Patient safety climate (PSC) perceptions of frontline staff in acute care hospitals: examining the role of ease of reporting, unit norms of openness, and participative leadership

Health Care Manage Rev. Jan-Mar 2015;40(1):13-23. doi: 10.1097/HMR.0000000000000005.


Background: Increased awareness regarding the importance of patient safety issues has led to the proliferation of theoretical conceptualizations, frameworks, and articles that apply safety experiences from high-reliability industries to medical settings. However, empirical research on patient safety and patient safety climate in medical settings still lags far behind the theoretical literature on these topics.

Purpose: The broader organizational literature suggests that ease of reporting, unit norms of openness, and participative leadership might be important variables for improving patient safety. The aim of this empirical study is to examine in detail how these three variables influence frontline staff perceptions of patient safety climate within health care organizations.

Methodology: A cross-sectional study design was used. Data were collected using a questionnaire composed of previously validated scales.

Findings: The results of the study show that ease of reporting, unit norms of openness, and participative leadership are positively related to staff perceptions of patient safety climate.

Practice implications: Health care management needs to involve frontline staff during the development and implementation stages of an error reporting system to ensure staff perceive error reporting to be easy and efficient. Senior and supervisory leaders at health care organizations must be provided with learning opportunities to improve their participative leadership skills so they can better integrate frontline staff ideas and concerns while making safety-related decisions. Finally, health care management must ensure that frontline staff are able to freely communicate safety concerns without fear of being punished or ridiculed by others.

MeSH terms

  • Critical Care* / organization & administration
  • Cross-Sectional Studies
  • Female
  • Hospital Administration
  • Hospitals, Special* / organization & administration
  • Humans
  • Leadership
  • Male
  • Medical Errors / psychology
  • Patient Safety*
  • Personnel, Hospital / psychology*
  • Risk Management / organization & administration*
  • Surveys and Questionnaires