Safety Performance and Patient Safety Culture: Examining their Relationship in a Malaysian Private Hospital

Abstract

Patient safety is central to healthcare quality, and nurses play a pivotal role in sustaining safe practices. Examining patient safety culture and its link to safety performance provides insights into areas for improvement. This study aimed to (1) identify the perceived level of safety performance among registered nurses, (2) assess the perceived level of patient safety culture, (3) determine the relationship of patient safety culture on safety performance, and (4) evaluate the influence of sociodemographic factors in a private hospital in Kedah, Malaysia.
A quantitative correlational cross-sectional design was conducted with 247 registered nurses selected through purposive sampling. Data were collected using validated questionnaires and analysed with descriptive statistics, chi-square tests, t-tests, ANOVA, regression, and Pearson correlation. Nurses reported highly positive safety performance, with safety participation (98.0%), compliance (96.8%), and overall performance significantly above benchmarks (p < 0.05). Patient safety culture was positively perceived in organizational learning (89.9%), event reporting (91.1%), management support (65.2%), teamwork (59.9%), and communication openness (57.1%). However, staffing (51.4% positive, 48.6% negative) and overall perceptions of patient safety scored lower. Pearson correlation and regression confirmed a strong positive relationship between patient safety culture and safety performance (p < 0.05). Sociodemographic characteristics—age, education, years of service, and unit type were significantly associated with variations, with older, more experienced, and highly educated nurses in surgical and intensive care units reporting stronger safety culture and performance. Patient safety culture is a significant predictor of safety performance. While overall perceptions were positive, staffing adequacy and communication openness remain challenges. Leadership commitment, non-punitive reporting, and safe staffing policies are essential to strengthen safety culture and improve patient outcomes.