ORCID

https://orcid.org/0000-0002-3788-0270

Keywords

patient safety culture; Hospital Survey on Patient Safety Culture; HSOPSC; Hospital; U.S.; longitudinal; partial least squares structural equation modeling; PLS-SEM; multi-group analysis; MGA

Abstract

Patient Safety Culture (PSC) is recognized as a cornerstone of healthcare quality and a key determinant of patient outcomes. Despite the Institute of Medicine’s early calls to establish safety-oriented systems, evidence on the long-term stability of PSC in U.S. hospitals has remained limited. This dissertation addresses this gap through a multi-year evaluation of PSC using the Hospital Survey on Patient Safety Culture (HSOPSC v1.0) and advanced statistical methods. Drawing on one of the largest national datasets—comprising over 993,000 healthcare providers from 1,601 U.S. hospitals across three survey cycles (2013–2020)—the study employed a longitudinal repeated cross-sectional design. Analyses combined descriptive statistics, second-order factor modeling, and Partial Least Squares Structural Equation Modeling (PLS-SEM) with multi-group analysis to capture temporal trends, determinants, and outcomes of PSC. Findings showed that overall PSC scores averaged 65% across years, with strengths in “Supervisor/Manager Expectations” and “Teamwork within Units,” and persistent weaknesses in “Nonpunitive Response to Error” and “Handoffs and Transitions.” PSC declined slightly over time, with regional and institutional variations: smaller, non-teaching, and Southern/Central hospitals reported higher PSC. Hospital size and region exerted inconsistent effects, while workforce factors—such as staff role, tenure, and patient contact—were stronger and more stable predictors of PSC outcomes. Importantly, PSC demonstrated robust predictive power, explaining 56.7% of the variance in overall safety perceptions and 23.2% in error reporting frequency. The dissertation provides rare longitudinal evidence confirming PSC as a dynamic, multidimensional construct. While PSC’s influence on safety outcomes has strengthened over time, sustaining improvements remains challenging, particularly in fostering blame-free reporting, ensuring adequate staffing, and improving care transitions. Practical implications highlight leadership commitment, nonpunitive systems, and workforce-centered strategies, alongside interprofessional education to embed safety in daily practice. Collectively, the findings offer actionable insights for policy, leadership, and training, while advancing methodological rigor in PSC research.

Completion Date

2026

Semester

Spring

Committee Chair

Karwowski, Waldemar

Degree

Doctor of Philosophy (Ph.D.)

College

College of Engineering and Computer Science

Department

Industrial Engineering and Management Systems

Format

PDF

Document Type

Thesis

Identifier

DP0053089

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