgery (19.5%) and platform departments (13.2%). In contrast, the blood transfusion (1.0%) and laboratory (1.9%) departments had the fewest personnel (Table 1 ). Table 1 Information of medical staff Variable Categories Frequency Percentage Length of Service Less than 6 months 19 2.30% 6 months to less than 1 year 46 5.50% 1–2 years 156 18.60% 3–7 years 182 21.70% 8–12 years 340 40.50% More than 12 years 97 11.50% Job Category Nurse 496 59.00% Administration & Management 97 11.50% Medical Support Staff 105 12.50% Physician 142 16.90% Department Gynecology & Pediatrics 62 7.40% Emergency & Critical Care 98 11.70% Clinical Laboratory 16 1.90% Outpatient Department 66 7.90% Internal Medicine 252 30.00% Platform Department 111 13.20% Blood Transfusion Department 8 1.00% Surgery Department 164 19.50% Pharmacy Department 34 4.00% Oncology Department 29 3.50% The positive response rate of each dimension of safety culture Analysis of positive response rates for the six safety culture dimensions revealed notable variability. In descending order, managers’ support for patient safety scored the highest (77.70%), signifying staff’s broad recognition of management’s patient safety efforts, followed closely by colleague collaboration (76.15%, reflecting robust teamwork) and communication and exchange (75.43%, indicating generally effective information flow with room for improvement). Safety culture awareness stood at 71.21%, showing that most staff had a basic comprehension of its importance. By contrast, abnormal event reporting reached only 66.47%, implying that there were suboptimal reporting levels, affected by potential barriers. Hospital-wide safety culture recognition was the lowest (58.21%), highlighting the need for targeted strategies to enhance staff’s cultural identity, confidence, and engagement in safety initiatives (see Table 2 ). Table 2 Positive Response Rate of Medical Staff's Perception of Team Safety Culture Dimension Score Positive response rate (%) Ranking Managers' support for patient safety 3.98 ± 0.71 77.70 1 Colleague collaboration 4.08 ± 0.79 76.15 2 Communication 4.10 ± 0.61 75.43 3 Awareness of safety culture 3.89 ± 0.63 71.21 4 Reporting of adverse events 3.88 ± 0.81 66.47 5 Employees' recognition of hospital safety culture 3.59 ± 0.63 58.21 6 Univariate analysis of safety culture among healthcare staff in non-public tertiary hospitals Results of the univariate analysis showed significant differences in the total mean safety culture score across healthcare staff with varying years of experience (F = 5.939, P = 0.000). Staff with 1–2 years of experience reported the highest scores (4.06 ± 0.52), whereas those with 8–12 years had the lowest (3.80 ± 0.49). This pattern suggests that increased tenure does not correspond to a linear improvement in safety culture awareness; instead, a mid-career decline in perception may emerge. Departmental affiliation also had a significant effect on safety culture (F = 3.844, P = 0.000). Scores were highest in the Blood Transfusion Department (4.13 ± 0.44) and lowest in the Clinical Laboratory (3.58 ± 0.66). Staff in emergency or critical care (3.80 ± 0.54) and platform departments (3.76 ± 0.50) also demonstrated relatively low scores, indicating that high-risk and auxiliary units may encounter unique barriers to fostering a strong safety culture. Although differences across job categories were not statistically significant (F = 2.539, P = 0.055), nurses had slightly higher total mean scores (3.94 ± 0.53) than doctors (3.84 ± 0.52) and administrative personnel (3.81 ± 0.54). This trend may reflect the nature of nursing practice, which emphasizes standardized procedures and collaborative workflows (see Table 3 ). Table 3 Univariate Analysis of Team Safety Culture Among Healthcare Staff Variable Score F Value P Value Working Years 5.939 0.000 Les than 6 months 3.85 ± 0.68 6 months to less than 1 year 3.96 ± 0.49 1–2 years 4.06 ± 0.52 3–7 years 3.96 ± 0.55 8–12 years 3.80 ± 0.49 More than 12 years 3.90 ± 0.61 Job category 2.539 0.055 Nurse 3.94 ± 0.53 Administrative management 3.81 ± 0.54 Medical assistant 3.92 ± 0.54 Doctor 3.84 ± 0.52 Department 3.844 0.000 Obstetrics & pediatrics 3.95 ± 0.51 Emergency & critical care 3.80 ± 0.54 Clinical laboratory 3.58 ± 0.66 Outpatient department 3.88 ± 0.58 Internal medicine department 3.92 ± 0.48 Platform department 3.76 ± 0.50 Blood transfusion department 4.13 ± 0.44 Surgery department 4.02 ± 0.52 Pharmacy department 4.03 ± 0.59 Oncology department 4.11 ± 0.72 Multivariate logistic regression analysis of safety culture among medical staff in non-public tertiary hospitals Multivariate logistic regression analysis showed that department was an independent risk factor influencing safety culture among medical staff in non-public tertiary hospitals. Using the obstetrics and pediatrics department as the reference, staff in emergency and critical care departments had a significantly higher likelihood of presenting a lower level of safety culture (OR = 0.42, 95% CI: 0.22–0.82, P = 0.01), indicating their probability of lower safety culture was 0.42 times that of the reference group. Medical staff in laboratory departments also demonstrated a significantly increased risk (OR = 0.25, 95% CI: 0.07–0.88, P = 0.03), as did those in platform departments (OR = 0.49, 95% CI: 0.26–0.93, P = 0.03). The ORs of acute and critical care departments, clinical laboratories, and platform departments were all less than 0.5, indicating that healthcare workers in these departments had a significantly higher risk of perceiving a low level of safety culture; in particular, clinical laboratories (OR = 0.25) had approximately a quarter the odds that gynecology and pediatrics departments did. The dependent variable was dichotomized based on the median of the total mean score. Although this method may lead to information loss, it facilitates clinical interpretation and grouping for intervention [ 15 ]. These findings suggest that both high-risk clinical units and auxiliary technical departments face greater challenges in maintaining strong safety culture performance. Working years showed no statistically significant association with safety culture level after adjusting for covariates (all P > 0.05), indicating that tenure did not independently influence staff perceptions of safety culture (See Table 4 ). Table 4 Summary of multivariate logistic regression on team safety culture of medical staff Variable B S.E. Wald χ 2 P-value OR 95% CI Working years (Reference: < 6 months) 6 months – 12 years 0.08 0.52 0.02 0.88 1.08 0.39–2.97 Department (Reference: Obstetrics & Pediatrics) Emergency & critical care −0.86 0.34 6.5 0.01 0.42 0.22–0.82 Laboratory −1.38 0.64 4.63 0.03 0.25 0.07–0.88 Outpatient department −0.09 0.36 0.06 0.81 0.91 0.45–1.85 Internal medicine −0.29 0.29 0.98 0.32 0.75 0.42–1.33 Platform departments −0.72 0.33 4.81 0.03 0.49 0.26–0.93 Blood transfusion department 1.03 0.86 1.41 0.23 2.80 0.51–15.21 Surgery 0.14 0.31 0.21 0.65 1.15 0.63–2.11 Pharmacy department −0.20 0.44 0.21 0.65 0.82 0.35–1.93 Oncology department 0.88 0.51 2.97 0.08 2.41 0.89–6.54 Discussion and recommendations Team safety culture In this study, the overall positive response rate for team safety culture in non-public tertiary general hospitals was 66.65%, with a total score of 3.78 ± 0.51, indicating a moderate level. This score is slightly higher than the national average for patient safety culture in 2016 (62%) but lower than the level reported in Zhejiang Province (73.03%) [ 24 ]. These findings suggest that although non-public tertiary hospitals have established a foundation for safety culture, substantial improvement is still needed. This is consistent with the hypothesis that there exists inter-departmental imbalance in the construction of safety culture in non-public hospitals, suggesting that it is necessary to shift from hospital-wide overall planning to department-specific targeted interventions. Compared with public hospitals, non-public institutions face unique challenges related to management structures, staff turnover, and operational pressures, all of which may hinder systematic and sustained safety culture development. For example, the strategic emphasis on service experience and economic performance may reduce long-term investment in structured safety culture initiatives. With ongoing healthcare reform, non-public hospitals are experiencing increased pressure to enhance internal quality while simultaneously expanding. Li et al. [ 4 ] reported that these hospitals often prioritize infrastructural growth over “soft culture,” causing safety culture construction to lag behind operational expansion. This imbalance is reflected in limited staff identification with, and participation in, safety culture activities. Non-public hospitals mostly adopt a corporate-oriented operation model, in which performance appraisal is often directly linked to revenue and service volume. However, investment in safety culture has a long payback period and is difficult to quantify, which puts it at a disadvantage in terms of resource allocation and policy prioritization. Furthermore, high personnel mobility—particularly among intermediate and senior professionals—may undermine the continuity and stability needed for sustained culture development. Consequently, non-public hospitals should elevate safety culture to a core strategic priority and strengthen it through systematic policy development, adequate resource allocation, and sustained cultural guidance. Effects of safety culture The results showed that the positive response rates for “managerial support for patient safety,” “colleague collaboration,” and “communication” were relatively high, indicating that non-public hospitals demonstrate strong managerial engagement and effective internal teamwork. However, “staff recognition of hospital safety culture” had the lowest positive response rate (58.21%), and “adverse event reporting” was also low (66.47%), revealing substantial weaknesses in institutional safety culture identity and reporting practices. Li and Liu [ 25 ] similarly noted that “non-punitive response to errors” and “frequency of event reporting” remain common deficiencies in domestic medical institutions, and these gaps may be more pronounced in non-public hospitals due to less mature management systems. Chen et al. [ 26 ] found that medical staff frequently worry about potential blame following event reporting, with junior staff particularly likely to conceal or minimize errors. In addition, the performance evaluation systems of many non-public hospitals often prioritize economic outcomes and service quality, which can inadvertently marginalize the implementation of safety culture initiatives. Notably, Meng et al. [ 27 ] reported that although non-public hospitals show progress in “cross-department collaboration” and “information-sharing mechanisms,” they remain weak in “systematic risk prevention” and “organizational mechanisms for learning from errors.” This study found that the dimension of "employee recognition" scored the lowest, which indirectly supports the inference that safety culture is marginalized in the institutional system [ 28 ]. However, the pervasiveness of punitive culture needs to be further verified through the analysis of qualitative data. Therefore, moving forward, non-public hospitals should build on their existing strengths while prioritizing staff engagement in safety culture, strengthening non-punitive reporting systems, and transforming safety events into opportunities for institutional learning through structured feedback and continuous quality improvement. Factors influencing perceived level of safety culture Both univariate and multivariate analyses showed that department was an independent factor influencing safety culture perception in non-public hospitals. Safety culture levels in emergency and critical care, laboratory, and platform departments were significantly lower than in obstetrics and pediatrics, likely due to higher workload, elevated clinical risk, and weaker communication structures. Although working years differed in the univariate analysis, this factor was not significant in the multivariate model, suggesting its effects may be overshadowed by other variables. Shao et al. [ 29 ] similarly reported that professional title, education, and participation in “5 + 1” S training influence medical staff’s safety culture perception. Zhang et al. [ 30 ] found that staff in high-risk units such as ICUs and emergency departments were more susceptible to safety fatigue and exhibited reduced reporting willingness due to rapid workflows and psychological strain. As supportive units, platform departments (e.g., laboratory, imaging) frequently encounter information asymmetry and communication barriers in collaborating with clinical departments, which further diminishes their safety culture perception. From the perspective of conservation of resources theory [ 31 ], medical staff in high-risk departments are in a state of chronic resource depletion, which may reduce their psychological resources for participating in safety improvement initiatives and reporting adverse events, thus forming positive feedback loop of a high workload and low reporting rate [ 31 ]. Cui et al. [ 32 ] highlighted that departmental climate and organizational support are mediating factors shaping safety behaviors, and in non-public hospitals, departmental management efficiency plays a critical role in cultivating safety culture. Therefore, efforts to advance safety culture development should prioritize the specific needs of high-risk and auxiliary departments. Optimizing workflow, strengthening psychological support, and improving interdepartmental collaboration can enhance staff recognition of safety culture and compliance with safety practices. Recommendations for constructing a positive team safety culture Strengthen the non-punitive reporting mechanism and foster an open reporting culture Studies have shown that medical staff commonly worry about “errors being documented” and “being penalized for mistakes” [ 15 , 16 , 18 , 20 – 25 ]. The WHO Guidelines for Patient Safety Reporting [ 33 ] and the Institute for Healthcare Improvement [ 34 ] recommend establishing a non-punitive culture as a foundation for improving the reporting rate of safety incidents. Non-public hospitals should therefore establish a confidential, non-punitive adverse event reporting system, clearly define reporting procedures and feedback pathways, and provide positive incentives for staff who actively report events. Anonymous or confidential reporting channels that clearly distinguish between individual negligence and systemic errors should be implemented, the scope of non-liability reporting should be defined [ 33 ], and public recognition or performance incentives should be offered for cases where voluntary reporting leads to systemic improvements to gradually build an organizational consensus that reporting constitutes contribution [ 34 ]. Such measures can enhance reporting rates and expand opportunities for systematic quality improvement. Optimize human resource allocation and reduce workload “Staffing” remains a common weakness across many hospitals [ 27 , 29 ]. Non-public hospitals should allocate workload more effectively through scientific scheduling, flexible employment models, and the integration of auxiliary positions. Particular attention must be given to ensuring adequate human resource support for emergency and critical care units and platform departments to prevent safety risks associated with insufficient staffing. Enhance inter-departmental collaboration and communication mechanisms Poor interdepartmental collaboration is a key factor influencing safety culture. Non-public hospitals should enhance the accuracy and timeliness of information exchange by conducting regular interdepartmental safety meetings, implementing standardized handover procedures, and promoting the use of structured communication tools such as situation–background–assessment–recommendation (SBAR). The hospital under study has begun to implement the SBAR handover model, but its application in inter-departmental and inter-professional teams is not yet widespread, and there is a lack of standardized supervision and feedback mechanisms [ 35 ]. Implement hierarchical training to improve staff-wide awareness of safety culture Targeted safety culture training should be provided for medical staff across different roles, professional titles, and departments in non-public hospitals. Particular emphasis is needed for junior staff and those in high-risk units to strengthen adherence to safety norms and enhance risk-prevention awareness. Zhou et al. [ 10 ] reported that nurses who received training in modern quality management tools, including “5 + 1” S management, demonstrated higher safety culture awareness, underscoring the positive impact of systematic training on safety culture improvement. In light of the characteristics of high workload intensity and heavy psychological burden in high-risk departments, it is necessary to design short-duration, high-frequency, and scenario-based safety training modules that integrate stress management, team resource management [ 36 ], and real-time feedback mechanisms. Meanwhile, simulated drills and case reviews should be reinforced to enhance the practicality and participation of such training programs. Encourage the leadership role of managers and strengthen employees’ cultural identity Managers play a central role in advancing safety culture. Policymakers should incorporate indicators of safety culture maturity into the existing quality assessment system, such as incident reporting rates, closed-loop feedback completion rates, and participation rates in cross-departmental safety activities [ 37 ]. They should also encourage non-public hospitals to establish regular self-assessment practices and mechanisms for improving safety culture, and then link these mechanisms to hospital accreditation, merit evaluation, and medical insurance payment schemes [ 38 ]. Non-public hospitals should integrate safety culture indicators into departmental performance assessments and encourage managers to engage directly with frontline staff to better understand their needs. Such involvement can strengthen employees’ sense of identity and belonging within the hospital’s safety culture. Conclusion Team safety culture in non-public tertiary hospitals is at a moderate level, though there are significant inter-departmental differences. Emergency and critical care departments, clinical laboratories, and platform departments are the weakest links. in terms of safety culture scores. Targeted interventions should be implemented related to non-punitive reporting, human resource optimization, and inter-departmental collaboration. This study provides empirical evidence at the departmental level for the construction of safety culture in non-public tertiary hospitals. The conclusions of this study are based on a single non-public tertiary hospital, whose management model and resource allocation differ from those of public hospitals. Medical institutions in different regions, with different hospital levels (e.g., primary, secondary, tertiary) and ownership structures, may exhibit heterogeneity in their patient safety cultures. This study adopted a cross-sectional survey design, which precludes the inference of causal relationships, and the data were derived from self-reported questionnaires, which may lead to social desirability bias. Because department classification was based on a single medical institution, caution should be exercised when extrapolating the findings to other settings. Hospital-level variables (e.g., bed size and ownership structure) were not included in the analysis, which may have resulted in the omission of important influencing factors. Future research should conduct longitudinal and multi-center studies, and should also integrate qualitative data to allow for the in-depth analysis of the mechanisms that influence team safety culture [ 39 ]. Abbreviations WHO World Health Organization AHRQ Agency for Healthcare Research and Quality HSOPS Hospital Survey on Patient Safety Culture HROs high-reliability organizations ICU intensive care unit VIF variance inflation factor CI confidence intervals ORs odds ratios SBAR situation–background–assessment–recommendation Declarations Ethical approval and consent to participate This study involving human participants was conducted in strict accordance with the ethical principles set forth in the Declaration of Helsinki. The study protocol was approved by the Research Ethics Committee of Peking University International Hospital. To ensure that all participants were fully informed, the research team provided each one an information sheet and informed consent form, which detailed the purpose of the study, potential benefits, possible risks, and the conditions for withdrawal from the study. All participants took part in this study on a voluntary basis and signed the informed consent form. To prevent any potential adverse effects or consequences for the participants arising from their expressed views, all information collected during the study was anonymized and treated with strict confidentiality. Consent for publication Not applicable. Availability of data and materials The data supporting the findings of this study are available from the first author upon reasonable request. Competing interests The authors declare no competing interests. Funding This study was funded by Peking University International Hospital (Grant No.: 2025-KY-0124). The funder played no role in the study design, data collection, data analysis and interpretation, or the writing of this manuscript. Authors’ contributions QZ and CZ contributed equally to this work. QZ conceptualized the study, performed data extraction and analysis, drafted the initial manuscript, and interpreted the study findings. CZ conceptualized the study, performed data analysis, drafted the initial manuscript, and interpreted the study findings. TL, JF, HW, and MZ were responsible for data extraction and collation. YY performed data analysis, drafted the initial manuscript, critically revised the manuscript, and interpreted the study findings. Acknowledgments We sincerely thank all the participants who took part in this survey, as well as the reviewers, for their valuable contributions to this study. References Han G. Hospital culture of safety and medical safety. Chin J Hosp Adm 2004, 20(3):129–131. https://doi.org/10.3760/j.issn:1000-6672.2004.03.001. Patient safetyhttps://www.who.int/health-topics/patient-safety. Accessed 8 Jan. 2026. Patient safety culturehttps://www.ahrq.gov/sops/index.html. Accessed 8 Jan. 2026. Li L, Chen Q, Zeng W, Chen M, Xu Y. Latent profile analysis of nurses'perception of patient safety culture and its influencing factors. Nurs Pract Res 2024, 21(10):1492–1498. https://doi.org/10.3969/j.issn.1672-9676.2024.10.011. Chen X, Li L. Nurses' perception of patient safety culture and the influencing factors. J Nurs Sci 2018, 33(22):52–56. https://doi.org/10.3870/j.issn.1001-4152.2018.22.052. Qin S, Song Y, Huang Q. Analysis of the present situation of patient safety awareness of medical staff in the tertiary a hospital and the influencing factors. Chin Hosp Manage 2021, 41(5):68–71. Chen X, Zhang H, Li J. Research progress on the comparison of patient safety culture between public and private hospitals. Chin Hosp Manage 2022, 42(5):64–67. Nie Y, Mao X, Cui H, He S, Li J, Zhang M. Hospital survey on patient safety culture in China. BMC Health Serv Res 2013, 13(1):228. https://doi.org/10.1186/1472-6963-13-228. Cui Y, Xi X, Zhang J, Feng J, Deng X, Li A, Zhou J. The safety attitudes questionnaire in Chinese: psychometric properties and benchmarking data of the safety culture in Beijing hospitals. BMC Health Serv Res 2017, 17(1):590. https://doi.org/10.1186/s12913-017-2543-2. Zhou J, Wang F, Dai Q. Investigation on the current status of nurses' perception of patient safety culture in a Grade A tertiary hospital in Anhui Province. Nurs Pract Res 2020, 17(7):123–125. https://doi.org/10.3969/j.issn.1672-9676.2020.07.048. Guiding opinions on promoting the standardized development of non-public medical institutions. Accessed 8 Jan. 2026. Jha AK, Prasopa-Plaizier N, Larizgoitia I, Bates DW. Patient safety research: An overview of the global evidence. Qual Saf Health Care 2010, 19(1):42–47. https://doi.org/10.1136/qshc.2008.029165. Zohar D Safety climate conceptual and measurement issues. In: Handbook of Occupational Health Psychology. edn. Edited by Quick JC, Tetrick LE: American Psychological Association; 2011: 141–164. Huang Y-h, Lee J, Perry M, He Y, Tondokoro T. Safety climate in the utility industry. J Occup Environ Med 2024, 66(4):298–304. https://doi.org/10.1097/jom.0000000000003037. Li K, He J: Medical statistics, 8th edn. Beijing: People's Medical Publishing House; 2025. Li T, Liu L. Analysis of the current situation of classified management of clinical departments in public hospitals in China. Chin J Woman Child Health Res 2016, 27(S2):570–571. Stoyanova R, Dimova R, Tarnovska M, Boeva T. Linguistic validation and cultural adaptation of Bulgarian version of hospital survey on patient safety culture (HSOPSC). Open Access Maced J Med Sci 2018, 6(5):925. https://doi.org/10.3889/oamjms.2018.222. Liang S: Hospital survey on patient safety culture in tertiary general hospitals in Beijing. Master’s thesis. Peking Union Medical College; 2014. Li T, Hao H, Li Z, Yao L, Lin H, Zhang M. Application on hierarchical linear model in hospital survey of patient safety culture in tertiary public hospitals. Chin Hosp 2019, 23(1):27–29. https://doi.org/10.19660/j.issn.1671-0592.2019.01.10. Costello AB, Osborne J. Best practices in exploratory factor analysis: Four recommendations for getting the most from your analysis. Pract Assess Res Eval 2005, 10(1):7. Jum C, Nunnally B, Bernstein IH: Psychometric theory. New York: McGraw-Hill College; 1994. Sun Z, Xu Y: Medical statistics, 4th edn. Beijing: People's Medical Publishing House; 2014. Fang J: Health statistics, 7th edn. Beijing: People's Medical Publishing House; 2018. Li Y, Wang L, Zhao P, Zhang M, Wang J, Yin D. The status quo and thoughts on hospital patient safety culture in China. Chin Hosp 2017, 21(7):1,1–3. https://doi.org/10.3969/j.issn.1671-0592.2017.07.001. Li L, Liu X. Analysis of nurses' assessment of the patient safety culture in hospital. Chin J Nurs 2009, 44(4):304–307. Chen X, Jiang X, Wang B, Wu G, Gao H, Lü J, Wang Y. Current situation and influencing factors of patient safety culture among medical staff in a 3A hospital. J Mod Clin Med 2024, 50(4):244–246,255. https://doi.org/10.11851/j.issn.1673-1557.2024.04.002. Meng N, Zhao D, Wang Y, Yang W. Study on the current status and influencing factors of patient safety culture among medical staff in a tertiary hospital. J Anhui Med Coll 2024, 23(3):1–3,7. https://doi.org/10.20072/j.cnki.issn2097-0196.2024.03.001. Zhuang R: Study on near miss management in petrochemical company based on safety culture. Master thesis. Qingdao University of Science & Technology; 2010. Shao X, Han L, Wang X, Li X, Wang G. Study on nurses' status quo of patient safety culture. J Nurs Adm 2021, 21(3):199–202. https://doi.org/10.3969/j.issn.1671-315x.2021.03.010. Zhang A, Ye L, Feng X, Lin T. Correlation between patient safety culture perception and safety behavior of emergency nurses in tertiary hospitals. J Nurs Train 2022, 37(13):1225–1230. https://doi.org/10.16821/j.cnki.hsjx.2022.13.015. Hobfoll SE. Conservation of resources: A new attempt at conceptualizing stress. Am Psychol 1989, 44(3):513–524. https://doi.org/10.1037/0003-066x.44.3.513. Cui Y, Zhang X, Wu J, Zhang X. Research on the correlation between adverse event reporting barriers in medical quality (Safety) and patient safety culture. Chin Hosp Manage 2025, 45(4):61–65. World Health Organization. Charter: Health worker safety: A priority for patient safety. 2020. Available from: https://www.who.int/publications-detail-redirect/9789240011595. Frankel A, Haraden C, Federico F, Lenoci-Edwards J. A framework for safe, reliable, and effective care. Cambridge, MA: 2017. Available from: https://www.ihi.org. Song X, Huang P, Xu H, Song J, Huang Y. Application of the SBAR communication model in reducing the defect rate of shift handover among ICU nurses. J Nurs Train 2017, 32(5):413–415. https://doi.org/10.16821/j.cnki.hsjx.2017.05.009. Liu J, Tian D Application and effect of Team Resource Management in emergency handover shift. In: Chinese Nursing Association 2017 National Academic Exchange Conference on Emergency Nursing, Changchun, 2017; pp. 305–307. Standards for the accreditation of tertiary hospitals (2022 Edition)https://www.nhc.gov.cn/yzygj/c100068/202212/ccd5aaa9f4fd46fea57d5a94c3e98002/files/1733999175393_69074.pdf. Accessed 8 Jan. 2026. O’Leary KJ, Buck R, Fligiel HM, Haviley C, Slade ME, Landler MP, Kulkarni N, Hinami K, Lee J, Cohen SE et al. Structured interdisciplinary rounds in a medical teaching unit. Arch Intern Med 2011, 171(7):678–684. https://doi.org/10.1001/archinternmed.2011.128. Li H, Guo Q. Analysis of current perceptions regarding hospital safety culture and fall prevention strategies among physicians and patients. Shanghai Nurs 2024, 24(8):23–27. https://doi.org/10.3969/j.issn.1009-8399.2024.08.006. Additional Declarations No competing interests reported. Supplementary Files EDSP365251204W600v260109Supplementarymaterialsvfinal.docx Supplementarymaterial.docx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 10 Apr, 2026 Reviews received at journal 01 Apr, 2026 Reviewers agreed at journal 20 Mar, 2026 Reviews received at journal 12 Feb, 2026 Reviewers agreed at journal 10 Feb, 2026 Reviewers agreed at journal 10 Feb, 2026 Reviewers agreed at journal 25 Jan, 2026 Reviewers invited by journal 19 Jan, 2026 Editor assigned by journal 19 Jan, 2026 Editor invited by journal 19 Jan, 2026 Submission checks completed at journal 19 Jan, 2026 First submitted to journal 19 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8581892","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":576835300,"identity":"b791211b-b0f5-441d-a2e6-ed4dfd9d4b37","order_by":0,"name":"Qiannan Zhao","email":"","orcid":"","institution":"Peking University International Hospital","correspondingAuthor":false,"prefix":"","firstName":"Qiannan","middleName":"","lastName":"Zhao","suffix":""},{"id":576835301,"identity":"ecf24c74-02a2-422b-a426-7df17d2fa6b6","order_by":1,"name":"Chenxiao Zhu","email":"","orcid":"","institution":"Peking University International Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chenxiao","middleName":"","lastName":"Zhu","suffix":""},{"id":576835302,"identity":"6fc4bd53-0e45-4702-ad40-4dd3df502e3c","order_by":2,"name":"Ting Li","email":"","orcid":"","institution":"Peking University International Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ting","middleName":"","lastName":"Li","suffix":""},{"id":576835303,"identity":"dab8a2d3-beb1-4704-80e7-247118fb326e","order_by":3,"name":"Jiahui Fu","email":"","orcid":"","institution":"Peking University International Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jiahui","middleName":"","lastName":"Fu","suffix":""},{"id":576835304,"identity":"38573ae3-0d1b-4cf1-b34d-db8e06056d63","order_by":4,"name":"Huahua Wei","email":"","orcid":"","institution":"Peking University International Hospital","correspondingAuthor":false,"prefix":"","firstName":"Huahua","middleName":"","lastName":"Wei","suffix":""},{"id":576835305,"identity":"ac6e61a8-df7f-4122-b77d-f772ca05b055","order_by":5,"name":"Manyun Zhang","email":"","orcid":"","institution":"Peking University International Hospital","correspondingAuthor":false,"prefix":"","firstName":"Manyun","middleName":"","lastName":"Zhang","suffix":""},{"id":576835306,"identity":"fb0300f0-eb5c-4424-b285-323673ee2b58","order_by":6,"name":"Yanjun Yang","email":"data:image/png;base64,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","orcid":"","institution":"Peking University International Hospital","correspondingAuthor":true,"prefix":"","firstName":"Yanjun","middleName":"","lastName":"Yang","suffix":""}],"badges":[],"createdAt":"2026-01-12 12:53:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8581892/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8581892/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":100858124,"identity":"763893bd-7aa8-49f5-9baa-b74f483539b3","added_by":"auto","created_at":"2026-01-22 07:23:54","extension":"json","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":9407,"visible":true,"origin":"","legend":"","description":"","filename":"769980c20bab448991925deced6c9319.json","url":"https://assets-eu.researchsquare.com/files/rs-8581892/v1/6f1e5bb5afdf1daac9b1ad1a.json"},{"id":100858673,"identity":"4e901246-70b6-44da-a937-69eebd88bfbe","added_by":"auto","created_at":"2026-01-22 07:24:35","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":21634,"visible":true,"origin":"","legend":"","description":"","filename":"EDSP365251204W600v260109Supplementarymaterialsvfinal.docx","url":"https://assets-eu.researchsquare.com/files/rs-8581892/v1/ff69178b205ba830a7db2f45.docx"},{"id":100822554,"identity":"8129524c-a232-456a-a6df-a2e06092e9c3","added_by":"auto","created_at":"2026-01-21 18:12:22","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":122487,"visible":true,"origin":"","legend":"","description":"","filename":"769980c20bab448991925deced6c93191enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8581892/v1/a4e2e674902b635e9bb7626a.xml"},{"id":100822552,"identity":"9abc7be1-1514-4836-bf37-d38cd587a7ad","added_by":"auto","created_at":"2026-01-21 18:12:22","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":119554,"visible":true,"origin":"","legend":"","description":"","filename":"769980c20bab448991925deced6c93191structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8581892/v1/7650d5f2ce129eb2224ede7c.xml"},{"id":100822553,"identity":"559e2256-3e4f-432d-9af5-832c14228fdc","added_by":"auto","created_at":"2026-01-21 18:12:22","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":130526,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8581892/v1/adf8882b41d11398a5389dcc.html"},{"id":105727587,"identity":"aa186300-7b0a-403b-a527-96ec0738a0bd","added_by":"auto","created_at":"2026-03-30 10:50:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":723603,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8581892/v1/4d01a828-9af7-4935-bf73-f61e87ffa559.pdf"},{"id":100822549,"identity":"fa7ff2ae-bce0-4a78-b645-9c3795fe8b3b","added_by":"auto","created_at":"2026-01-21 18:12:22","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":21634,"visible":true,"origin":"","legend":"","description":"","filename":"EDSP365251204W600v260109Supplementarymaterialsvfinal.docx","url":"https://assets-eu.researchsquare.com/files/rs-8581892/v1/3d23de6ecb6a6c6ff1f3a194.docx"},{"id":100822555,"identity":"8701ed4c-f0f4-49c1-8daa-7bdcba8b03e3","added_by":"auto","created_at":"2026-01-21 18:12:23","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":18105,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-8581892/v1/203c25b4bb03ccf9588c07d0.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis of the influencing factors of team safety culture in non-public tertiary general hospitals","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePatient safety is the cornerstone of medical quality, and the World Health Organization has consistently emphasized that cultivating a positive patient safety culture is one of the most effective strategies for reducing medical errors and safeguarding patients. Safety culture is defined as \u0026ldquo;a unified organizational behavior that advances all cultural connotations toward safety\u0026rdquo; [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This adopted definition is consistent with the World Health Organization (WHO) Patient Safety Framework [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] and the concepts put forward in the Agency for Healthcare Research and Quality (AHRQ) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] Hospital Survey on Patient Safety Culture (HSOPS). Both documents emphasize the sharing of safety values, attitudes, and behaviors among organizations, and they strive to reduce patient risk through systematic improvements.\u003c/p\u003e \u003cp\u003eIn medical institutions, it is expressed through shared values, attitudes, cognition, and behavioral patterns that collectively minimize the risk of patient harm.\u003c/p\u003e \u003cp\u003eIn recent years, national policy reforms and the influx of social capital have expanded the role of non-public hospitals within China\u0026rsquo;s medical service system. Their number and service capacity have increased rapidly, and non-public tertiary general hospitals, in particular, have become an essential force in meeting diverse, higher-level medical needs. However, unlike public hospitals with long-established management systems, non-public hospitals often prioritize hardware investment and market expansion during periods of rapid growth. Studies have shown that non-public hospitals often lack long-term and systematic investment in the development of safety culture due to their pursuit of short-term benefits and market response speed [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. As a result, internal development\u0026mdash;especially safety culture centered on human factors\u0026mdash;tends to lag and may lack systematic structure and depth.\u003c/p\u003e \u003cp\u003eExisting research underscores the importance of safety culture cognition. Chen and Li [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] reported that nurses\u0026rsquo; understanding of safety culture directly influences their willingness to report adverse events and affects patient outcomes. Similarly, Qin et al. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] found that medical staff in public hospitals frequently exhibit cognitive deficiencies regarding communication openness and the frequency of event reporting. Compared with public hospitals, non-public hospitals face unique organizational dynamics. Their flexible human resource systems may result in higher staff turnover, and although service awareness is strong, operational pressures can be substantial. These conditions pose challenges to cultivating a safety culture characterized by stability, trust, and transparency. However, most of these studies are based on public hospitals, with insufficient attention paid to non-public hospitals, especially in terms of safety culture differentiation at the internal departmental level; as a result, they fail to reveal the special predicaments faced by high-risk departments and supporting departments within the private hospital system [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Moreover, most studies [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] have focused on individual-level factors, with insufficient attention paid to department-level safety climate, the role of middle managers, and the mechanisms of inter-departmental collaboration. In addition, conclusions regarding the influencing mechanisms of reporting culture remain inconsistent, particularly the empirical relationship between punitive climates and willingness to report incidents.\u003c/p\u003e \u003cp\u003eFurther evidence highlights the prevalence of punitive attitudes toward errors. Zhou et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] found that only 48.8% of nurses in a public tertiary hospital recognized the non-punitive response dimension of patient safety culture, suggesting that a \u0026ldquo;blame culture\u0026rdquo; remains widespread. This issue may be more pronounced in non-public hospitals where management systems are still evolving. Moreover, most domestic studies focus on public hospitals, and comprehensive examinations of non-public tertiary hospitals\u0026mdash;especially from a team safety culture perspective\u0026mdash;remain limited.\u003c/p\u003e \u003cp\u003eGiven that clinical teams form the operational core of medical practice, the safety culture within and across teams is fundamental to maintaining a robust safety defense system. As non-public hospitals take on more responsibilities in the diagnosis and treatment of critical illness, high-end physical examinations, and specialized characteristic departments, their level of patient safety culture is directly linked to medical quality and patient trust [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Against the backdrop of a growing sensitivity to public opinion around medical safety incidents, the systematic evaluation and improvement of patient safety culture in non-public hospitals have become urgent tasks to ensure their sustainable development and brand building [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Therefore, this study conducts a cross-sectional assessment of team safety culture in non-public tertiary general hospitals and analyzes its key influencing factors.\u003c/p\u003e \u003cp\u003eSafety climate theory [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] emphasizes the perceptual differences in safety priorities among different units within an organization, while the principles of high-reliability organizations (HROs) indicate that high-risk units must be equipped with strong error tolerance and learning mechanisms. As the basic operational units of medical organizations, clinical departments often exhibit differences in their professional nature, risk levels, communication modes, and resource allocation, which in turn affect healthcare professionals' perceptions of safety and their behaviors [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Therefore, an intervention-based perspective at the department level enables more accurate identification of the weak points and priorities for improvement in the construction of patient safety culture. This study hypothesizes that in private tertiary hospitals, department type is an independent factor influencing the perception of team safety culture, and also that the level of safety culture in emergency and critical care departments, clinical laboratories, and platform departments is significantly lower than that of other clinical departments.\u003c/p\u003e \u003cp\u003e In the context of non-public tertiary hospitals and from a perspective of refined departmental stratification, this study quantitatively analyzes the perceived disadvantages in patient safety culture among high-risk or supporting departments, including acute and critical care departments, clinical laboratories, and platform departments. It also reveals the structural challenges present in the construction of patient safety culture at the departmental level in non-public hospitals, thereby providing empirical evidence for differentiated interventions.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eSubjects\u003c/p\u003e \u003cp\u003eThe study employed a cluster stratified sampling method to administer a questionnaire to all medical staff in a non-public tertiary general hospital from June to August 2025. The inclusion criteria were: (1) doctors, nurses, and medical technicians on duty during the survey period, and (2) individuals who provided informed consent and voluntarily participated. Exclusion criteria included interns, advanced trainees, and staff engaged in off-site study. The sample size was determined based on an estimated population size of approximately 1,200 individuals. With a confidence level of 95%, a margin of error of 5%, and an expected response rate of 85%, the calculated minimum sample size was 785 [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Of the 900 distributed questionnaires, 840 were returned and deemed valid, yielding an effective response rate of 93.3%.\u003c/p\u003e \u003cp\u003eData collection\u003c/p\u003e \u003cp\u003eThis study consisted of two components: collection of basic demographic and professional information from medical staff, and an assessment of the hospital\u0026rsquo;s patient safety culture. The basic information survey included three variables\u0026mdash;years of work experience, job category, and departmental affiliation. Department classification was conducted with reference to the actual organizational structure and functional attributes of the hospital. Acute and critical care departments included the emergency department, intensive care unit (ICU), anesthesiology department, and other similar departments; platform departments referred to supportive departments such as the clinical laboratory department, medical imaging department, and pathology department; and the remaining departments were classified based on clinical discipline, including internal medicine, surgery, gynecology, and pediatrics. This classification scheme was primarily based on work risks, work modes, and the intensity of clinical collaboration [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHospital Survey on Patient Safety Culture (HSOPSC) was compiled by the American research organization Westat for the Agency for Healthcare Research and Quality (AHRQ). It is primarily designed to assess nurses' cognitive level of patient safety culture, and it has demonstrated good reliability (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.918) and validity [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The Chinese version of Hospital Survey on Patient Safety Culture (HSOPSC) was translated and adapted by Liang [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], and it has demonstrated good reliability (Cronbach\u0026rsquo;s α coefficient\u0026thinsp;=\u0026thinsp;0.837) and validity [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBefore the formal survey, a pilot test and item analysis were conducted. Item discrimination analysis, factor loading tests, and reliability assessments revealed that three items\u0026mdash;including \u0026ldquo;I have a very good understanding of the hospital\u0026rsquo;s safety management policy\u0026rdquo; and \u0026ldquo;The department I work in often conducts safety training\u0026rdquo;\u0026mdash;had factor loadings below 0.40. Items were deleted based on a criterion of factor loading\u0026thinsp;\u0026lt;\u0026thinsp;0.40, which conforms to the commonly used threshold for item discrimination in psychometrics [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Removing these items increased the overall Cronbach\u0026rsquo;s α coefficient from 0.95 to 0.96, indicating that they contributed minimally to reliability and exhibited overlapping or ambiguous content. To strengthen structural validity and internal consistency, the final instrument retained 39 items across six core dimensions: employees\u0026rsquo; recognition of hospital safety culture (8 items), managerial support for patient safety (6 items), colleague collaboration (3 items), safety culture awareness (6 items), communication and exchange (10 items), and reporting of abnormal events (6 items). The dimensions of the revised questionnaire are detailed in Supplementary Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e. All items were positively worded and rated using a 5-point Likert scale. The overall Cronbach\u0026rsquo;s α coefficient was 0.95, with dimension-specific coefficients ranging from 0.78 to 0.95. The Cronbach\u0026rsquo;s α coefficients for the reliability of each dimension were all higher than the acceptable standard of 0.70, indicating that the scale had good measurement reliability [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAfter questionnaire recovery, invalid questionnaires with incomplete responses and patterned answers were first excluded. Mean imputation was subsequently adopted to address the missing values of individual items [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The selection of control variables was based on the results of a literature review and univariate analysis, and variables with P\u0026thinsp;\u0026lt;\u0026thinsp;0.01 were included in the multivariate model.\u003c/p\u003e \u003cp\u003eStatistical analysis methods\u003c/p\u003e \u003cp\u003eData were analyzed using Statistical Package for the Social Sciences (version 23.0). Categorical variables were summarized with frequencies and percentages, while continuous variables were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. Before model construction, the linear relationship between continuous variables and logit was tested, and multicollinearity was evaluated using the variance inflation factor (VIF) [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The model achieved a satisfactory fit as indicated by the Hosmer\u0026ndash;Lemeshow test (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The VIF values of all independent variables were less than 5, suggesting that there was no multicollinearity [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The 95% confidence intervals (95%CI) were reported for all odds ratios (ORs). One-way analysis of variance was used to compare differences in the overall safety culture scores across staff characteristics. The total safety culture score\u0026mdash;categorized into high and low groups based on the median\u0026mdash;served as the dependent variable. Variables showing statistical significance in univariate analysis were entered as independent variables into a multivariate logistic regression model to identify independent predictors of safety culture cognition. Dichotomization using the median value as the cut-off helped simplify the regression model and improve the interpretability of the results, which is suitable for exploring the directionality and significance of influencing factors. However, this approach may lead to a loss of partial information and a reduction in statistical test power. To compensate for this limitation, this study also reported the results of univariate analysis for continuous variables [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGiven the exploratory nature of this study, no correction was made for multiple comparisons; this was taken into account when interpreting the results. The significance level was set at α\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eInformation of medical staff\u003c/p\u003e \u003cp\u003eAmong the respondents, 40.5% had 8–12 years of work experience, making this the largest group, followed by those with 3–7 years of experience (21.7%). New staff with less than six months of experience accounted for the smallest proportion (2.3%). Regarding job categories, nurses formed the largest occupational group at 59.0%, followed by doctors (16.9%) and medical assistants (12.5%). Departmental distribution showed that internal medicine had the highest proportion of staff (30.0%), followed by surgery (19.5%) and platform departments (13.2%). In contrast, the blood transfusion (1.0%) and laboratory (1.9%) departments had the fewest personnel (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInformation of medical staff\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of Service\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess than 6 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.30%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 months to less than 1 year\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.50%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1–2 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e156\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.60%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3–7 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e182\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.70%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8–12 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e340\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40.50%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMore than 12 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.50%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJob Category\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e496\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59.00%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdministration \u0026amp; Management\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.50%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical Support Staff\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.50%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysician\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.90%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepartment\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGynecology \u0026amp; Pediatrics\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.40%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmergency \u0026amp; Critical Care\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.70%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClinical Laboratory\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.90%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOutpatient Department\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.90%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternal Medicine\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e252\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.00%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePlatform Department\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.20%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBlood Transfusion Department\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgery Department\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e164\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.50%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePharmacy Department\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.00%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOncology Department\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.50%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003eThe positive response rate of each dimension of safety culture\u003c/p\u003e \u003cp\u003eAnalysis of positive response rates for the six safety culture dimensions revealed notable variability. In descending order, managers’ support for patient safety scored the highest (77.70%), signifying staff’s broad recognition of management’s patient safety efforts, followed closely by colleague collaboration (76.15%, reflecting robust teamwork) and communication and exchange (75.43%, indicating generally effective information flow with room for improvement). Safety culture awareness stood at 71.21%, showing that most staff had a basic comprehension of its importance. By contrast, abnormal event reporting reached only 66.47%, implying that there were suboptimal reporting levels, affected by potential barriers. Hospital-wide safety culture recognition was the lowest (58.21%), highlighting the need for targeted strategies to enhance staff’s cultural identity, confidence, and engagement in safety initiatives (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"±\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePositive Response Rate of Medical Staff's Perception of Team Safety Culture\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDimension\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePositive response rate (%)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRanking\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManagers' support for patient safety\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e3.98 ± 0.71\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77.70\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eColleague collaboration\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e4.08 ± 0.79\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76.15\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunication\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e4.10 ± 0.61\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75.43\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAwareness of safety culture\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e3.89 ± 0.63\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71.21\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReporting of adverse events\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e3.88 ± 0.81\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66.47\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployees' recognition of hospital safety culture\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e3.59 ± 0.63\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58.21\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003eUnivariate analysis of safety culture among healthcare staff in non-public tertiary hospitals\u003c/p\u003e \u003cp\u003eResults of the univariate analysis showed significant differences in the total mean safety culture score across healthcare staff with varying years of experience (F = 5.939, P = 0.000). Staff with 1–2 years of experience reported the highest scores (4.06 ± 0.52), whereas those with 8–12 years had the lowest (3.80 ± 0.49). This pattern suggests that increased tenure does not correspond to a linear improvement in safety culture awareness; instead, a mid-career decline in perception may emerge. Departmental affiliation also had a significant effect on safety culture (F = 3.844, P = 0.000). Scores were highest in the Blood Transfusion Department (4.13 ± 0.44) and lowest in the Clinical Laboratory (3.58 ± 0.66). Staff in emergency or critical care (3.80 ± 0.54) and platform departments (3.76 ± 0.50) also demonstrated relatively low scores, indicating that high-risk and auxiliary units may encounter unique barriers to fostering a strong safety culture.\u003c/p\u003e \u003cp\u003eAlthough differences across job categories were not statistically significant (F = 2.539, P = 0.055), nurses had slightly higher total mean scores (3.94 ± 0.53) than doctors (3.84 ± 0.52) and administrative personnel (3.81 ± 0.54). This trend may reflect the nature of nursing practice, which emphasizes standardized procedures and collaborative workflows (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"±\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate Analysis of Team Safety Culture Among Healthcare Staff\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF Value\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorking Years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.939\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLes than 6 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e3.85 ± 0.68\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 months to less than 1 year\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e3.96 ± 0.49\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1–2 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e4.06 ± 0.52\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3–7 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e3.96 ± 0.55\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8–12 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e3.80 ± 0.49\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than 12 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e3.90 ± 0.61\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJob category\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.539\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e3.94 ± 0.53\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdministrative management\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e3.81 ± 0.54\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical assistant\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e3.92 ± 0.54\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDoctor\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e3.84 ± 0.52\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepartment\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.844\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObstetrics \u0026amp; pediatrics\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e3.95 ± 0.51\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergency \u0026amp; critical care\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e3.80 ± 0.54\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical laboratory\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e3.58 ± 0.66\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutpatient department\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e3.88 ± 0.58\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternal medicine department\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e3.92 ± 0.48\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlatform department\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e3.76 ± 0.50\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood transfusion department\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e4.13 ± 0.44\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery department\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e4.02 ± 0.52\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePharmacy department\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e4.03 ± 0.59\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOncology department\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e \u003cp\u003e4.11 ± 0.72\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003eMultivariate logistic regression analysis of safety culture among medical staff in non-public tertiary hospitals\u003c/p\u003e \u003cp\u003eMultivariate logistic regression analysis showed that department was an independent risk factor influencing safety culture among medical staff in non-public tertiary hospitals. Using the obstetrics and pediatrics department as the reference, staff in emergency and critical care departments had a significantly higher likelihood of presenting a lower level of safety culture (OR = 0.42, 95% CI: 0.22–0.82, P = 0.01), indicating their probability of lower safety culture was 0.42 times that of the reference group. Medical staff in laboratory departments also demonstrated a significantly increased risk (OR = 0.25, 95% CI: 0.07–0.88, P = 0.03), as did those in platform departments (OR = 0.49, 95% CI: 0.26–0.93, P = 0.03). The ORs of acute and critical care departments, clinical laboratories, and platform departments were all less than 0.5, indicating that healthcare workers in these departments had a significantly higher risk of perceiving a low level of safety culture; in particular, clinical laboratories (OR = 0.25) had approximately a quarter the odds that gynecology and pediatrics departments did. The dependent variable was dichotomized based on the median of the total mean score. Although this method may lead to information loss, it facilitates clinical interpretation and grouping for intervention [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. These findings suggest that both high-risk clinical units and auxiliary technical departments face greater challenges in maintaining strong safety culture performance. Working years showed no statistically significant association with safety culture level after adjusting for covariates (all P \u0026gt; 0.05), indicating that tenure did not independently influence staff perceptions of safety culture (See Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of multivariate logistic regression on team safety culture of medical staff\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eS.E.\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWald χ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorking years (Reference: \u0026lt; 6 months)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 months – \u0026lt; 1 year\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.52\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.50–4.65\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1–2 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.41\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.52–3.83\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3–7 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.41–2.93\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8–12 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e−0.44\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.25–1.68\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt; 12 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.39–2.97\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepartment (Reference: Obstetrics \u0026amp; Pediatrics)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergency \u0026amp; critical care\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e−0.86\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.22–0.82\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaboratory\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e−1.38\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.63\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.07–0.88\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutpatient department\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e−0.09\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.45–1.85\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternal medicine\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e−0.29\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.42–1.33\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlatform departments\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e−0.72\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.81\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.26–0.93\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood transfusion department\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.03\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.41\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.80\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.51–15.21\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.15\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.63–2.11\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePharmacy department\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e−0.20\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.35–1.93\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOncology department\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.97\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.41\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.89–6.54\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e "},{"header":"Discussion and recommendations","content":"\u003cp\u003eTeam safety culture\u003c/p\u003e\u003cp\u003eIn this study, the overall positive response rate for team safety culture in non-public tertiary general hospitals was 66.65%, with a total score of 3.78 ± 0.51, indicating a moderate level. This score is slightly higher than the national average for patient safety culture in 2016 (62%) but lower than the level reported in Zhejiang Province (73.03%) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. These findings suggest that although non-public tertiary hospitals have established a foundation for safety culture, substantial improvement is still needed. This is consistent with the hypothesis that there exists inter-departmental imbalance in the construction of safety culture in non-public hospitals, suggesting that it is necessary to shift from hospital-wide overall planning to department-specific targeted interventions.\u003c/p\u003e\u003cp\u003eCompared with public hospitals, non-public institutions face unique challenges related to management structures, staff turnover, and operational pressures, all of which may hinder systematic and sustained safety culture development. For example, the strategic emphasis on service experience and economic performance may reduce long-term investment in structured safety culture initiatives.\u003c/p\u003e\u003cp\u003eWith ongoing healthcare reform, non-public hospitals are experiencing increased pressure to enhance internal quality while simultaneously expanding. Li et al. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] reported that these hospitals often prioritize infrastructural growth over “soft culture,” causing safety culture construction to lag behind operational expansion. This imbalance is reflected in limited staff identification with, and participation in, safety culture activities. Non-public hospitals mostly adopt a corporate-oriented operation model, in which performance appraisal is often directly linked to revenue and service volume. However, investment in safety culture has a long payback period and is difficult to quantify, which puts it at a disadvantage in terms of resource allocation and policy prioritization.\u003c/p\u003e\u003cp\u003eFurthermore, high personnel mobility—particularly among intermediate and senior professionals—may undermine the continuity and stability needed for sustained culture development. Consequently, non-public hospitals should elevate safety culture to a core strategic priority and strengthen it through systematic policy development, adequate resource allocation, and sustained cultural guidance.\u003c/p\u003e\u003cp\u003eEffects of safety culture\u003c/p\u003e\u003cp\u003eThe results showed that the positive response rates for “managerial support for patient safety,” “colleague collaboration,” and “communication” were relatively high, indicating that non-public hospitals demonstrate strong managerial engagement and effective internal teamwork. However, “staff recognition of hospital safety culture” had the lowest positive response rate (58.21%), and “adverse event reporting” was also low (66.47%), revealing substantial weaknesses in institutional safety culture identity and reporting practices.\u003c/p\u003e\u003cp\u003eLi and Liu [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] similarly noted that “non-punitive response to errors” and “frequency of event reporting” remain common deficiencies in domestic medical institutions, and these gaps may be more pronounced in non-public hospitals due to less mature management systems. Chen et al. [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] found that medical staff frequently worry about potential blame following event reporting, with junior staff particularly likely to conceal or minimize errors.\u003c/p\u003e\u003cp\u003eIn addition, the performance evaluation systems of many non-public hospitals often prioritize economic outcomes and service quality, which can inadvertently marginalize the implementation of safety culture initiatives. Notably, Meng et al. [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] reported that although non-public hospitals show progress in “cross-department collaboration” and “information-sharing mechanisms,” they remain weak in “systematic risk prevention” and “organizational mechanisms for learning from errors.” This study found that the dimension of \"employee recognition\" scored the lowest, which indirectly supports the inference that safety culture is marginalized in the institutional system [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. However, the pervasiveness of punitive culture needs to be further verified through the analysis of qualitative data.\u003c/p\u003e\u003cp\u003eTherefore, moving forward, non-public hospitals should build on their existing strengths while prioritizing staff engagement in safety culture, strengthening non-punitive reporting systems, and transforming safety events into opportunities for institutional learning through structured feedback and continuous quality improvement.\u003c/p\u003e\u003cp\u003eFactors influencing perceived level of safety culture\u003c/p\u003e\u003cp\u003eBoth univariate and multivariate analyses showed that department was an independent factor influencing safety culture perception in non-public hospitals. Safety culture levels in emergency and critical care, laboratory, and platform departments were significantly lower than in obstetrics and pediatrics, likely due to higher workload, elevated clinical risk, and weaker communication structures. Although working years differed in the univariate analysis, this factor was not significant in the multivariate model, suggesting its effects may be overshadowed by other variables. Shao et al. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] similarly reported that professional title, education, and participation in “5 + 1” S training influence medical staff’s safety culture perception.\u003c/p\u003e\u003cp\u003eZhang et al. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] found that staff in high-risk units such as ICUs and emergency departments were more susceptible to safety fatigue and exhibited reduced reporting willingness due to rapid workflows and psychological strain. As supportive units, platform departments (e.g., laboratory, imaging) frequently encounter information asymmetry and communication barriers in collaborating with clinical departments, which further diminishes their safety culture perception. From the perspective of conservation of resources theory [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], medical staff in high-risk departments are in a state of chronic resource depletion, which may reduce their psychological resources for participating in safety improvement initiatives and reporting adverse events, thus forming positive feedback loop of a high workload and low reporting rate [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCui et al. [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] highlighted that departmental climate and organizational support are mediating factors shaping safety behaviors, and in non-public hospitals, departmental management efficiency plays a critical role in cultivating safety culture.\u003c/p\u003e\u003cp\u003eTherefore, efforts to advance safety culture development should prioritize the specific needs of high-risk and auxiliary departments. Optimizing workflow, strengthening psychological support, and improving interdepartmental collaboration can enhance staff recognition of safety culture and compliance with safety practices.\u003c/p\u003e\u003cp\u003eRecommendations for constructing a positive team safety culture\u003c/p\u003e\u003cp\u003eStrengthen the non-punitive reporting mechanism and foster an open reporting culture\u003c/p\u003e\u003cp\u003eStudies have shown that medical staff commonly worry about “errors being documented” and “being penalized for mistakes” [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan additionalcitationids=\"CR21 CR22 CR23 CR24\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e–\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The WHO Guidelines for Patient Safety Reporting [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] and the Institute for Healthcare Improvement [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] recommend establishing a non-punitive culture as a foundation for improving the reporting rate of safety incidents. Non-public hospitals should therefore establish a confidential, non-punitive adverse event reporting system, clearly define reporting procedures and feedback pathways, and provide positive incentives for staff who actively report events.\u003c/p\u003e\u003cp\u003eAnonymous or confidential reporting channels that clearly distinguish between individual negligence and systemic errors should be implemented, the scope of non-liability reporting should be defined [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], and public recognition or performance incentives should be offered for cases where voluntary reporting leads to systemic improvements to gradually build an organizational consensus that reporting constitutes contribution [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSuch measures can enhance reporting rates and expand opportunities for systematic quality improvement.\u003c/p\u003e\u003cp\u003eOptimize human resource allocation and reduce workload\u003c/p\u003e\u003cp\u003e“Staffing” remains a common weakness across many hospitals [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Non-public hospitals should allocate workload more effectively through scientific scheduling, flexible employment models, and the integration of auxiliary positions. Particular attention must be given to ensuring adequate human resource support for emergency and critical care units and platform departments to prevent safety risks associated with insufficient staffing.\u003c/p\u003e\u003cp\u003eEnhance inter-departmental collaboration and communication mechanisms\u003c/p\u003e\u003cp\u003ePoor interdepartmental collaboration is a key factor influencing safety culture. Non-public hospitals should enhance the accuracy and timeliness of information exchange by conducting regular interdepartmental safety meetings, implementing standardized handover procedures, and promoting the use of structured communication tools such as situation–background–assessment–recommendation (SBAR). The hospital under study has begun to implement the SBAR handover model, but its application in inter-departmental and inter-professional teams is not yet widespread, and there is a lack of standardized supervision and feedback mechanisms [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eImplement hierarchical training to improve staff-wide awareness of safety culture\u003c/p\u003e\u003cp\u003eTargeted safety culture training should be provided for medical staff across different roles, professional titles, and departments in non-public hospitals. Particular emphasis is needed for junior staff and those in high-risk units to strengthen adherence to safety norms and enhance risk-prevention awareness. Zhou et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] reported that nurses who received training in modern quality management tools, including “5 + 1” S management, demonstrated higher safety culture awareness, underscoring the positive impact of systematic training on safety culture improvement.\u003c/p\u003e\u003cp\u003eIn light of the characteristics of high workload intensity and heavy psychological burden in high-risk departments, it is necessary to design short-duration, high-frequency, and scenario-based safety training modules that integrate stress management, team resource management [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], and real-time feedback mechanisms. Meanwhile, simulated drills and case reviews should be reinforced to enhance the practicality and participation of such training programs.\u003c/p\u003e\u003cp\u003eEncourage the leadership role of managers and strengthen employees’ cultural identity\u003c/p\u003e\u003cp\u003eManagers play a central role in advancing safety culture. Policymakers should incorporate indicators of safety culture maturity into the existing quality assessment system, such as incident reporting rates, closed-loop feedback completion rates, and participation rates in cross-departmental safety activities [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. They should also encourage non-public hospitals to establish regular self-assessment practices and mechanisms for improving safety culture, and then link these mechanisms to hospital accreditation, merit evaluation, and medical insurance payment schemes [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Non-public hospitals should integrate safety culture indicators into departmental performance assessments and encourage managers to engage directly with frontline staff to better understand their needs. Such involvement can strengthen employees’ sense of identity and belonging within the hospital’s safety culture.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eTeam safety culture in non-public tertiary hospitals is at a moderate level, though there are significant inter-departmental differences. Emergency and critical care departments, clinical laboratories, and platform departments are the weakest links. in terms of safety culture scores. Targeted interventions should be implemented related to non-punitive reporting, human resource optimization, and inter-departmental collaboration. This study provides empirical evidence at the departmental level for the construction of safety culture in non-public tertiary hospitals. The conclusions of this study are based on a single non-public tertiary hospital, whose management model and resource allocation differ from those of public hospitals. Medical institutions in different regions, with different hospital levels (e.g., primary, secondary, tertiary) and ownership structures, may exhibit heterogeneity in their patient safety cultures. This study adopted a cross-sectional survey design, which precludes the inference of causal relationships, and the data were derived from self-reported questionnaires, which may lead to social desirability bias. Because department classification was based on a single medical institution, caution should be exercised when extrapolating the findings to other settings. Hospital-level variables (e.g., bed size and ownership structure) were not included in the analysis, which may have resulted in the omission of important influencing factors. Future research should conduct longitudinal and multi-center studies, and should also integrate qualitative data to allow for the in-depth analysis of the mechanisms that influence team safety culture [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eWHO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eWorld Health Organization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eAHRQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eAgency for Healthcare Research and Quality\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eHSOPS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eHospital Survey on Patient Safety Culture\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eHROs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003ehigh-reliability organizations\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eintensive care unit\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eVIF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003evariance inflation factor\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003econfidence intervals\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eORs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eodds ratios\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eSBAR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003esituation\u0026ndash;background\u0026ndash;assessment\u0026ndash;recommendation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study involving human participants was conducted in strict accordance with the ethical principles set forth in the Declaration of Helsinki. The study protocol was approved by the Research Ethics Committee of Peking University International Hospital. To ensure that all participants were fully informed, the research team provided each one an information sheet and informed consent form, which detailed the purpose of the study, potential benefits, possible risks, and the conditions for withdrawal from the study. All participants took part in this study on a voluntary basis and signed the informed consent form. To prevent any potential adverse effects or consequences for the participants arising from their expressed views, all information collected during the study was anonymized and treated with strict confidentiality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study are available from the first author upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by Peking University International Hospital (Grant No.: 2025-KY-0124). The funder played no role in the study design, data collection, data analysis and interpretation, or the writing of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQZ and\u0026nbsp;CZ\u0026nbsp;contributed equally to this work.\u0026nbsp;QZ conceptualized the study, performed data extraction and analysis, drafted the initial manuscript, and interpreted the study findings.\u0026nbsp;CZ\u0026nbsp;conceptualized the study, performed data analysis, drafted the initial manuscript, and interpreted the study findings. TL, JF, HW, and MZ were responsible for data extraction and collation.\u0026nbsp;YY performed data analysis, drafted the initial manuscript, critically revised the manuscript, and interpreted the study findings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe sincerely thank all the participants who took part in this survey, as well as the reviewers, for their valuable contributions to this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHan G. Hospital culture of safety and medical safety. Chin J Hosp Adm 2004, 20(3):129\u0026ndash;131. https://doi.org/10.3760/j.issn:1000-6672.2004.03.001.\u003c/li\u003e\n\u003cli\u003ePatient safetyhttps://www.who.int/health-topics/patient-safety. Accessed 8 Jan. 2026.\u003c/li\u003e\n\u003cli\u003ePatient safety culturehttps://www.ahrq.gov/sops/index.html. Accessed 8 Jan. 2026.\u003c/li\u003e\n\u003cli\u003eLi L, Chen Q, Zeng W, Chen M, Xu Y. Latent profile analysis of nurses\u0026apos;perception of patient safety culture and its influencing factors. Nurs Pract Res 2024, 21(10):1492\u0026ndash;1498. https://doi.org/10.3969/j.issn.1672-9676.2024.10.011.\u003c/li\u003e\n\u003cli\u003eChen X, Li L. Nurses\u0026apos; perception of patient safety culture and the influencing factors. J Nurs Sci 2018, 33(22):52\u0026ndash;56. https://doi.org/10.3870/j.issn.1001-4152.2018.22.052.\u003c/li\u003e\n\u003cli\u003eQin S, Song Y, Huang Q. Analysis of the present situation of patient safety awareness of medical staff in the tertiary a hospital and the influencing factors. Chin Hosp Manage 2021, 41(5):68\u0026ndash;71.\u003c/li\u003e\n\u003cli\u003eChen X, Zhang H, Li J. Research progress on the comparison of patient safety culture between public and private hospitals. Chin Hosp Manage 2022, 42(5):64\u0026ndash;67.\u003c/li\u003e\n\u003cli\u003eNie Y, Mao X, Cui H, He S, Li J, Zhang M. Hospital survey on patient safety culture in China. BMC Health Serv Res 2013, 13(1):228. https://doi.org/10.1186/1472-6963-13-228.\u003c/li\u003e\n\u003cli\u003eCui Y, Xi X, Zhang J, Feng J, Deng X, Li A, Zhou J. The safety attitudes questionnaire in Chinese: psychometric properties and benchmarking data of the safety culture in Beijing hospitals. BMC Health Serv Res 2017, 17(1):590. https://doi.org/10.1186/s12913-017-2543-2.\u003c/li\u003e\n\u003cli\u003eZhou J, Wang F, Dai Q. Investigation on the current status of nurses\u0026apos; perception of patient safety culture in a Grade A tertiary hospital in Anhui Province. Nurs Pract Res 2020, 17(7):123\u0026ndash;125. https://doi.org/10.3969/j.issn.1672-9676.2020.07.048.\u003c/li\u003e\n\u003cli\u003eGuiding opinions on promoting the standardized development of non-public medical institutions. Accessed 8 Jan. 2026.\u003c/li\u003e\n\u003cli\u003eJha AK, Prasopa-Plaizier N, Larizgoitia I, Bates DW. Patient safety research: An overview of the global evidence. Qual Saf Health Care 2010, 19(1):42\u0026ndash;47. https://doi.org/10.1136/qshc.2008.029165.\u003c/li\u003e\n\u003cli\u003eZohar D Safety climate conceptual and measurement issues. In: \u003cem\u003eHandbook of Occupational Health Psychology.\u003c/em\u003e edn. Edited by Quick JC, Tetrick LE: American Psychological Association; 2011: 141\u0026ndash;164.\u003c/li\u003e\n\u003cli\u003eHuang Y-h, Lee J, Perry M, He Y, Tondokoro T. Safety climate in the utility industry. J Occup Environ Med 2024, 66(4):298\u0026ndash;304. https://doi.org/10.1097/jom.0000000000003037.\u003c/li\u003e\n\u003cli\u003eLi K, He J: Medical statistics, 8th edn. Beijing: People\u0026apos;s Medical Publishing House; 2025.\u003c/li\u003e\n\u003cli\u003eLi T, Liu L. Analysis of the current situation of classified management of clinical departments in public hospitals in China. Chin J Woman Child Health Res 2016, 27(S2):570\u0026ndash;571.\u003c/li\u003e\n\u003cli\u003eStoyanova R, Dimova R, Tarnovska M, Boeva T. Linguistic validation and cultural adaptation of Bulgarian version of hospital survey on patient safety culture (HSOPSC). Open Access Maced J Med Sci 2018, 6(5):925. https://doi.org/10.3889/oamjms.2018.222.\u003c/li\u003e\n\u003cli\u003eLiang S: Hospital survey on patient safety culture in tertiary general hospitals in Beijing. Master\u0026rsquo;s thesis. Peking Union Medical College; 2014.\u003c/li\u003e\n\u003cli\u003eLi T, Hao H, Li Z, Yao L, Lin H, Zhang M. Application on hierarchical linear model in hospital survey of patient safety culture in tertiary public hospitals. Chin Hosp 2019, 23(1):27\u0026ndash;29. https://doi.org/10.19660/j.issn.1671-0592.2019.01.10.\u003c/li\u003e\n\u003cli\u003eCostello AB, Osborne J. Best practices in exploratory factor analysis: Four recommendations for getting the most from your analysis. Pract Assess Res Eval 2005, 10(1):7.\u003c/li\u003e\n\u003cli\u003eJum C, Nunnally B, Bernstein IH: Psychometric theory. New York: McGraw-Hill College; 1994.\u003c/li\u003e\n\u003cli\u003eSun Z, Xu Y: Medical statistics, 4th edn. Beijing: People\u0026apos;s Medical Publishing House; 2014.\u003c/li\u003e\n\u003cli\u003eFang J: Health statistics, 7th edn. Beijing: People\u0026apos;s Medical Publishing House; 2018.\u003c/li\u003e\n\u003cli\u003eLi Y, Wang L, Zhao P, Zhang M, Wang J, Yin D. The status quo and thoughts on hospital patient safety culture in China. Chin Hosp 2017, 21(7):1,1\u0026ndash;3. https://doi.org/10.3969/j.issn.1671-0592.2017.07.001.\u003c/li\u003e\n\u003cli\u003eLi L, Liu X. Analysis of nurses\u0026apos; assessment of the patient safety culture in hospital. Chin J Nurs 2009, 44(4):304\u0026ndash;307.\u003c/li\u003e\n\u003cli\u003eChen X, Jiang X, Wang B, Wu G, Gao H, L\u0026uuml; J, Wang Y. Current situation and influencing factors of patient safety culture among medical staff in a 3A hospital. J Mod Clin Med 2024, 50(4):244\u0026ndash;246,255. https://doi.org/10.11851/j.issn.1673-1557.2024.04.002.\u003c/li\u003e\n\u003cli\u003eMeng N, Zhao D, Wang Y, Yang W. Study on the current status and influencing factors of patient safety culture among medical staff in a tertiary hospital. J Anhui Med Coll 2024, 23(3):1\u0026ndash;3,7. https://doi.org/10.20072/j.cnki.issn2097-0196.2024.03.001.\u003c/li\u003e\n\u003cli\u003eZhuang R: Study on near miss management in petrochemical company based on safety culture. Master thesis. Qingdao University of Science \u0026amp; Technology; 2010.\u003c/li\u003e\n\u003cli\u003eShao X, Han L, Wang X, Li X, Wang G. Study on nurses\u0026apos; status quo of patient safety culture. J Nurs Adm 2021, 21(3):199\u0026ndash;202. https://doi.org/10.3969/j.issn.1671-315x.2021.03.010.\u003c/li\u003e\n\u003cli\u003eZhang A, Ye L, Feng X, Lin T. Correlation between patient safety culture perception and safety behavior of emergency nurses in tertiary hospitals. J Nurs Train 2022, 37(13):1225\u0026ndash;1230. https://doi.org/10.16821/j.cnki.hsjx.2022.13.015.\u003c/li\u003e\n\u003cli\u003eHobfoll SE. Conservation of resources: A new attempt at conceptualizing stress. Am Psychol 1989, 44(3):513\u0026ndash;524. https://doi.org/10.1037/0003-066x.44.3.513.\u003c/li\u003e\n\u003cli\u003eCui Y, Zhang X, Wu J, Zhang X. Research on the correlation between adverse event reporting barriers in medical quality (Safety) and patient safety culture. Chin Hosp Manage 2025, 45(4):61\u0026ndash;65.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Charter: Health worker safety: A priority for patient safety. 2020. Available from: https://www.who.int/publications-detail-redirect/9789240011595.\u003c/li\u003e\n\u003cli\u003eFrankel A, Haraden C, Federico F, Lenoci-Edwards J. A framework for safe, reliable, and effective care. Cambridge, MA: 2017. Available from: https://www.ihi.org.\u003c/li\u003e\n\u003cli\u003eSong X, Huang P, Xu H, Song J, Huang Y. Application of the SBAR communication model in reducing the defect rate of shift handover among ICU nurses. J Nurs Train 2017, 32(5):413\u0026ndash;415. https://doi.org/10.16821/j.cnki.hsjx.2017.05.009.\u003c/li\u003e\n\u003cli\u003eLiu J, Tian D Application and effect of Team Resource Management in emergency handover shift. In: Chinese Nursing Association 2017 National Academic Exchange Conference on Emergency Nursing, Changchun, 2017; pp. 305\u0026ndash;307.\u003c/li\u003e\n\u003cli\u003eStandards for the accreditation of tertiary hospitals (2022 Edition)https://www.nhc.gov.cn/yzygj/c100068/202212/ccd5aaa9f4fd46fea57d5a94c3e98002/files/1733999175393_69074.pdf. Accessed 8 Jan. 2026.\u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Leary KJ, Buck R, Fligiel HM, Haviley C, Slade ME, Landler MP, Kulkarni N, Hinami K, Lee J, Cohen SE et al. Structured interdisciplinary rounds in a medical teaching unit. Arch Intern Med 2011, 171(7):678\u0026ndash;684. https://doi.org/10.1001/archinternmed.2011.128.\u003c/li\u003e\n\u003cli\u003eLi H, Guo Q. Analysis of current perceptions regarding hospital safety culture and fall prevention strategies among physicians and patients. Shanghai Nurs 2024, 24(8):23\u0026ndash;27. https://doi.org/10.3969/j.issn.1009-8399.2024.08.006.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Non-public hospital, Patient safety culture, Team safety culture, Influencing factors, Cross-sectional study","lastPublishedDoi":"10.21203/rs.3.rs-8581892/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8581892/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eWith the rapid development of non-public tertiary general hospitals in China, the construction of team safety culture has become a priority to narrow the gap with public hospitals in terms of patient safety management, however, the current driving factors have not been identified. To evaluate the current status of team safety culture in a non-public tertiary general hospital and identify key influencing factors, thereby providing a scientific basis for targeted safety culture enhancement.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional survey was conducted among 840 medical staff in a non-public tertiary general hospital from June to August 2025. Stratified cluster sampling was adopted, with stratification first performed according to clinical departments, followed by cluster sampling, with each department treated as a sampling cluster. Team safety culture was assessed using the Chinese version of the Hospital Patient Safety Culture Survey Scale, which includes six dimensions and 39 items. One-way analysis of variance was applied for the preliminary comparison of the total mean patient safety culture scores across medical staff with different characteristics. Statistically significant variables from the one-way analysis were included in a multivariate logistic regression model to identify independent factors affecting the perception of patient safety culture. Department type, working tenure, and professional category were taken as the core independent variables, and their impacts on the perception of team patient safety culture were evaluated.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe overall positive response rate for team safety culture was 66.65%. \u0026ldquo;Managerial Support for Patient Safety\u0026rdquo; (77.70%), \u0026ldquo;Colleague Collaboration\u0026rdquo; (76.15%), and \u0026ldquo;Communication\u0026rdquo; (75.43%) were strengths, whereas \u0026ldquo;Staff Recognition of Hospital Safety Culture\u0026rdquo; (58.21%) and \u0026ldquo;Incident Reporting\u0026rdquo; (66.47%) were weaknesses. Multivariate analysis identified department as an independent influencing factor. Medical staff in critical care (OR\u0026thinsp;=\u0026thinsp;0.42), laboratory (OR\u0026thinsp;=\u0026thinsp;0.25), and platform departments (OR\u0026thinsp;=\u0026thinsp;0.49) had significantly lower safety culture perception (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eTeam safety culture in the non-public tertiary general hospital is at a moderate level, with marked departmental differences. Future interventions should prioritize fostering a non-punitive reporting environment, improving staffing in high-risk units, and strengthening interdepartmental communication and collaboration to enhance the overall patient safety culture climate.\u003c/p\u003e","manuscriptTitle":"Analysis of the influencing factors of team safety culture in non-public tertiary general hospitals","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-21 18:12:14","doi":"10.21203/rs.3.rs-8581892/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-10T14:36:48+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-02T01:41:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"132706775756884191009200116996412716797","date":"2026-03-20T13:33:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-12T16:13:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"238403403282681477534958682737630223115","date":"2026-02-11T00:39:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"131285014418380108966299225293624606420","date":"2026-02-10T20:02:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"225124527244815743953144502167466466619","date":"2026-01-25T14:49:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-19T11:10:39+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-19T11:00:54+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-19T09:33:31+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-19T07:48:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2026-01-19T07:36:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d9fc05c6-c043-4cfe-8744-ff9320f72e31","owner":[],"postedDate":"January 21st, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-19T09:08:30+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-21 18:12:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8581892","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8581892","identity":"rs-8581892","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}